Carbon monoxide poisoning symptoms first aid prevention. Signs and treatment of carbon monoxide poisoning

Carbon monoxide (carbon monoxide) is a colorless, tasteless and odorless gas. Carbon monoxide can form wherever conditions are created for incomplete combustion of carbon-containing substances. Is integral part many gases and aerosols: in generator gases - 9-29%, in explosive gases - up to 60%, in car exhaust gases - on average 6.3%.

Carbon monoxide poisoning is possible in boiler rooms, foundries, when testing engines, in garages, on vehicles, in gas plants, in mines, etc.; in everyday life due to improper heating of stoves or improper use of gas stoves. MPC - 20 mg/m3.

Entry and excretion from the body is through the respiratory organs in unchanged form. Due to the high affinity for hemoglobin, it causes blockade of hemoglobin (formation of carboxyhemoglobin) and disruption of oxygen transport. Inhibits the dissociation of oxyhemoglobin, inhibits tissue respiration (mixed hemic-tissue hypoxia), and causes hypocapnia. Carbon monoxide quickly crosses the blood-brain barrier. The effect on the central nervous system is due to both hypoxia and the direct effect of carbon monoxide.

Symptoms

Symptoms of acute intoxication

Mild degree of carbon monoxide intoxication - headache, mainly in the area of the temples and forehead, “pulsation in the temples”, dizziness, tinnitus, vomiting, muscle weakness. Increased breathing and heart rate. Fainting, especially when performing physical work. One of the earliest symptoms is a decrease in reaction speed and impaired color perception.

Symptoms of moderate intoxication

Loss of consciousness for several hours or significant memory loss. Loss of criticism. Sharp adynamia. Loss of coordination of movements, trembling. Upon return of consciousness there is a pronounced asthenic state.

Symptoms of severe intoxication

Prolonged coma (up to 5-7 days or more). Brain lesions, rigidity of limb muscles, clonic and tonic convulsions, seizures. Involuntary urination and defecation. Cyanosis of the extremities, general hyperhidrosis. The complexion is bright scarlet (carboxyhemoglobin gives this color). Breathing is intermittent, maybe Cheyne-Stokes type. Pulse 110-120 beats per minute, hypotension, tendency to collapse. Temperature 39-40°C (possible hypothermia), neutrophilic leukocytosis, decreased ESR. Possible death from respiratory paralysis. Upon recovery from a coma, there is a long-term state of stunning. Apathy. There may be a short-term delirious state, sudden motor agitation, delirium, and complete retrograde amnesia. The forecast is determined mainly by depth and duration comatose state. The increase in the phenomena of depression of the central nervous system on the 2nd day makes the prognosis unfavorable. With moderate and severe degrees of intoxication, mononeuritis of the ulnar, median or common peroneal nerve is possible, paresis and paralysis are possible.

Visual impairment

Double vision color blindness; nipple swelling optic nerve and retina, optic nerve atrophy (rare).

Skin and hair damage

Trophic lesions skin, hemorrhagic rashes, erythematous-bullous forms (picture “ thermal burn"), painful dense swelling, often of the distal extremities, graying, hair loss.

Changes in the circulatory and respiratory system

From the very first hours of carbon monoxide intoxication, pronounced changes occur in the circulatory and respiratory systems. At first functional disorders- tachycardia, pulse lability, extrasystole, coronary insufficiency may also be observed. For moderate and severe poisoning - toxic damage myocardium (as a result of both hypoxia and the direct effect of carbon monoxide on the heart muscle) with symptoms of cardiovascular failure. ECG shows diffuse muscle changes, after a few days taking on a focal character such as a heart attack. Various conduction disorders, up to partial or complete blockade. Focal changes myocardium last up to 1.5 months and often occur in young people (under 30 years of age). Coronary insufficiency may not be clinically detected ( pain syndrome may be completely absent). Recovery is slow. Exacerbations are possible.

Changes in the bronchopulmonary apparatus

Bronchitis, in moderate and severe intoxication - toxic pneumonia, pulmonary edema, developing within 1 - less than 2 days. Clinical symptoms very scarce and does not correspond to the severity of radiological data.

X-ray data

An X-ray examination of the lungs, taken 10-15 hours after the onset of carbon monoxide intoxication, reveals changes in three forms:

1. Emphysema and increased pulmonary pattern. The shadows of the hilum of the lungs are expanded and consist of small focal and linear formations. After 1-3 days - complete recovery.

2. Along with those indicated, changes focal nature with unclear contours, occupying the basal region, densely located, without a tendency to merge. On the 3-4th day, the normal pulmonary pattern is restored.

3. Diffuse large-focal changes in the lung tissue, irregular shape, with blurred contours, 1-2 cm in size, merging in places. Emphysema of the bullous type.

Despite such extensive anatomical changes, their complete resolution is possible on the 7-10th day from the onset of intoxication.

Clinical and radiological data indicate impaired circulation in the pulmonary circulation from small degrees congestion in the pulmonary vessels (with the first of the described forms) to interstitial (with the second form) and alveolar pulmonary edema (with the third form).

In a small number of cases, moderate fever develops in the 2nd week, general state worsens again, and upon auscultation, moist and scattered dry wheezing is detected (the so-called post-carbon pneumonia). These bronchopneumopneumopic changes with favorable course soon disappear, and normal pneumatization of the lungs is restored.

Particular attention should be paid to hemodynamic disturbances during carbon monoxide intoxication. In almost half of the victims, an acute total enlargement of the heart with a predominance of the right parts is observed radiographically. Normalization after 3-5 days. Pulmonary edema and acute expansion of the heart sharply aggravate intoxication. For early diagnosis of changes in the lungs and heart, X-ray examination must be performed as early as possible.

Blood changes

High content of hemoglobin and red blood cells. With toxic pulmonary edema - neutrophilic leukocytosis, band shift; ESR is not increased (if years of infection); increased levels of sugar, lactic acid, acetone bodies, urea, transferase activity, decreased alkaline reserve. Sometimes rapid development of anemia.

Possible consequences of acute intoxication

Subcortical syndrome (parkinsonism) 2-3 weeks after emerging from coma, hemiparesis (capsular and extrapyramidal), Korsakoff syndrome, cerebellar disorders, prolonged headaches and dizziness, disorders of the peripheral nervous system (mononeuritis, radiculitis, etc.), visual impairment ( diplopia, narrowing of visual fields, etc.), decreased hearing acuity and dysfunction vestibular apparatus, vegetative-vascular crises, diencephalic epilepsy.

The development of psychoses, optic-vestibular, and endocrine disorders occurs. If poisoned in the first 3 months of pregnancy, fetal deformities are possible.

Arrhythmias, intracardiac conduction disorders, up to blockade, degenerative changes in the heart muscle, coronary thrombosis are observed: focal nephritis, thyrotoxicosis, susceptibility to infections.

Chronic intoxication

Complaints of headaches, noise in the head, dizziness, increased fatigue, irritability, bad dream, memory impairment, short-term disorientation, palpitations, pain in the heart area, shortness of breath, fainting states, disorders of skin sensitivity, smell, hearing, function of the vestibular apparatus, vision (impaired color perception, narrowing of the visual field, impaired accommodation). Nutrition decline. Functional disorders central nervous system - asthenia, autonomic dysfunction with angiodystonic syndrome, a tendency to vascular spasms, hypertension, which may develop in the future hypertension. Myocardial dystrophy, angina symptoms. The ECG shows focal and diffuse changes, coronary disorders.

Chronic poisoning contributes to the development of atherosclerosis and aggravates the course of the latter if it already existed before intoxication. Endocrine disorders, in particular thyrotoxicosis.

Possible violations menstrual cycle, unfavorable course of pregnancy, weakened sexual function in men.

Sometimes vascular cerebral and diencephalic crises occur. The development of toxic encephalopathy is rare. Exacerbation of the tuberculosis process, decreased resistance to infections.

In the blood - an increase in the amount of hemoglobin and red blood cells, less often - moderate anemia, reticulocytosis, shift leukocyte formula to the left, there may be an increase in serum levels of cholesterol, sugar, and calcium.

Determining the content of carboxyhemoglobin in the blood has some diagnostic value, but there is no parallelism between its amount and the severity of intoxication. The speed of development and severity of acute and chronic intoxications may depend on individual characteristics body and from the presence of other diseases. Poisoning is more severe in young people and pregnant women, with diseases of the lungs and heart, circulatory disorders, anemia, diabetes mellitus, liver diseases, neurasthenia, chronic alcoholism.

While in air environment some others toxic substances- gasoline, benzene, nitrogen oxides, cyanides, hydrogen sulfide - the toxic effect is summed up and potentiated.

The unfavorable effect of carbon monoxide is enhanced by increased physical activity, vibration, noise, decrease and increase in air temperature, and a decrease in the partial pressure of oxygen.

First aid and treatment

Take the patient in a supine position (even if independent movement is possible) into fresh air. Peace. Be sure to warm up (hot water bottles, mustard plasters on your feet). Early and prolonged inhalation of oxygen.

In case of severe carbon monoxide intoxication - emergency hyperbaric oxygen therapy for 1-1.5 hours at general pressure 0.3 mPa (3 kgf/cm2), if necessary this procedure repeat.

Against the background of oxygen therapy, drug therapy. In mild cases - ammonia, tea, coffee.

If there is a simultaneous absence of pulse and breathing stops, massage the heart area, artificial respiration. Emergency treatment must be carried out before full recovery functions of the cardiovascular and respiratory systems.

Treatment of chronic poisoning

Depending on the underlying syndrome: glucose, vitamin therapy, cardiac, vasodilator, pantothenic acid, ATP, glutamic acid.

Work ability examination

After treatment of acute carbon monoxide poisoning in moderate and severe form with release from work (in a hospital), provision of a sick leave certificate. Subsequent careful medical observation. Depending on the presence and severity of complications, work capacity may be permanently limited. At initial signs chronic intoxication - transfer to another job (temporarily) for a period of 2 months. If the treatment and preventive measures taken are ineffective or the symptoms of chronic poisoning are severe, a permanent transfer to another job with a possible determination of disability.

Prevention

Sealing equipment and pipelines where carbon monoxide may be released. Systematic monitoring of the concentration of carbon monoxide in the room air and rapid removal of the released gas, automatic signaling of dangerous concentrations of carbon monoxide.

Personal protection: work, if necessary, in gas masks and respirators.

If poisoning occurs carbon monoxide , then we are talking about a serious pathological condition. It develops if a certain concentration enters the body carbon monoxide .

This condition is dangerous to health and life, and if you do not seek help from specialists in a timely manner, death from carbon monoxide may occur.

Carbon monoxide (carbon monoxide, CO) is a product that is released during combustion and enters the atmosphere. Since poisonous gas has no smell or taste, and it is impossible to determine its presence in the air, it is very dangerous. In addition, it can penetrate through soil, walls, and filters. Many people are interested in the question of whether carbon monoxide is heavier or lighter than air; the answer is that it is lighter than air.

That is why it is possible to determine that the concentration of carbon monoxide in the air is exceeded using special devices. You can also suspect CO poisoning if a person rapidly develops certain symptoms.

In urban environments, the concentration of carbon monoxide in the air is increased by vehicle exhaust gases. But poisoning from car exhaust gases can only occur at high concentrations.

How does CO affect the body?

This gas enters the blood very quickly and actively binds to. As a result, it is produced carboxyhemoglobin , which is more closely related to hemoglobin than oxyhemoglobin (oxygen and hemoglobin). The resulting substance blocks the transfer of oxygen to tissue cells. As a result, it develops hemic type.

Carbon monoxide in the body binds to myoglobin (this is protein skeletal muscles and cardiac muscle). As a result, the pumping function of the heart decreases and severe muscle weakness develops.

Also carbon monoxide enters into oxidative reactions, which disrupts the normal biochemical balance in tissues.

Where can carbon monoxide poisoning occur?

There are many situations that can occur in which carbon monoxide poisoning is possible:

poisoning by combustion products during a fire;
in rooms where gas equipment is operated, and there is no normal ventilation, there is not enough supply air, which is necessary for normal gas combustion;
in those industries where CO is involved in the synthesis reactions of substances ( acetone , phenol );
in places where automobile exhaust gases can accumulate due to insufficient ventilation - in tunnels, garages, etc.;
at home, when there is a leak of lighting gas;
when staying near very busy highways for a long time;
at long-term use kerosene lamp if the room is not ventilated;
if the stove damper of a home stove, fireplace, or sauna stove was closed too early;
when using breathing apparatus with poor quality air.

Who may suffer from hypersensitivity to CO?

people who have been diagnosed with exhaustion of the body;
those who suffer;
future mothers;
teenagers, children;
those who smoke a lot;
people who abuse alcohol.

You should know that organs and systems are more quickly affected by carbon monoxide poisoning in women. The symptoms of poisoning are very similar methane .

Signs of carbon monoxide poisoning

The following describes the symptoms of carbon monoxide poisoning in people depending on the concentration of CO. Symptoms of household gas poisoning and poisoning from other sources manifest themselves differently, and by the way carbon monoxide (not carbon dioxide, as it is sometimes mistakenly called) affects a person, one can assume how strong its concentration in the air was. However, carbon dioxide in high concentrations can also lead to poisoning and the manifestation of a number of alarming symptoms.

Concentration up to 0.009%

Clinical manifestations are observed after 3-5 hours:

decreased speed of psychomotor reactions;
increased blood flow in vital organs;
in people with heart failure in severe form, chest pain is also noted.

Concentration up to 0.019%

Clinical manifestations are observed after 6 hours:

performance decreases;
shortness of breath during moderate physical exertion;
headache , slightly pronounced;
visual impairment;
Death may occur in those with severe heart failure, and fetal death may also occur.

Concentration 0.019-0.052%

severe throbbing headache;
irritability, instability of emotional state;
nausea;
disturbance of attention, memory;
problems with fine motor skills.

Concentration up to 0.069%

Clinical manifestations are observed after 2 hours:

vision problems;
worse headache pain;
confusion;
weakness;
nausea, vomiting;
runny nose.

Concentration 0.069-0.094%

Clinical manifestations are observed after 2 hours:

severe motor impairment (ataxia);
appearance;
strong rapid breathing.

Concentration 0.1%

Clinical manifestations are observed after 2 hours:

weak pulse;
state of fainting;
convulsions;
breathing becomes rare and shallow;
state .

Concentration 0.15%

Clinical manifestations are observed after 1.5 hours. The manifestations are similar to the previous description.

Concentration 0.17%

Clinical manifestations are observed after 0.5 hours.

The manifestations are similar to the previous description.

Concentration 0.2-0.29%

Clinical manifestations are observed after 0.5 hours:

convulsions appear;
respiratory and cardiac depression is noted;
coma ;
death is likely.

Concentration 0.49-0.99%

Clinical manifestations are observed after 2-5 minutes:

no reflexes;
pulse is threadlike;
deep coma;
death.

Concentration 1.2%

Clinical manifestations are observed after 0.5-3 minutes:

convulsions;
lack of consciousness;
vomit;
death.

Symptoms of carbon monoxide poisoning

The table below summarizes the symptoms that appear when different degrees poisoning:

Mechanism of symptom development

Various types of symptoms are associated with exposure to carbon monoxide. Let us consider in more detail the symptoms of different types and the features of the mechanisms of their manifestation.

Neurological

Greatest sensitivity to hypoxia demonstrate nerve cells, as well as the brain. That is why the development of dizziness, nausea, headaches indicate that what is happening oxygen starvation cells. More serious neurological symptoms appear as a consequence of severe or irreversible damage nerve structures. In this case, convulsions and impaired consciousness occur.

Respiratory

When breathing quickens, it “turns on” compensatory mechanism. However, in case of defeat respiratory center after poisoning breathing movements become superficial and ineffective.

Cardiovascular

Due to the insufficient amount of oxygen, more active cardiac activity is observed, that is, tachycardia . But due to hypoxia of the heart muscle, pain in the heart can also occur. If such pain becomes acute, it means that oxygen has completely stopped flowing to the myocardium.

Skin

Due to the very strong compensatory blood flow to the head, the mucous membranes and skin of the head become blue-red.

If carbon monoxide poisoning or poisoning occurs natural gas mild or moderate degree, then for a long time a person may experience: dizziness and headaches. His memory is also deteriorating, intellectual abilities, emotional fluctuations are noted, since poisoning affects the gray and white matter brain.

The consequences of severe poisoning are usually irreversible. Very often such lesions end in death. In this case, the following severe manifestations are noted:

subarachnoid hemorrhages;
disorders of a skin-trophic nature (edema and tissue);
cerebral edema ;
disturbance of cerebral hemodynamics;
deterioration of vision and hearing up to complete loss;
polyneuritis ;
pneumonia in severe form, which is complicated by coma;

Providing first aid for carbon monoxide poisoning

First of all, emergency care for carbon monoxide poisoning involves the immediate cessation of human contact with the gas that poisons the body, as well as the restoration of all important functions body. It is extremely important that whoever turns out to be first aid, was not poisoned during these actions. Therefore, if possible, it is necessary to put on a gas mask, and only after that go to the room where the poisoning occurred.

Before starting PMP, it is necessary to remove or remove the person who was injured from the room in which the concentration of carbon monoxide is increased. You need to clearly understand what kind of gas CO is and how quickly it can harm the body. And since every breath of poisoned air will only intensify negative symptoms, the victim must be taken to fresh air as soon as possible.

No matter how quickly and professionally the first health care, even if the person feels relatively well, it is necessary to call ambulance. There is no need to be deceived by the fact that the victim is joking and laughing, because such a reaction can be provoked by the effect of carbon monoxide on the vital centers of the nervous system. Only professional doctor can clearly assess the patient's condition and understand what to do in case of carbon monoxide poisoning.

If the degree of poisoning is mild, the victim should be given strong tea, warmed up and provided with complete rest.

If there is confusion of consciousness, or there is no confusion at all, you should lay the person on his side on a flat surface, make sure that he receives an influx of fresh air by unfastening his belt, collar, and underwear. Let the ammonia smell, holding the cotton wool at a distance of 1 cm.

If there is no heartbeat and breathing, artificial respiration should be performed and the sternum should be massaged in the projection of the heart.

In an emergency, you should not act rashly. If there are still people in the burning building, you cannot save them yourself, as this may lead to an increase in the number of victims. It is important to call the Ministry of Emergency Situations immediately.

Even after just a few breaths of CO poisoned air, a person can die. Therefore, it is a mistake to believe that a wet rag or gauze mask can protect against the harmful effects of carbon monoxide. Only a gas mask can prevent the fatal effects of CO.

Treatment of carbon monoxide poisoning

Treatment at home after poisoning should not be practiced. A person in such a situation needs the help of specialists.

Provided that the victim is in critical condition, doctors carry out a complex resuscitation measures. Immediately 1 ml of 6% antidote is injected intramuscularly. The victim must be taken to the hospital.

It is important that in such conditions the patient is provided with complete rest. He is provided with breathing pure oxygen (partial pressure 1.5-2 atm.) or carbogen (composition - 95% oxygen and 5% carbon dioxide). This procedure is carried out over 3-6 hours.

Next, it is important to ensure the restoration of the functions of the central nervous system and other organs. The treatment regimen prescribed by a specialist depends on how severe the patient’s condition is and whether the pathological reactions that occurred after poisoning are reversible.

To prevent natural gas and CO poisoning, it is important to carefully follow the rules that will help prevent dangerous situations.

If there is a risk of carbon monoxide poisoning during certain work, it should only be carried out in well-ventilated areas.
Carefully check the dampers of fireplaces and stoves, do not close them completely until the wood is burned.
In rooms where CO poisoning could potentially occur, it is necessary to install autonomous gas detectors.
If possible exposure to carbon monoxide is anticipated, take one capsule Acizola half an hour before such contact. The protective effect will last up to two and a half hours after taking the capsule.

Acizol is a domestically produced medicine that is an effective and fast-acting antidote against acute poisoning CO. It creates an obstacle in the body to the formation carboxyhemoglobin , and also speeds up the process of removing carbon monoxide.

The sooner Acizol is administered intramuscularly in case of poisoning, the greater the person’s chances of survival. This medicine also increases the effectiveness of those measures that will subsequently be taken for resuscitation and treatment.

conclusions

Thus, carbon monoxide poisoning is a very dangerous condition. The higher the gas concentration, the more likely it is death. Therefore, it is very important to be extremely careful in observing all the rules of prevention, and at the first suspicion of such poisoning, immediately call emergency help.

Carbon monoxide poisoning (from the colloquial word “burn out”) is an extremely dangerous human condition that can even lead to death. According to statistics, CO poisoning is one of the most common among the main causes of household accidents. And since first aid for carbon monoxide poisoning can be decisive, everyone needs to know the basic rules for providing it.

Carbon monoxide poisoning can occur:

during a fire;
in production conditions in which CO is used for synthesis organic matter: acetone, methyl alcohol, phenol, etc.;
in garages, tunnels, and other rooms with poor ventilation - from a running internal combustion engine;
when staying near a busy highway for a long time;
in case of premature closing of the stove damper, clogging of the chimney or if there are cracks in the stove;
using breathing apparatus with poor quality air.

This insidious carbon monoxide

Carbon monoxide is indeed very insidious: it has no odor and is formed wherever the combustion process can occur in conditions of lack of oxygen. Carbon monoxide replaces carbon dioxide, so poisoning occurs completely unnoticed.

When CO enters the human blood during breathing, it binds hemoglobin cells and forms carboxyhemoglobin. Bound hemoglobin is unable to transport oxygen to tissue cells.

With a decrease in the amount of “workable” hemoglobin in the blood, the amount of oxygen also decreases, necessary for the body For normal functioning. Hypoxia or suffocation occurs, headache occurs, blackout or loss of consciousness occurs. If first aid is not provided to a person in a timely manner, death from carbon monoxide poisoning is inevitable.

When carbon monoxide poisoning occurs, the following symptoms occur sequentially:

muscle weakness;
ringing in the ears and pounding in the temples;
dizziness;
chest pain, nausea and vomiting;
drowsiness or, on the contrary, increased motor activity;
movement coordination disorder;
delusions, auditory and visual hallucinations;
loss of consciousness;
convulsions;
dilation of the pupils with a weakened reaction to the light source;
involuntary passage of urine and feces;
coma and death due to respiratory arrest or cardiac arrest.

The degree of harm caused to the body directly depends on the concentration of CO in the inhaled air:

0.08% cause suffocation and headache;
0.32% lead to paralysis and loss of consciousness;
1.2% loss of consciousness occurs after just 2-3 breaths, death - after 2-3 minutes.

If you come out of a coma, serious complications are possible, since hemoglobin cells are restored and purified for quite some time. That is why it is extremely important to promptly and correctly provide first aid for carbon monoxide poisoning.

First aid for carbon monoxide poisoning

First aid for carbon monoxide poisoning involves the following measures:

it is necessary to eliminate the supply of CO (turn off the source), while breathing through gauze or a handkerchief yourself, so as not to become a victim of poisoning;
the victim should be immediately taken out or taken to clean air;
if the degree of poisoning is not great, wipe your temples, face and chest with vinegar, give the solution baking soda(1 teaspoon per 1 glass of water), offer hot coffee or tea;
if the victim received large dose SO, but is conscious, he needs to be put down and ensured rest;
the victim in an unconscious state must bring cotton wool with ammonia, you need to place a container with cold water or ice, and, on the contrary, warm the feet;
If a person does not come to his senses, then before the ambulance arrives, it may be necessary to give the victim a closed heart massage and artificial respiration.

Remember: the effects of CO on the human body can be irreversible consequences Therefore, proper first aid for carbon monoxide poisoning can save someone's life.

What is carbon monoxide and where is it formed?

Carbon monoxide is formed during incomplete combustion different substances. Carbon monoxide has been an everyday companion of people for a long time. It is released into the atmosphere in large quantities by vehicles, gas stoves, fuel heating systems, during smoking, and even by the person himself when breathing.

Since this gas is odorless, it can be detected increased content indoors is almost impossible. According to statistics, carbon monoxide intoxication ranks second among the causes of death from toxic substances, second only to alcohol and its surrogates.

Why is carbon monoxide dangerous?

What happens when a person inhales air high concentration CO? To do this, you need to remember what function the lungs perform. A person breathes to saturate all systems and organs of his body with oxygen, otherwise hypoxia and death will occur. Carbon monoxide combines with the main blood protein to form carboxyhemoglobin. This deprives red blood cells of the ability to deliver oxygen to blood cells, and, as a result, carbon monoxide poisoning occurs. The consequences vary depending on the severity of such intoxication. First, hypoxia manifests itself in the form of dizziness, weakness in the legs, and darkening of the eyes. If the concentration of carbon monoxide increases, confusion and death occur.

There are constant low levels of carbon monoxide in the air in every major city. Signs of chronic poisoning with this gas include causeless headaches, fatigue, weakness, irritability and sleep problems. Smoking residents of megacities and people forced to breathe are especially affected. tobacco smoke. The carbon monoxide content in the lungs of these people exceeds the norm by forty times.

How to protect yourself from carbon monoxide poisoning?

To minimize the risk of toxicity from this substance, you need to know where its concentrations can be dangerously high. Carbon monoxide is always deadly in unventilated areas. Therefore, you should not turn on the car engine in a closed garage or box. Also, do not lock the damper in a room with a stove or other fuel heating. Cooking on a gas stove is a reason to open the window. There is a huge danger of getting caught in fires and explosions, so an attempt to save property when the fire is small can be fatal. Often people die in their sleep precisely because they did not feel sick in time due to carbon monoxide poisoning. Unfortunately, it is practically impossible to completely protect yourself from carbon monoxide in large cities. Getting carbon monoxide while smoking is voluntary, but it is better to protect yourself from passive smoking. Doctors advise against jogging or cycling near busy highways. This will hurt yourself more harm than good. For sports, it is better to choose a quiet park or alley, which are located away from places where carbon monoxide accumulates.

Carbon monoxide poisoning

Carbon monoxide poisoning- an acute pathological condition that develops as a result of carbon monoxide entering the human body is dangerous to life and health, and without qualified medical care can lead to death.

Carbon monoxide enters the atmospheric air during any type of combustion. In cities, mainly as part of exhaust gases from internal combustion engines. Carbon monoxide actively binds to hemoglobin, forming carboxyhemoglobin, and blocks the transfer of oxygen to tissue cells, which leads to hemic hypoxia. Carbon monoxide is also included in oxidative reactions, disturbing the biochemical balance in tissues.

Poisoning is possible:

in case of fires;

in production, where carbon monoxide is used for the synthesis of a number of organic substances (acetone, methyl alcohol, phenols, etc.);

in garages with poor ventilation, in other unventilated or poorly ventilated rooms, tunnels, since the car exhaust contains up to 1-3% CO according to standards and over 10% if the carburetor engine is poorly adjusted;

when spending a long time on or near a busy road. On major highways, the average CO concentration exceeds the toxicity threshold;

at home when there is a leak of lighting gas and when the stove dampers are untimely closed in rooms with stove heating (houses, baths);

when using low-quality air in breathing apparatus.

General information

Carbon monoxide poisoning ranks fourth in the list of the most frequently observed poisonings (after alcohol poisoning, drug and drug poisoning). Carbon monoxide, or carbon monoxide (CO), occurs wherever conditions exist for incomplete combustion of carbon-containing substances. CO is a colorless, tasteless gas; its odor is very weak, almost imperceptible. Burns with a bluish flame. A mixture of 2 volumes of CO and 1 volume of O2 explodes when ignited. CO does not react with water, acids and alkalis. Carbon monoxide is colorless and odorless, so carbon monoxide poisoning most often occurs unnoticed. The mechanism of the effect of carbon monoxide on humans is that, when it enters the blood, it binds hemoglobin cells. Then hemoglobin loses its ability to carry oxygen. And what longer person breathes carbon monoxide, the less workable hemoglobin remains in his blood, and the less oxygen the body receives. A person begins to choke, a headache appears, and consciousness becomes confused. And if you don’t go out into the fresh air in time (or don’t take someone who has already lost consciousness out into the fresh air), then a fatal outcome is possible. In case of carbon monoxide poisoning, sufficient for a long time so that hemoglobin cells can completely clear carbon monoxide. The higher the concentration of carbon monoxide in the air, the faster the life-threatening concentration of carboxyhemoglobin in the blood is created. For example, if the concentration of carbon monoxide in the air is 0.02-0.03%, then in 5-6 hours of inhaling such air a carboxyhemoglobin concentration of 25-30% will be created, if the concentration of CO in the air is 0.3-0.5% , then the lethal content of carboxyhemoglobin at the level of 65-75% will be achieved after 20-30 minutes of a person’s stay in such an environment. Carbon monoxide poisoning can occur suddenly or slowly, depending on the concentration. At very high concentrations, poisoning occurs quickly, characterized by rapid loss of consciousness, convulsions and respiratory arrest. In blood taken from the region of the left ventricle of the heart or from the aorta, a high concentration of carboxyhemoglobin is detected - up to 80%. With a low concentration of carbon monoxide, symptoms develop gradually: muscle weakness appears; dizziness; noise in ears; nausea; vomit; drowsiness; sometimes, on the contrary, short-term increased mobility; then movement coordination disorder; rave; hallucinations; loss of consciousness; convulsions; coma and death from paralysis of the respiratory center. The heart may continue to contract for some time after breathing has stopped. There have been cases of death from the consequences of poisoning even 2-3 weeks after the poisoning event.

Acute effects of carbon monoxide poisoning relative to ambient concentrations in parts per million (concentration, ppm): 35 ppm (0.0035%) - headache and dizziness during six to eight hours of continuous exposure 100 ppm (0.01%) - minor headache after two to three hours of exposure 200 ppm (0.02%) - minor headache after two to three hours of exposure, loss of criticism 400 ppm (0.04%) - frontal headache after one to two hours of exposure 800 ppm (0.08%) - dizziness, nausea and convulsions after 45 minutes of exposure; loss of senses after 2 hours 1600 ppm (0.16%) - headache, tachycardia, dizziness, nausea after 20 minutes of exposure; death in less than 2 hours 3200 ppm (0.32%) - headache, dizziness, nausea after 5-10 minutes of exposure; death after 30 minutes 6400 ppm (0.64%) - headache, dizziness after 1-2 minutes of exposure; convulsions, respiratory arrest and death after 20 minutes 12800 ppm (1.28%) - unconscious after 2-3 breaths, death in less than three minutes

Concentration 0.1 ppm - natural atmospheric level (MOPITT) 0.5 - 5 ppm - average level in houses 5 - 15 ppm - next to a properly adjusted gas stove in a house 100 - 200 ppm - from exhaust gases from cars in the central square of Mexico City 5000 ppm - in smoke from a wood stove 7000 ppm - in warm exhaust gases from cars without a catalyst

The diagnosis of poisoning is confirmed by measuring the level of carbon monoxide in the blood. This can be determined by measuring the amount of carboxyhemoglobin compared to the amount of hemoglobin in the blood. The carboxyhemoglobin ratio in the hemoglobin molecule can average up to 5%; in smokers who smoke two packs a day, levels up to 9% are possible. Intoxication appears when the ratio of carboxyhemoglobin to hemoglobin is above 25%, and the risk of mortality is at a level of more than 70%.

Concentration of CO in the air, carboxyhemoglobin HbCO in the blood and symptoms of poisoning.
% about. (20°C)	mg/m 3	Time impact, h	in blood, %	Main signs and symptoms of acute poisoning
				A decrease in the speed of psychomotor reactions, sometimes a compensatory increase in blood flow to vital important bodies. In persons with severe cardiovascular insufficiency - chest pain with physical activity, shortness of breath
				Minor headache, decreased mental and physical performance, shortness of breath with moderate physical exertion. Visual perception disorders. May be fatal to fetuses and persons with severe heart failure

				Throbbing headache, dizziness, irritability, emotional instability, memory disorder, nausea, loss of coordination of small hand movements

				Severe headache, weakness, runny nose, nausea, vomiting, blurred vision, confusion

				Hallucinations, severe ataxia, tachypnea
				Fainting or coma, convulsions, tachycardia, weak pulse, Cheyne-Stokes breathing

				Coma, convulsions, respiratory and cardiac depression. Possible death

				Deep coma with decreased or absent reflexes, thready pulse, arrhythmia, death.
				Loss of consciousness (after 2-3 breaths), vomiting, convulsions, death.

Symptoms:

For mild poisoning:

headache appears

knocking in the temples,

dizziness,

chest pain,

dry cough,

lacrimation,

visual and auditory hallucinations are possible,
redness of the skin, carmine red coloring of the mucous membranes,
tachycardia,
increased blood pressure.

in case of moderate poisoning:

drowsiness,

possible motor paralysis with preserved consciousness

in case of severe poisoning:

loss of consciousness, coma

convulsions,

involuntary passage of urine and feces,

breathing disorder that becomes continuous, sometimes Cheyne-Stokes type,

dilated pupils with weakened reaction to light,

sharp cyanosis (blue discoloration) of the mucous membranes and facial skin. Death usually occurs at the scene as a result of respiratory arrest and a drop in cardiac activity.

Help for carbon monoxide poisoning

The first symptoms of poisoning can develop after 2 - 6 hours of exposure to an atmosphere containing 0.22-0.23 mg of CO per 1 liter of air; severe poisoning with loss of consciousness and fatal can develop after 20 - 30 minutes at a CO concentration of 3.4 - 5.7 mg/l and after 1-3 minutes at a poison concentration of 14 mg/l. The first symptoms of poisoning are headache, heaviness in the head, tinnitus, nausea, dizziness and palpitations. With further stay in a room whose air is saturated with carbon monoxide, the victim begins to vomit, general weakness increases, and severe drowsiness and shortness of breath appear. Skin turn pale. If a person continues to inhale carbon monoxide, his breathing becomes shallow and convulsions occur. Death occurs from respiratory arrest due to paralysis of the respiratory center.

First aid for carbon monoxide poisoning

First of all, it is necessary to take the victim out into the fresh air (in the warm season outside, in the cold season - in a ventilated room, on a staircase). The person is placed on his back and tight, constricting clothing is removed; The victim's entire body is rubbed with vigorous movements; A cold compress is placed on the head and chest; If the victim is conscious, it is recommended to give him warm tea; If a person is unconscious, you need to bring a cotton swab moistened with ammonia to his nose; If there is no breathing, it is necessary to start artificial ventilation of the lungs and immediately call an ambulance. To prevent poisoning, it is recommended to follow safety precautions at work, install a well-functioning ventilation system in garages, and in houses with a stove, close the damper only after there are no blue lights left in the ash.

Treatment of carbon monoxide poisoning

In case of CO poisoning, prompt removal of the poison from the body and specific therapy are necessary. The victim is taken out into the fresh air, and upon the arrival of medical workers, inhalations of humidified oxygen are carried out (in an emergency setting using KI-Z-M, AN-8 devices). In the first hours, use for inhalation pure oxygen, then switch to inhalation of a mixture of air and 40-50% oxygen. In specialized hospitals, oxygen inhalation is used under a pressure of 1-2 atm in a pressure chamber (hyperbaric oxygenation). In case of breathing disorders, it is necessary to restore patency before oxygen inhalation respiratory tract(oral toilet, duct insertion), perform artificial respiration up to tracheal intubation and artificial ventilation of the lungs. In case of hemodynamic disturbances (hypotension, collapse), most often resulting from damage to the central nervous system, in addition to the intravenous administration (boost) of analeptics (2 ml of cordiamine, 2 ml of 5% ephedrine solution), rheopolyglucin (400 ml) should be administered intravenously drip in combination with prednisolone (60-90 mg) or hydrocortisone (125-250 mg). In case of CO poisoning, great attention must be paid to the prevention and treatment of cerebral edema, since the severity patients' conditions, especially with a long-term disorder of consciousness, is determined cerebral edema, developed as a result of hypoxia. On prehospital stage patients are administered intravenously 20-30 ml of 40% glucose solution with 5 ml of 5% solution ascorbic acid, 10 ml of a 2.4% solution of aminophylline, 40 mg of Lasix (furosemide), intramuscularly - 10 ml of a 25% solution of magnesium sulfate. It is very important to eliminate acidosis, for which, in addition to measures to restore and maintain adequate breathing, it is necessary to administer a 4% sodium bicarbonate solution (at least 600 ml) intravenously. In a hospital setting with severe symptoms of cerebral edema (stiffness occipital muscles, convulsions, hyperthermia) a specialist neurologist conducts repeated lumbar punctures, craniocerebral hypothermia is required, in the absence of a special apparatus - ice on the head. In order to improve metabolic processes in the central nervous system sick, especially with severe poisoning, vitamins are prescribed, especially ascorbic acid (5-10 ml of 5% solution intravenously 2-3 times a day), vitamins B1, (3-5 ml of 6% solution intravenously), B6 (3-5 ml of 5% solution 2-3 times a day intravenously). To prevent and treat pneumonia, antibiotics and sulfonamides should be administered. Severely ill patients with CO poisoning require careful care; toilet needed body skin, especially the back and sacrum, changes in body position (turning to the side), heavy percussion chest(effleurage with the side surface of the palm), vibration massage, ultraviolet irradiation chest with erythemal doses (by segments). In some cases, CO poisoning can be combined with other severe conditions, significantly complicating the course of intoxication and often having decisive influence on the outcome of the disease. Most often this is a burn of the respiratory tract, which occurs when inhaling hot air or smoke during a fire. As a rule, in these cases, the severity of the patient’s condition is due not so much to carbon monoxide poisoning (which can be mild or moderate), but rather to a burn to the respiratory tract. The latter is dangerous because in the acute period acute respiratory failure due to prolonged, intractable laryngobronchospasm, and in the next day severe pneumonia develops. The patient is bothered by a dry cough, sore throat, and suffocation. Objectively, shortness of breath (as during an attack of bronchial asthma), dry wheezing in the lungs, cyanosis of the lips, face, and anxiety are noted. When toxic pulmonary edema or pneumonia occurs, the patient's condition worsens even more, shortness of breath increases, breathing is frequent, up to 40-50 per minute, and there is an abundance of dry and moist wheezing of various sizes in the lungs. Mortality in this group of patients is high. Treatment is mainly symptomatic: intravenous administration of bronchodilators (10 ml of 2.4% aminophylline solution with 10 ml of saline solution, 1 ml of 5% ephedrine solution, 60-90 mg of prednisolone 3-4 times or 250 mg of hydrocortisone 1 time per day, according to 1 ml of 5% ascorbic acid solution 3 times a day). Of great importance local therapy in the form of oil inhalations (olive, apricot oil), antibiotic inhalations (penicillin 500 thousand units in 10 ml of saline), vitamins (1 - 2 ml of 5% ascorbic acid solution with 10 ml of saline); with severe laryngobronchospasm - 10 ml of 2.4% aminophylline solution, 1 ml of 5% ephedrine solution, 125 mg of hydrocortisone in 10 ml saline solution. At severe cough use codeine with soda (1 tablet 3 times a day). The second severe complication of CO intoxication is positional injury (compartment syndrome), which develops in cases where the victim lies unconscious (or sits) in one position for a long time, touching parts of the body (most often with limbs) to a hard surface (corner of the bed, floor) or crushing the limb with the weight of his own body. In areas subject to compression, unfavorable conditions for blood and lymph circulation are created. In this case, the nutrition of muscle and nerve tissue, skin, which leads to their death. The victim develops lesions skin redness, sometimes with the formation of blisters filled with liquid (like burns), hardening of soft tissues, which are further intensified due to developing edema. The affected areas become sharply painful, increased in volume, dense (up to stone density). As a result of the breakdown of muscle tissue, myoglobin (a protein that is part of muscle tissue) enters the blood; if the injury area is large, a large amount of myoglobin affects the kidneys: myoglobinuric nephrosis develops. Thus, the patient develops the so-called myorenal syndrome, characterized by a combination of positional trauma and renal failure. Treatment of patients with myorenal syndrome is long-term and is carried out in specialized hospitals, as it requires the use of various special methods (hemodialysis, lymphatic drainage, etc.). If there is severe pain, you can administer painkillers - 1 ml of a 2% solution of promedol and 2 ml of a 50% solution of analgin subcutaneously or intravenously.

Carbon monoxide analysis

To diagnose acute carbon monoxide poisoning, you should immediately determine the level of either carboxyhemoglobin (Hb CO) in the blood or carbon monoxide CO in the exhaled air.

Qualitative definition

The analysis uses whole blood treated with heparin or another stabilizer that prevents it from clotting. Approximately triple the volume of a 1% tannin solution is added to diluted samples (1:4) of test and normal blood. Normal blood turns gray, but blood containing carboxyhemoglobin remains unchanged. A similar test is carried out with the addition of formaldehyde. Wherein normal blood takes on a dirty brown color, and the blood being tested, containing carboxyhemoglobin, retains its color for several weeks. If the laboratory does not have these reagents, you can use a 30% sodium hydroxide solution, which is added to blood samples diluted 1:100 with water. Blood that does not contain carboxyhemoglobin acquires a green-black color. In the presence of carboxyhemoglobin, it remains pink color blood. Carboxyhemoglobin can be detected in the blood using a microdiffusion method based on the reaction with palladium chloride and spectrophotometrically.

quantitation

Quantitative determination of carboxyhemoglobin (HbCO) in the blood is based on the fact that both oxyhemoglobin (HbO2) and methemoglobin can be reduced by sodium dithionite, and HbCO does not interact with this reagent. For determination, an ammonia aqueous solution (1 ml/l) is required; solid sodium dithionite Na 2 S 2 O 4 2H 2 O (stored in a desiccator); a cylinder with pure gaseous CO or a mixture of CO and nitrogen; a cylinder containing oxygen gas or compressed air. It is possible to obtain CO by reacting concentrated sulfuric and formic acids. To determine, 0.2 ml of blood is added to 25 ml of ammonia solution and mixed thoroughly. The sample is divided into 3 approximately equal portions A, B and C. Portion A is stored in a sealed test tube. A portion of blood B is saturated with carbon monoxide until oxygen is completely replaced by CO (i.e., to obtain 100% Hb CO), blowing the gas through the solution for 5 - 10 minutes. Portion C is saturated with oxygen by blowing pure oxygen or compressed air through the solution for 10 minutes to completely replace CO with oxygen (0% Hb CO). To each solution (A, B, C) add a small amount (about 20 mg) of Na 2 S 2 O 4 2H 2 O and 10 ml of ammonia solution and mix. Take a spectrum in the visible region or measure absorption at 540 and 579 nm. A solution of sodium dithionite in an aqueous ammonia solution is used as a reference solution. The percentage of carboxyhemoglobin saturation can be calculated using the following formula: HbCO (%) = ( (A 540 / A 579 solution A) - (A 540 / A 579 solution C) * 100%) / ( (A 540 / A 579 solution B) - (A 540 / A 579 solution C) ), taking into account that (A 540 / A 579 solution B) = 1.5, which corresponds to 100% HbCO, (A 540 / A 579 solution C) = 1.1, which corresponds to 0% HCO. Measurements are carried out in the region of maximum difference between the absorption of Hb CO [λ max (Hb*CO) = 540 nm] and the point of equal absorption of Hb CO and Hb O 2 (579 nm, isosbestic point). The presence in the spectrum of solution A of two almost symmetrical peaks (“rabbit ears”) - characteristic feature carbon monoxide poisoning. Conclusion

More than 140 substances can be found in the combustion products of polymers, that is, poisoning of people occurs through the combined influence of many volatile poisons. The multifactorial influence during fires complicates the forensic chemical examination of the blood of the dead. In most cases, blood testing is limited to detecting carbon monoxide. In the vast majority of cases, poisoning occurs due to the fault of the victims themselves: improper operation of heating stoves, gas water heaters, smoking in bed (especially when drunk), leading to a fire; storing matches in places accessible to children; a long stay in a closed garage, where there is a car with a running engine, a long rest (sleep) in a car with the heater and engine on, even if the car is in the open air. It is especially important to conduct conversations and lectures with the population on the prevention of carbon monoxide poisoning in the autumn-winter season. In conclusion, it should be said that, despite significant progress in studying the problems of the mechanism of action of poisons, not all toxic substances have a fully disclosed biochemical mechanism of action. Many difficult questions The interactions of different chemical agents with different enzymes have not yet been resolved.