Emergency first aid for acute poisoning. General principles for the provision of PHC in acute poisoning In acute poisoning, it is necessary

Poisoning- a painful condition caused by the introduction of toxic substances into the body.

Poisoning should be suspected in cases where a completely healthy person suddenly feels ill immediately or after a short time after eating or drinking, taking medication, as well as cleaning clothes, dishes and plumbing with various chemicals, treating the room with substances that destroy insects or rodents, etc. P. Suddenly, general weakness may appear, up to loss of consciousness, vomiting, convulsive states, shortness of breath, the skin of the face may turn pale or turn blue. The suggestion of poisoning is reinforced if one of the described symptoms or a combination of them occurs in a group of people after a joint meal or work.

Causes of poisoning can be: medicines, foodstuffs, household chemicals, poisons of plants and animals. A toxic substance can enter the body in various ways: through the gastrointestinal tract, respiratory tract, skin, conjunctiva, when the poison is injected (subcutaneously, intramuscularly, intravenously). The disturbance caused by the poison may be limited only to the place of the first direct contact with the body (local effect), which is very rare. Most often, the poison is absorbed and has a general (resorptive) effect on the body, manifested by a predominant lesion of individual organs and body systems.

General principles of first aid for poisoning

1. Call an ambulance.

2. Resuscitation measures.

3. Measures to remove from the body, not absorbed poison.

4. Methods for accelerating the removal of already absorbed poison.

5. Use of specific antidotes (antidotes).

1. In case of any acute poisoning, you must immediately call an ambulance. To provide qualified assistance, it is necessary to determine the type of poison that caused the poisoning. Therefore, it is necessary to save all the secretions of the affected person for presentation to the ambulance personnel, as well as the remains of the poison found near the victim (tablets with a label, an empty vial with a characteristic odor, opened ampoules, etc.).

2. Resuscitation measures are necessary in case of cardiac and respiratory arrest. They proceed to them only in the absence of a pulse on the carotid artery, and after the removal of vomit from the oral cavity. These measures include mechanical ventilation (ALV) and chest compressions. But not all poisonings can be done. There are poisons that are released with exhaled air (FOS, chlorinated hydrocarbons) from the respiratory tract of the victim, so resuscitators can be poisoned by them.

3. Removal from the body of poison that has not been absorbed through the skin and mucous membranes.

a) When poison enters through the skin and conjunctiva of the eye.

If poison gets on the conjunctiva, it is best to rinse the eye with clean water or milk so that the washing water from the affected eye does not get into the healthy one.

If the poison enters through the skin, the affected area should be washed with a stream of tap water for 15–20 minutes. If this is not possible, the venom should be removed mechanically with a cotton swab. It is not recommended to intensively treat the skin with alcohol or vodka, rub it with a cotton swab or washcloth, as this leads to the expansion of skin capillaries and increased absorption of poisons through the skin.

b) When poison enters through the mouth it is urgent to call an ambulance, and only if this is not possible, or if it is delayed, only then can one proceed to gastric lavage with water without a tube. The victim is given several glasses of warm water to drink and then vomits by irritating the root of the tongue and throat with a finger or spoon. The total volume of water should be large enough, at home - at least 3 liters, when washing the stomach with a probe, use at least 10 liters.

For gastric lavage, it is better to use only clean warm water.

Tubeless gastric lavage (described above) is ineffective, and in case of poisoning with concentrated acids and alkalis it is dangerous. The fact is that the concentrated poison contained in the vomit and gastric lavage re-contacts with the affected areas of the mucous membrane of the oral cavity and esophagus, and this leads to a more severe burn of these organs. It is especially dangerous to carry out gastric lavage without a tube for small children, since there is a high probability of aspiration (inhalation) of vomit or water into the respiratory tract, which will cause suffocation.

Forbidden: 1) induce vomiting in an unconscious person; 2) induce vomiting in case of poisoning with strong acids, alkalis, as well as kerosene, turpentine, as these substances can additionally cause burns of the pharynx; 3) wash the stomach with an alkali solution (baking soda) in case of acid poisoning. This is due to the fact that when acids and alkalis interact, gas is released, which, accumulating in the stomach, can cause perforation of the stomach wall or pain shock.

In case of poisoning with acids, alkalis, heavy metal salts, the victim is given enveloping agents to drink. This is jelly, an aqueous suspension of flour or starch, vegetable oil, egg whites whipped in boiled cold water (2-3 proteins per 1 liter of water). They partially neutralize alkalis and acids, and form insoluble compounds with salts. With subsequent gastric lavage through a tube, the same means are used.

A very good effect is obtained when activated charcoal is injected into the stomach of a poisoned person. Activated carbon has a high sorption (absorbing) ability to many toxic substances. The victim is given it at the rate of 1 tablet
per 10 kg of body weight or prepare a coal suspension at the rate of 1 tablespoon of coal powder per glass of water. But it must be remembered that sorption on carbon is not strong, if it is in the stomach or intestines for a long time, the toxic substance can be released from the microscopic pores of activated carbon and begin to be absorbed into the blood. Therefore, after taking activated charcoal, it is necessary to introduce a laxative. Sometimes, in first aid, activated charcoal is given before gastric lavage, and then after this procedure.

Despite gastric lavage, part of the poison can enter the small intestine and be absorbed there. To speed up the passage of the poison through the gastrointestinal tract and thereby limit its absorption, saline laxatives (magnesium sulfate - magnesia) are used, which are best administered through a tube after gastric lavage. In case of poisoning with fat-soluble poisons (gasoline, kerosene), vaseline oil is used for this purpose.

To remove poison from the large intestine, cleansing enemas are indicated in all cases. The main fluid for bowel lavage is pure water.

4. The implementation of methods for accelerating the removal of absorbed poison requires the use of special equipment and trained personnel, therefore they are used only in a specialized department of the hospital.

5. Antidotes are used by the medical staff of the ambulance or the toxicological department of the hospital only after determining the poison that poisoned the victim

Children get poisoned mainly at home, all adults should remember this!

First aid for drug poisoning.

drug poisoning especially dangerous to human life when it is caused sleeping pills or sedatives means. Drug poisoning is characterized by two phases.

Symptoms: in the first phase - agitation, disorientation, incoherent speech, chaotic movement, pale skin, rapid pulse, noisy breathing, frequent. In the second phase, sleep occurs, which can go into an unconscious state.

Urgent care: before the doctor arrives, rinse the stomach and give strong tea or coffee, 100 g of black crackers to drink, do not leave the patient alone, immediately call an ambulance.

Barbiturates

After 30-60 min. after taking toxic doses of barbiturates, symptoms similar to those observed with alcohol intoxication are observed. There may be nystagmus, constriction of the pupils. Gradually, deep sleep or (in severe poisoning) loss of consciousness sets in. The depth of the coma depends on the concentration of the drug in the blood. In a deep coma - breathing is rare, shallow, the pulse is weak, cyanosis, a symptom of "pupil play" (alternate dilation and constriction of the pupils).

Urgent care. If the patient is conscious, it is necessary to induce vomiting or wash the stomach through a tube with salted water, introduce activated charcoal and a saline diuretic. In coma - gastric lavage after preliminary intubation. Repeated washing is shown every 3-4 hours until consciousness is restored.

Antipsychotics

Shortly after taking toxic doses of chlorpromazine, general weakness, dizziness, drowsiness, nausea, vomiting, and dry mouth are observed. In case of poisoning of moderate severity, after a while, a shallow sleep occurs, lasting a day or more. The skin is pale, dry. Body temperature is reduced. Coordination is broken. Tremor and hyperkinesis are possible.

In severe poisoning, a coma develops.

Reflexes are reduced or disappear. Paroxysms of general convulsions, respiratory depression may develop. Cardiac activity is weakened, the pulse is frequent, weak filling and tension, arrhythmias are possible. Blood pressure is reduced (up to the development of shock), the skin is pale, cyanosis. Death occurs from depression of the respiratory center, cardiovascular insufficiency.

Urgent care. Gastric lavage with water with the addition of sodium chloride or isotonic solution of sodium chloride. Salt laxative and activated charcoal. Oxygen therapy. With respiratory depression - IV L; with collapse - in / in the introduction of fluids and norepinephrine. With arrhythmia - lidocaine and difenin. For convulsions - diazepam, 2 ml of 0.5% solution.

tranquilizers

After 20 minutes - 1 hour after taking the drug, general weakness, dizziness, unsteady gait, impaired coordination (staggering when sitting, walking, limb movements) and speech (chanting) occur. Psychomotor agitation may develop. Sleep soon sets in, lasting 10-13 hours. In severe poisoning, a deep coma may develop with muscle atony, areflexia, respiratory and cardiac depression, which can lead to death.

Urgent care. Repeated gastric lavage every 3-4 hours during the first day. Salt laxative and activated charcoal. With respiratory depression - IVL.

drug poisoning can be by ingestion, as well as by injecting the method of administering narcotic drugs. Narcotic drugs are rapidly absorbed in the stomach. The lethal dose, for example, when morphine is taken orally, is 0.5-1 g.

Opiates

The clinical picture of opioid intoxication: euphoria, pronounced miosis - the pupils are narrowed, their reaction to light is weakened, skin redness, increased muscle tone or convulsions, dry mouth, dizziness, frequent urination.

Stunning gradually increases and coma develops. Respiration is oppressed, slow, superficial. Death occurs due to paralysis of the respiratory center.

Urgent care: turn the victim on his side or stomach, clear the airways of mucus and vomit; bring a cotton swab with ammonia to the nose; call an ambulance; before the arrival of doctors, monitor the nature of breathing, if the respiratory rate drops below 8-10 times per minute, start artificial respiration.

Repeated gastric lavages with activated charcoal or potassium permanganate (1:5000), forced diuresis, saline laxative. Oxygen therapy, IVL. Warming. The drug of choice - morphine antagonist - naloxone, IM 1 ml (to restore breathing); in the absence - nalorfin, 3-5 ml of 0.5% solution in/in. With bradycardia - 0.5-1 ml of 0.1% solution of atropine, with OL - 40 mg of lasix.

alcohol poisoning occurs as a result of taking large amounts of alcohol (more than 500 ml of vodka) and its surrogates. In sick, weakened, overworked people, and especially in children, even small doses of alcohol can cause poisoning.

Ethyl alcohol belongs to a number of drugs and has a depressant effect on the central nervous system. The lethal oral dose for adults is about 1 liter 40% of the solution, but in people who abuse alcohol or systematically use it, the lethal dose can be much higher. The lethal concentration of alcohol in the blood is about 3-4%.

Symptoms: violation of mental activity (excitation or depression), increased heart rate, increased blood pressure, dizziness, nausea, vomiting.

Patients who are unconscious up to a coma need medical attention.

The causes of death are respiratory disorders (most often mechanical asphyxia), o. cardiovascular insufficiency, collapse.

Urgent care: turn the patient on his side and clear the airways of mucus and vomit; wash the stomach; put a cold on your head; bring a cotton swab with ammonia to your nose: call an ambulance.

Gastric lavage through a thick tube with small portions of warm water with the addition of sodium bicarbonate or a weak solution of potassium permanganate. With a sharp depression of consciousness, tracheal intubation is preliminarily carried out to prevent aspiration of vomit, if intubation is impossible, gastric lavage is not recommended for patients in a coma. To restore impaired breathing, 2 ml of 10% caffeine-benzoate solution, 1 ml of 0.1% atropine or cordiamine solution on glucose are injected intravenously. To accelerate the oxidation of alcohol in the blood, 500 ml of 20% glucose solution, 3-5 ml of 5% thiamine bromide solution, 3-5 ml of 5% pyridoxine hydrochloride solution, 5-10 ml of 5% r-ra -ra of ascorbic acid.

Antihistamines

The severity of poisoning depends both on the dose of the drug taken and on the degree of individual sensitivity to it.

The first symptoms appear after 10-90 minutes. since taking the drug. Intoxication is manifested by lethargy, drowsiness, unsteady gait, incoherent slurred speech, dilated pupils. There is dryness in the mouth, with poisoning diphenhydramine- numbness of the mouth.

In case of moderate poisoning, a short period of stunning is replaced by a state of psychomotor agitation, ending in restless sleep after 5-7 hours. The entire period of intoxication persists dry skin and mucous membranes, tachycardia and tachypnea.

A severe form of poisoning is accompanied by arterial hypotension, respiratory depression and ends with sleep or coma. In the initial period of intoxication, convulsive twitches of the muscles of the face and limbs are noted. Attacks of general tonic-clonic convulsions are possible.

Urgent care. Gastric lavage, administration of a saline laxative, cleansing enema. For the relief of seizures - seduxen, 5-10 mg IV; when excited - chlorpromazine or tizercin i / m. Shown physostigmine (s / c), or galantamine (s / c), aminostigmine (in / in or / m).

Clonidine

The clinical picture of clonidine poisoning includes CNS depression up to coma, bradycardia, collapse, miosis, dry mouth, dizziness, weakness.

Urgent care. Gastric lavage, administration of adsorbents, forced diuresis. With bradycardia - atropine 1 mg IV with 20 ml of 40% glucose solution. With collapse - 30-60 mg of prednisolone IV.

They pursue the following goals:
a) definition of a toxic substance;
b) immediate removal of the poison from the body;
c) neutralization of the poison with the help of antidotes;
d) maintaining the basic vital functions of the body (symptomatic treatment).

First aid.

Poison removal. If the poison has got through the skin or external mucous membranes (wound, burn), it is removed with a large amount of water - saline, weak alkaline (baking soda) or acidic solutions (citric acid, etc.). If toxic substances enter the cavities (rectum, vagina, bladder), they are washed with water using an enema, douching. The poison is removed from the stomach by gastric lavage (glanding technique—see Chapter XX, Nursing), by emetics, or by reflex induction of vomiting by tickling the throat. It is forbidden to induce vomiting in the unconscious and poisoned by cauterizing poisons. Before reflex inducing vomiting or taking emetics, it is recommended to drink several glasses of water or 0.25 - 0.5% sodium bicarbonate solution (baking soda), or 0.5% potassium permanganate solution (pale pink solution), warm saline solution (2-4 teaspoons per glass of water). Ipecac root and others are used as emetics, soapy water, mustard solution can be used. Poison is removed from the intestines with laxatives. The lower segment of the intestine is washed with high siphon enemas. Poisoned people are given plenty of fluids, diuretics are prescribed for better urine excretion.

Neutralization of poison. Substances that enter into a chemical combination with a poison, turning it into an inactive state, are called antidotes, since an acid neutralizes an alkali and vice versa. Unithiol is effective in poisoning with cardiac glycosides and in alcoholic delirium. Antarsin is effective in poisoning with arsenic compounds, in which the use of unithiol is contraindicated. Sodium thiosulfate is used for poisoning with hydrocyanic acid and its salts, which in the process of chemical interaction turn into non-toxic thiocyanate compounds or cyanhydrides, which are easily removed with urine.

The ability to bind toxic substances is possessed by: activated carbon, tannin, potassium permanganate, which are added to the wash water. For the same purpose. use a plentiful drink of milk, protein water, egg whites (according to indications).

Enveloping agents (up to 12 egg whites per 1 liter of boiled cold water, vegetable mucus, kissels, vegetable oil, an aqueous mixture of starch or flour) are especially indicated for poisoning with irritating and cauterizing poisons, such as acids, alkalis, salts of heavy metals.

Activated charcoal is administered orally in the form of an aqueous slurry (2-3 tablespoons per 1-2 glasses of water), has a high sorption capacity for many alkaloids (atropine, cocaine, codeine, morphine, strychnine, etc.), glycosides (strophanthin, digitoxin and etc.), as well as microbial toxins, organic and, to a lesser extent, inorganic substances. One gram of activated charcoal can adsorb up to 800 mg of morphine, up to 700 mg of barbiturates, up to 300 mg of alcohol.

Vaseline oil (3 ml per 1 kg of body weight) or glycerin (200 ml) can be used as a means to accelerate the passage of poison through the gastrointestinal tract and prevent absorption. ).

Methods for the accelerated removal of poison from the body.

Active detoxification of the body is carried out in specialized centers for the treatment of poisoning. The following methods are applied.

1. Forced diuresis - based on the use of diuretics (urea, manpitol, lasix, furosemide) and other methods that contribute to increased urine output. The method is used for most intoxications, when the excretion of toxic substances is carried out mainly by the kidneys.

Water load is created by drinking plenty of alkaline water (up to 3-5 liters per day) in combination with diuretics. Patients in a coma or with severe dyspeptic disorders are given subcutaneous or intravenous administration of sodium chloride solution or glucose solution. Contraindications to water exercise are acute cardiovascular insufficiency (pulmonary edema) or renal failure.

Alkalinization of urine is created by intravenous drip injection of sodium bicarbonate solution up to 1.5-2 liters per day under the control of determining the alkaline reaction of urine and the reserve alkalinity of the blood. In the absence of dyspeptic disorders, sodium bicarbonate (baking soda) can be given orally at 4-5 g every 15 minutes for an hour, then 2 g every 2 hours. Alkalinization of urine is a more active diuretic than water load, and is widely used in acute poisoning with barbiturates, salicylates, alcohol and its surrogates. Contraindications are the same as for water load.

Osmotic diuresis is created by intravenous administration of osmotically active diuretic drugs, which significantly enhance the process of reabsorption in the kidneys, which makes it possible to achieve excretion of a significant amount of poison circulating in the blood in the urine. The most famous drugs in this group are: hypertonic glucose solution, urea solution, mannitol.

2. Hemodialysis is a method that uses an "artificial kidney" machine as a measure of emergency care. The rate of purification of blood from poisons is 5-6 times higher than forced diuresis.

3. Peritoneal dialysis - accelerated elimination of toxic substances that have the ability to accumulate in fatty tissues or bind strongly to blood proteins. During the peritoneal dialysis operation, 1.5-2 liters of sterile dialysis fluid is injected through a fistula sewn into the abdominal cavity, changing it every 30 minutes.

4. Hemosorption - a method of perfusion (distillation) of the patient's blood through a special column with activated carbon or other sorbent.

5. The operation of blood replacement is performed in case of acute poisoning with chemicals that cause toxic damage to the blood. Use 4-5 liters of one-group, Rh-compatible, individually selected donor blood.

Resuscitation and symptomatic treatment.

Those who have been poisoned require the most careful observation and care in order to take timely measures against threatening symptoms. In case of a decrease in body temperature or a cold snap of the extremities, patients are wrapped in warm blankets, rubbed, and given a hot drink. Symptomatic therapy is aimed at maintaining those functions and systems of the body that are most damaged by toxic substances. Below are the most common complications from the respiratory system, gastrointestinal tract, kidneys, liver, cardiovascular system.

a) Asphyxia (suffocation) in a coma.

The result of retraction of the tongue, aspiration of vomit, a sharp hypersecretion of the bronchial glands and salivation.

Symptoms: cyanosis (blue), in the oral cavity - a large amount of thick mucus, weakened breathing and coarse bubbling wet rales over the trachea and large bronchi are heard.

First aid: remove vomit from the mouth and throat with a swab, remove the tongue with a tongue holder and insert an air duct.

Treatment: with pronounced salivation, subcutaneously - 1 ml of 0.1% atropine solution.

b) Burns of the upper respiratory tract.

Symptoms: with stenosis of the larynx - hoarseness of the voice or its disappearance (aphonia), shortness of breath, cyanosis. In more pronounced cases, breathing is intermittent, with convulsive contraction of the cervical muscles.

First aid: inhalation of sodium bicarbonate solution with diphenhydramine and ephedrine.

Treatment: emergency tracheotomy.

c) Respiratory disorders of central origin, due to depression of the respiratory center.

Symptoms: chest excursions become superficial, arrhythmic, up to their complete cessation.

First aid: mouth-to-mouth artificial respiration, chest compressions (see Chapter 1, Internal Medicine, Section 2, Sudden Death).

Treatment: artificial respiration. Oxygen therapy.

d) Toxic pulmonary edema occurs with burns of the upper respiratory tract with chlorine vapor, ammonia, strong acids, as well as poisoning with nitrogen oxides, etc.

Symptoms. Little noticeable manifestations (cough, chest pain, palpitations, single wheezing in the lungs). Early diagnosis of this complication is possible with the help of fluoroscopy.

Treatment: prednisolone 30 mg up to 6 times a day intramuscularly, intensive antibiotic therapy, large doses of ascorbic acid, aerosols using an inhaler (1 ml of diphenhydramine + 1 ml of ephedrine + 5 ml of novocaine), with hypersecretion subcutaneously - 0.5 ml 0.1 % solution of atropine, oxygen therapy (oxygen therapy).

e) Acute pneumonia.

Symptoms: fever, weakening of breathing, moist rales in the lungs.

Treatment: early antibiotic therapy (daily intramuscular injection of at least 2,000,000 units of penicillin and 1 g of streptomycin).

e) Decreased blood pressure.

Treatment: intravenous drip of plasma-substituting fluids, hormonal therapy, as well as cardiovascular agents.

g) Violation of the heart rhythm(decreased heart rate to 40-50 per minute).

Treatment: intravenous administration of 1-2 ml of 0.1% solution of atropine.

h) Acute cardiovascular insufficiency.

Treatment: intravenously - 60-80 mg of prednisolone with 20 ml of 40% glucose solution, 100-150 ml of 30% urea solution or 80-100 mg of lasix, oxygen therapy (oxygen).

i) vomiting.

In the early stages of poisoning is considered as a favorable phenomenon, because. promotes the elimination of poison from the body. The occurrence of vomiting in the unconscious state of the patient, in young children, in case of respiratory failure, is dangerous. possible entry of vomit into the respiratory tract.

First aid: give the patient a position on his side with his head slightly lowered, remove vomit from the oral cavity with a soft swab.

j) Pain shock in burns of the esophagus and stomach.

Treatment: painkillers and antispasmodics (2% solution of promedol - 1 ml subcutaneously, 0.1% solution of atropine - 0.5 ml subcutaneously).

k) Esophageal-gastric bleeding.

Treatment: locally on the abdomen with an ice pack, intramuscularly - hemostatic agents (1% solution of vikasol, 10% solution of calcium gluconate).

m) Acute renal failure.

Symptoms: sudden decrease or cessation of urination, the appearance of edema on the body, increased blood pressure.

Providing first aid and effective treatment is possible only in the conditions of specialized nephrological or toxicological departments.

Treatment: control over the amount of fluid administered and the volume of urine excreted. Diet N 7. In the complex of therapeutic measures, an intravenous administration of a glucose-novoca and a new mixture is carried out, as well as alkalization of the blood by intravenous injections of 4% sodium bicarbonate solution. Apply hemodialysis (apparatus "artificial kidney").

m) Acute liver failure.

Symptoms: an enlarged and painful liver, its functions are disturbed, which is established by special laboratory tests, icterus of the sclera and skin.

Treatment: diet N 5. Drug therapy - methionine in tablets up to 1 gram per day, lipocaine in tablets 0.2-0.6 grams per day, B vitamins, glutamic acid in tablets up to 4 grams per day. Hemodialysis (apparatus "artificial kidney").

o) Trophic complications.

Symptoms: redness or swelling of certain areas of the skin, the appearance of "pseudo-burn blisters", further necrosis, rejection of the affected areas of the skin.

Prevention: constant replacement of wet linen, treatment of the skin with camphor alcohol, regular changes in the position of the patient in bed, placing cotton-gauze rings under the protruding parts of the body (sacrum, shoulder blades, feet, nape).

MOST COMMON POISONINGS

Section 2. ACUTE DRUG POISONING

Sleeping pills (barbiturates)

All derivatives of barbituric acid (phenobarbital, barbital, medinal, etaminal-patriy, a mixture of Sereysky, tardil, bellaspon, bromital, etc.) are absorbed quite quickly and almost completely in the gastrointestinal tract.

Lethal dose: about 10 medical doses with great individual differences.

Acute poisoning with sleeping pills is primarily accompanied by depression of the functions of the central nervous system. The leading symptom is respiratory failure and the progressive development of oxygen starvation. Breathing becomes rare, intermittent. All types of reflex activity are suppressed. The pupils first constrict and react to light, and then (due to oxygen starvation) dilate and no longer react to light. Kidney function suffers sharply: a decrease in diuresis contributes to the slow release of barbiturates from the body. Death occurs as a result of paralysis of the respiratory center and acute circulatory disorders.

There are 4 clinical stages of intoxication.

Stage 1 - "falling asleep": characterized by snottiness, apathy, decreased reactions to external stimuli, but contact with the patient can be established.

Stage 2 - "superficial coma": there is a loss of consciousness. Patients can respond to painful stimulation with a weak motor reaction, short-term dilation of the pupils. Swallowing is difficult and the cough reflex weakens, breathing disorders are added due to the retraction of the tongue. An increase in body temperature up to 39b-40°C is characteristic.

Stage 3 - "deep coma": characterized by the absence of all reflexes, there are signs of a threatening violation of the vital functions of the body. Respiratory disorders from superficial, arrhythmic to its complete paralysis, associated with depression of the central nervous system, come to the fore.

In stage 4 - "post-coma state" consciousness is gradually restored. On the first day after awakening, most patients experience tearfulness, sometimes moderate psychomotor agitation, and sleep disturbance.

The most common complications are pneumonia, tracheobronchitis, bedsores.

Treatment. Poisoning with sleeping pills requires emergency care. First of all, it is necessary to remove the poison from the stomach, reduce its content in the blood, support breathing and the cardiovascular system. The poison is removed from the stomach by washing it (the earlier washing is started, the more effective it is), spending 10-13 liters of water, it is advisable to repeat washing, best through a probe. If the victim is conscious and there is no probe, washing can be done by repeated intake of several glasses of warm water, followed by induction of vomiting (irritation of the pharynx). Vomiting can be induced with mustard powder (1/2-1 teaspoon per glass of warm water), table salt (2 tablespoons per glass of water), warm soapy water (one glass), or an emetic, including apomorphine subcutaneously (1 ml 0 ,5%).

To bind the poison in the stomach, activated charcoal is used, 20-50 g of which is injected into the stomach in the form of an aqueous emulsion. The reacted coal (after 10 minutes) must be removed from the stomach, since the adsorption of the poison is a reversible process. That part of the poison that has passed into the stomach can be removed with laxatives. Preference is given to sodium sulfate (Glauber's salt), 30-50 g. Magnesium sulfate (bitter salt) in case of impaired renal function can have a depressant effect on the central nervous system. Castor oil is not recommended.

To accelerate the removal of absorbed barbiturates and their excretion by the kidneys, give plenty of fluids and diuretics. If the patient is conscious, then the liquid (plain water) is taken orally, in cases of severe poisoning, 5% glucose solution or isotonic sodium chloride solution (up to 2-3 liters per day) is injected intravenously. These measures are carried out only in cases where the excretory function of the kidneys is preserved.

For accelerated removal of poison and excess fluid, a fast-acting diuretic is prescribed intravenously. With severe respiratory failure, intubation, suction of the contents of the bronchi and artificial ventilation of the lungs are carried out, with less significant respiratory disorders, they resort to the use of respiratory stimulants (analeptics). To prevent pneumonia, antibiotics are prescribed, with a sharp increase in temperature - intramuscularly 10 ml of a 4% solution of amidopyrine. Vasoconstrictors are used to restore vascular tone. To stimulate cardiac activity - fast-acting glycosides, when the heart stops, the introduction of adrenaline into the cavity of the left ventricle is indicated, followed by massage through the chest.

Antidepressant drugs

The group of aptidepressants includes imizin (imipramine), amitriptyline, azafen, fluorocyzine, etc. They are well absorbed in the gastrointestinal tract, easily bind to the proteins of blood and organs, and are quickly distributed throughout the body, exerting a toxic effect.

The prognosis is always serious and mortality when taking more than 1 g exceeds 20%.

Symptoms. Characterized by changes in the central and cardiovascular systems. Already from an early date after poisoning, psychomotor agitation occurs, hallucinations appear, body temperature drops sharply, and a coma develops with respiratory depression. Acute cardiopathy and cardiac arrest is the main cause of death in these poisonings. The main manifestations of the toxic effect on the myocardium are expressed during the first 12 hours, but may develop over the next 6 days.

The severity of poisoning is manifested by a sharp dilation of the pupils, dryness of the oral mucosa, impaired motility of the gastrointestinal tract up to intestinal paresis.

First aid. Gastric lavage with a solution of sodium bicarbonate (baking soda), saline solution or water with activated charcoal. Washing is carried out in the first 2 hours after poisoning, and then again. At the same time, a saline laxative is introduced, a cleansing enema is placed. Emetics, artificial respiration are used in case of respiratory failure. Cardiac glycosides are contraindicated, since the toxicity of tricyclic antidepressants increases dramatically in this case.

Hypertensin is used to correct vascular tone. For the relief of seizures and psychomotor agitation, it is advisable to use barbiturates and chlorpromazine. The main antidote drug is physostigmine, which is administered intravenously. The criterion for its effectiveness is a decrease in heart rate to 100-120 beats per minute and an increase in blood pressure (100/80 mm Hg).

tranquilizers

The drugs in this group include meprotan (Andaxin, meprobamate), diazepam (Seduxen, Relanium, Valium), nitrazepam, trioxazine, Elenium, Librium and other drugs that have a pronounced tranquilizing or sedative effect. All substances are easily absorbed in the gastrointestinal tract and form strong compounds with blood and tissue proteins.

Symptoms. The clinical picture is manifested in the depression of the central nervous system. Against the background of muscle weakness, there is a tremor (trembling) of the limbs, heart rhythm disturbance, and a drop in blood pressure. Motility increases or peristalsis of the gastrointestinal tract is sharply suppressed, combined with a decrease in saliva secretion and a feeling of dry mouth.

In severe poisoning, symptoms from the central nervous system predominate: confusion, psychomotor agitation, hallucinations, convulsions. From the side of the cardiovascular system - tachycardia, a tendency to collapse; respiratory failure, cyanosis.
First aid. Early frequent and repeated gastric lavage with activated charcoal, saline laxative, siphon enema. The role of conservative therapy in order to maintain vital functions is great: the use of vasoconstrictors in case of severe circulatory failure, the introduction of cardiac agents (strophanthin, cocarboxylase, corglycon), the introduction of alkaline solutions, the correction of convulsive state and external respiration, including oxygen therapy.

Central nervous system stimulants

A group of caffeine and its apologists (theophylline, theobromine, eufillin, aminophylline, theofedrin, diprofillin, etc.). Of the entire group, caffeine has the greatest stimulating effect, the toxic dose of which is at the level of 1 g, and the lethal dose is about 20 g, with large individual differences. With intravenous administration of aminophylline, there are cases of death from a dose of the order of 0.1 g, lethal doses in children when administered in suppositories - 25100 mg / kg.

Symptoms. The main signs of toxic action with prolonged use of relatively large doses (for example, in people who abuse coffee and tea) are manifested in irritability, anxiety, excitability, persistent headaches that are difficult to drug therapy, and sleep disorders. The effect on the gastrointestinal tract is manifested by a burning sensation in the epigastric region, nausea, vomiting, a sharp increase in gastric secretion, which is especially dangerous for ulcer patients, and constipation.

Acute caffeine poisoning is expressed in psychomotor reactions, turning into delirium and hallucinations, there are violations of sensory functions (determining time and distance) and speed of movement. The initial phase of excitation is quickly replaced by a soporous state. The most dangerous complication of caffeine and its analogues is the development of acute cardiovascular failure with collapse phenomena. Paralysis of the heart is also possible with the rapid introduction of aminophylline into a vein.

First aid. Gastric lavage with a 1-2% solution of tannin or sodium bicarbonate (baking soda), a suspension of activated charcoal. If the poisoning is caused by suppositories containing aminophylline, an enema is given, a saline laxative is taken.

To stop psychomotor agitation and convulsions, chloral hydrate is used in an enema (1.5-2 g per 50 ml of water), chlorpromazine (2 ml of a 2.5% solution on novocaine), diphenhydramine (1 ml of a 2% solution with novocaine) - intramuscularly.

Correction of cardiovascular insufficiency in case of caffeine poisoning is difficult in terms of first aid, since most vasoconstrictors will enhance the toxic effect of caffeine and its analogues. It is advisable to carry out this type of resuscitation in a hospital, where exchange transfusion of blood (plasma) can be performed and forced diuresis with alkalization is used.

Strychnine. Lethal dose: 0.2-0.3 g. Strychnine is easily absorbed from the gastrointestinal tract and also easily penetrates into the body from all injection sites.

Symptoms: agitation, headaches, shortness of breath. Increased tone of the occipital muscles, trismus of masticatory muscles, tetanic convulsions at the slightest irritation. Spasm of the respiratory muscles with the development of a sharp rigidity of the chest. Death occurs with symptoms of asphyxia (suffocation).

Treatment. When the poison is ingested - early gastric lavage, saline laxative, chloral hydrate in the enema again. Sedative therapy: barbamil (3-5 ml of a 10% solution) into a vein, morphine (1 ml of a 1% solution), diphenhydramine (2 ml of a 1% solution) under the skin. In case of respiratory disorders - intubation anesthesia with the use of muscle relaxants (listenone, diplacin). Forced diuresis (urine alkalinization).

Narcotics

Indian hemp (hashish, plan) is a narcotic intoxicant. It is used for chewing, smoking and ingestion for the purpose of a kind of intoxication. The toxic effect is associated with depression of the central nervous system.

Symptoms. Initially, psychomotor agitation, dilated pupils, tinnitus, vivid visual hallucinations (seeing flowers, large spaces), a quick change of thoughts, laughter, and ease of movement are characteristic. Then come general weakness, lethargy, whiny mood and a long deep sleep with a slow pulse and a decrease in body temperature.

Treatment. Gastric lavage when poison is taken orally. With a sharp excitation - chlorpromazine (1-2 ml of a 2.5% solution) intramuscularly, chloral hydrate in an enema, cardiovascular agents.

Nicotine is a tobacco alkaloid. The lethal dose is 0.05 g.

Symptoms: if the poison gets inside in the mouth, behind the sternum and in the epigastric region - a feeling of itching, areas of numbness of the skin, dizziness, headache, visual and hearing impairment. Dilation of pupils, pallor of the face, salivation, repeated vomiting. Shortness of breath with difficult exhalation, palpitations, abnormal pulse, fibrillar twitching of individual muscle groups with the development of general clonic-tonic convulsions. During seizures, there is an increase in blood pressure followed by a fall. Loss of consciousness. Cyanosis of the mucous membranes.

Death occurs with paralysis of the respiratory center and respiratory muscles.

Cardiac arrest in diastole. When taking toxic doses, the picture of poisoning develops quickly.

Treatment. Inside activated charcoal, followed by copious gastric lavage with a solution of potassium permanganate (1:1000), saline laxative. Cardiovascular agents (caffeine, cordiamine). Novocain with glucose in a vein drip, magnesium sulfate intramuscularly, diphenhydramine under the skin. For convulsions with difficulty breathing - 10% solution of barbamyl (2.5% solution of hexenal or thiopental sodium is possible) 5-10 ml into a vein slowly at intervals of 20-30 seconds until seizures stop or 1% solution of chloral hydrate in an enema.

If these measures are unsuccessful, ditilin (or other similar drugs) into a vein, followed by intubation and artificial respiration. In violation of the heart rhythm such as tachycardia - cardiac glycosides, with a sharp slowdown in the pulse - atropine and a solution of calcium chloride intravenously. Oxygen therapy.

morphine group. Lethal dose: 0.1-0.2 g orally.

Symptoms. Ingestion or intravenous administration of toxic doses of drugs develops a coma, which is characterized by a significant constriction of the pupils with a weakening of the reaction to light. Predominant depression of the respiratory center is characteristic - respiratory paralysis even with a shallow coma or with the patient's consciousness preserved (with codeine poisoning). There may also be a significant drop in blood pressure. Death occurs as a result of inhibition of the activity of the respiratory center.

First aid: gastric lavage with warm solutions of potassium permanganate (since it oxidizes morphine) with the addition of activated charcoal, saline laxative. Do not let the poisoned person sleep, hot baths with cold douches, rubbing. On the head, to the arms and legs of the heating pad.

Treatment. Repeated gastric lavages, even with intravenous morphine. Nalorfin (antorfin) 1-3 ml of a 0.5% solution in a vein again. Forced diuresis (urine alkalinization). Cardiovascular drugs according to indications. Antibiotics. Vitamin therapy. Artificial ventilation of the lungs.

Anti-inflammatory and antipyretic drugs

The most commonly used of them belong to three different chemical groups: salicylates (drugs containing acetylsalicylic acid), pyrazolones (amidopyrine, analgin, butadione) and anilines (paracetamol and phenacetin). Each of the groups has its own side effects, but the picture of poisoning has quite a few similarities.

Aspirin, askafen and other salicylates. Lethal dose: 30-50 g, for children - 10 g.

Symptoms. When ingesting salicylic acid, especially an alcohol solution, there is a burning sensation and pain along the esophagus, in the stomach, repeated vomiting, often with blood, sometimes loose stools mixed with blood. Tinnitus, hearing loss, visual impairment are characteristic. Patients are excited, euphoric. Breathing is noisy, rapid, a coma may occur. Salicylates reduce blood clotting, so a constant sign of poisoning is hemorrhage on the skin, profuse (massive) nasal and uterine bleeding. The prognosis is usually favorable for life.

Treatment. After gastric lavage, vaseline oil (a glass) is injected through a probe, a laxative is given - 20-30 g of sodium sulfate (Glauber's salt). Strengthened alkaline drinking of sodium bicarbonate (baking soda) or in an enema (at the rate of 0.4 g / kg of body weight) every hour until the normal respiratory rate is restored and the appearance of an alkaline urine reaction.

The appointment of large doses of ascorbic acid (up to 0.5-1 g) per day orally or by injection accelerates the neutralization of salicylic acid. With bleeding - vikasol, calcium chloride, blood transfusion. Treatment of renal and hepatic insufficiency, burns of the digestive tract.

Analgin, amidopyrine and other pyrazolone derivatives. Lethal dose: 10-15 g.

Symptoms: tinnitus, nausea, vomiting, general weakness, fever, shortness of breath, palpitations. In severe poisoning - convulsions, drowsiness, delirium, loss of consciousness and coma. Perhaps the development of peripheral edema, gastric bleeding, hemorrhagic rash.

Treatment. The main measures are the same as for salicylates poisoning: gastric lavage, laxative, plentiful brush drinking, diuretics. Additionally, anticonvulsant treatment is possible - chloral hydrate 1 g in an enema with starch mucus, barbamil intramuscularly, diazepam intravenously. With convulsions, analeptics are best avoided, using strophanthin or similar means to stimulate the heart. Mandatory is the appointment of potassium chloride or acetate inside 0.5-1 g for 1-2 doses.

Paracetamol and other derivatives of aniline. The phenomena of irritation of the digestive tract during poisoning are less pronounced, but the signs of the formation of methemoglobin in the blood are more significant - pallor, cyanosis, brownish-brown skin color. In severe cases - dilated pupils, shortness of breath, convulsions, vomiting with the smell of aniline. In later periods, anemia and toxic nephritis develop. The prognosis is usually favorable.

Treatment is the same as in previous cases. However, severe methemoglobinemia often forces one to resort to exchange blood transfusion. More attention should be paid to the fight against impaired renal function (osmotic diuresis or furosemide with abundant fluid and mineral salts).

Antiseptics

Iodine. Lethal dose: 2-3 g. Symptoms: brown staining of the tongue and oral mucosa, vomiting with brown and blue masses (if there is starch in the contents of the stomach), diarrhea. Headache, runny nose, skin rash. Irritation of the mucous membrane of the respiratory tract. In severe cases - pulmonary edema, convulsions, small rapid pulse, coma.

First aid: gastric lavage, inside - liquid starch or flour paste in large quantities, milk, mucous drink, laxative - burnt magnesia (magnesium oxide).

Treatment: inside 1% solution of sodium thiosulfate in the amount of 250-300 ml. Symptomatic therapy, treatment of burns of the digestive tract.

Potassium permanganate (potassium permanganate). Lethal dose: 0.5-1 g.

Symptoms: sharp pain in the mouth, along the esophagus, in the abdomen. Diarrhea, vomiting. The mucous membrane of the oral cavity is dark brown. Laryngeal edema, burn shock, convulsions.

First aid and treatment - see Strong acids.

Hydrogen peroxide. Symptoms: after contact with the skin - its whitening, burns, blisters. When ingested - burns of the digestive tract. Treatment - see Iodine.

Ethyl alcohol (wine alcohol) - is part of alcoholic beverages, perfumes, cologne, lotions, medicinal herbal tinctures, is a solvent for alcohol varnishes, alkaline polishes, BF brand adhesives, etc. The lethal concentration of ethyl alcohol in the blood: about 300-400 mg%.

Symptoms. With mild intoxication, the leading symptom is euphoria (elevated mood). When moderately intoxicated, gait disturbance and coordination of movements, moderate arousal, which is replaced by drowsiness and deep sleep, join. These stages of intoxication do not require treatment.

In severe poisoning, all phenomena are more pronounced and intoxication ends with anesthesia, i.e. deep sleep with loss of all types of sensitivity, including pain and temperature. And although this condition is not life-threatening in itself, as it disappears after a few hours, but in a state of anesthesia, severe injuries are possible, the occurrence of deep bedsores, up to gangrene of soft tissues, caused by impaired local blood circulation when sleeping in the same uncomfortable position . Hypothermia is a significant risk. It can occur even at an air temperature of 12°C. At the same time, the body temperature drops to 31-32°C, the pulse slows down to 28-52 beats, breathing is depressed to 8-10 beats per minute. Such a combined lesion is very dangerous and can lead to death either on the first day from respiratory failure or in the coming weeks from pneumonia and gangrene of the lungs caused by hypothermia.

With very severe alcohol intoxication, the patient quickly passes all the previous stages of intoxication (euphoria, arousal, anesthesia) and falls into a deep coma. There are three stages of coma.

Superficial coma 1: Pupils constricted with temporary dilatation on painful stimulation. From the mouth - a sharp smell of alcohol. Patients respond to the inhalation of ammonia with a mimic reaction, protective movements of the hands. This stage of alcohol intoxication is characterized by the most favorable course, and often after washing the stomach through a tube, patients regain consciousness.

Superficial coma 2: characterized by severe muscle hypotonia (relaxation) with preserved reflexes (tendon, pupillary). They react weakly to inhalation irritation with ammonia vapors. These patients are subject to hospitalization, since the coma is longer and measures to stop further absorption of alcohol (gastric lavage through a tube) are not accompanied by a rapid recovery of consciousness.

Deep coma: characterized by a complete absence of reflex activity. The pupils are constricted or, with symptoms of respiratory failure, dilated. Pain sensitivity and reaction to irritation with ammonia are absent.

It must be remembered that alcohol intoxication may be accompanied by respiratory failure due to retraction of the tongue, aspiration of mucus and vomit into the respiratory tract, and increased secretion of the bronchial glands. Violations of the function of the cardiovascular system affect in the form of moderate hypertension, alternating with hypotension (lowering blood pressure) and severe tachycardia in the stage of deep coma.

Recognition. Alcoholic coma should be distinguished from stroke, uremic coma, poisoning with morphine and its derivatives. The smell of alcohol from the mouth does not prove anything, since combined lesions are possible.

Stroke is most often accompanied by paralysis of half of the body with deviation of the eye in the direction of the lesion and nystagmus. In this case, the coma is deeper than alcoholic, and usually comes on suddenly.

With uremia, the smell of ammonia from the mouth is characteristic, the pupils either narrow to medium sizes, or expand. Diuresis is absent or extremely poor, while in alcoholic coma diuresis, on the contrary, is increased, vomiting, involuntary urination and defecation are not uncommon.

Morphine coma is characterized by a sharp narrowing of the pupil to the size of a "pinhead", preserved tendon reflexes.

The leading sign for the diagnosis in a difficult case is the determination of the amount of alcohol in the blood, which is possible only in a specialized hospital. Alcoholic coma is usually short-lived, lasting only a few hours. Its duration for more than a day, combined with severe respiratory disorders, is an unfavorable sign.

First aid. In a very serious condition (coma), it should be energetic, especially if breathing is disturbed.

With a drop in blood pressure, cardiovascular agents (cordiamin, ephedrine, strophanthin) are prescribed, polyglucin and prednisolone are administered intravenously.

The main thing in the treatment of intoxication is to stop the absorption of alcohol, wash the stomach abundantly through a tube. It is also removed from the body by intravenous administration of hypertonic glucose solution with insulin; in a deep coma, it is advisable to use the method of forced diuresis, vitamin therapy. Analeptics and, in particular, bemefid in the stage of severe alcoholic coma are contraindicated. Of the emetics - only apomorphine subcutaneously, but it is contraindicated in the absence of consciousness, as well as low blood pressure, severe general exhaustion, which is often found in alcoholics.

To restore consciousness, an ammonia solution is also used inside (5-10 drops of ammonia in a glass of water). Since the patient develops acidosis ("acidification of the blood"), it is imperative to inject a solution of sodium bicarbonate into a vein or orally (2-7 g of baking soda per reception). It is obligatory to warm the patient with heating pads, especially when intoxication is combined with cooling. When excited, barbiturates or drugs of the morphine group should not be given to calm the patient because of the danger of respiratory depression. In this case, chlorpromazine or chloral hydrate should be administered no more than 0.2-0.5 g in an enema with starch mucus. The patient should be given hot strong sweet tea or coffee, the caffeine contained in these drinks helps to stimulate respiration, the cardiovascular system and awakening.

Alcohol substitutes:

Methyl alcohol is less toxic than ethyl alcohol, but in the process of its oxidation, extremely toxic products (formic acid and formaldehyde) are formed in the body, which cause delayed and very serious consequences. Individual sensitivity to methyl alcohol fluctuates even more than to ethyl alcohol, the minimum dose for a person is 100 ml. Mortality in methyl alcohol poisoning is significant.

Symptoms and course. At very high doses, poisoning can occur in a lightning-fast form. In this case, all phenomena similar to severe alcohol intoxication (euphoria, coordination disorders, agitation) develop much faster, and death can occur within 2-3 hours. At relatively small doses of methyl alcohol, poisoning develops as a latent period.

With a mild form of poisoning, headache, nausea, persistent vomiting, pain in the stomach, dizziness and moderate visual impairment appear: flashing "flies" before the eyes, blurred vision - "fog before the eyes". These phenomena last from 2 to 7 days, and then pass.

In the middle form of poisoning, the same phenomena are observed, but more pronounced, and after 1-2 days blindness occurs. At the same time, vision is first slowly restored, but not completely, and after a while it worsens again. The prognosis for life is good, for vision is poor. An unfavorable sign is persistent pupil dilation.

The severe form begins in the same way, but then drowsiness and stupor appear, after 6-10 hours pain in the legs and head may appear, thirst increases. The skin and mucous membranes are dry, inflamed, with a bluish tint, the tongue is covered with a gray coating, the smell of alcohol from the mouth. The pulse is frequent, with a gradual slowdown and rhythm disturbance, blood pressure is increased with its subsequent fall. Consciousness becomes confused, psychomotor agitation occurs, convulsions are possible. Sometimes a coma quickly develops, stiff neck, hypertonicity of the muscles of the extremities. Death occurs from respiratory paralysis and a drop in cardiovascular activity.

Treatment. Similar to that in an alcoholic coma: gastric lavage, followed by the introduction of 20-30 g of sodium sulfate, dissolved in a glass of water, through a probe. The fight against respiratory disorders - inhalation of pure oxygen, if necessary and possible - artificial ventilation of the lungs. Gastric lavage should be repeated several times for 2-3 days, since methyl alcohol is slowly absorbed from the gastrointestinal tract. In the first hours after poisoning, the appointment of ethyl alcohol in the form of a glass of cognac orally or in the form of a 2-5% solution into a vein is indicated by drip at the rate of up to 1 ml of pure alcohol per 1 kg of the patient's weight. The introduction of ethyl alcohol prevents the oxidation of methyl to formic acid and formaldehyde and accelerates its excretion. To combat eye damage, one should resort to early lumbar punctures and the appointment of ATP, atropine, prednisolone, vitamins (retinol, ascorbic acid, thiamine, riboflavin, etc.) in the accepted doses.

Hydrolysis and sulfite alcohols. They are ethyl alcohol obtained from wood by hydrolysis, 1.11.4 times more toxic than ethyl alcohol due to impurities of methyl alcohol, carbonyl compounds, etc.

Formic alcohol. By the nature of the action, it approaches methyl. The lethal dose is about 150 g. Symptoms - see Methyl alcohol. More often there is a pronounced psychomotor agitation, a delirious state (of the type of "delirious tremens"), after 2-4 days acute renal failure develops.

For treatment, see Methyl alcohol. Treatment of acute renal failure.

Colognes and lotions are cosmetics containing up to 60% ethyl alcohol, methyl alcohol, aldehydes, essential oils and other impurities, which makes them more toxic than ethyl alcohol.

Symptoms, treatment, see Ethyl alcohol.

Polishes - toxic ethyl alcohol containing a large amount of acetone, butyl and amyl alcohols and other impurities. Some polishes contain aniline dyes.

Symptoms, treatment, see Ethyl alcohol, Aniline.

Clay BF. Its basis is phenol-formaldehyde resin and polyvinyl acetal, dissolved in ethyl alcohol, acetone and chloroform. The toxic effect depends on the composition of the adhesive series, the solvent substance, as well as the degree of precipitation and removal from the resin solution before ingestion.

Symptoms, treatment - see Ethyl alcohol, methyl alcohol, Acetone.

Antifreeze is a mixture of glycols: ethylene glycol, propylene glycol and polyglycols (brake fluid). The toxic effect of antifreeze is mainly due to ethylene glycol. The lethal dose of the latter is about 100 ml, i.e. glass of antifreeze.

Ethylene glycol itself is slightly toxic, its metabolites, in particular oxalic acid, cause severe consequences. It causes acidosis ("acidification of the blood"), and the calcium oxalate crystals formed in the urine damage the kidneys.

Symptoms. The phenomenon of light alcohol intoxication with good health. After 5-8 hours, there are pains in the epigastric region and abdomen, severe thirst, headache, vomiting, diarrhea. The skin is dry, hyperemic. Mucous membranes with a bluish tinge. Psychomotor agitation, dilated pupils, fever. Dyspnea. Pulse increase. In severe poisoning, loss of consciousness, stiff neck, convulsions occur. Breathing deep, noisy. The phenomena of acute cardiovascular insufficiency (collapse, pulmonary edema). From 2-3 days after poisoning, symptoms of acute renal failure develop. Yellowness of the skin appears, the liver increases and becomes painful. Poisoned can die with symptoms of increasing uremia.

Recognition. A diagnostic sign is the appearance of calcium oxalate crystals in the urine and the onset of the stage of renal phenomena after 2-3 days: pain in the lower back and abdomen, painful urination, urine of the color of "meat slops".

Treatment. Basically the same as in alcohol poisoning: gastric lavage and saline laxative, the fight against respiratory disorders and acidosis with a solution of sodium hydrocarbopate (soda), which is taken orally or injected intravenously.

Specific to this poisoning is the fight against impaired renal function. To do this, you should prescribe plenty of fluids, osmotic diuretics or furosemide (0.04-0.12 g orally or 23 ml of a 1% solution in a vein or muscle). When taking diuretics, the loss of water, potassium, sodium and chlorine from the body should be compensated by the concomitant administration of saline plasma-substituting solutions in an amount equal to or slightly greater than diuresis. To prevent damage to the kidneys by calcium oxalate, it is necessary to prescribe intramuscularly magnesium sulfate, 5 ml of a 25% solution per day. If there are signs of cerebral edema and meningeal symptoms, a lumbar puncture should be performed. When ingesting more than 200 ml of poison - hemodialysis on the 1st day after poisoning, peritoneal dialysis. With the development of anuria, the prognosis is extremely unfavorable.

Acetone. It is used as a solvent in the production of various varnishes, rayon, film, etc. A weak narcotic poison that affects all parts of the central nervous system. Penetrates into the body through the respiratory system, the digestive system (when taken orally).

Symptoms: the clinical picture is similar to alcohol intoxication. However, the coma does not reach great depth. The mucous membrane of the oral cavity and pharynx is edematous, inflamed. From the mouth - the smell of acetone. In case of poisoning with acetone vapor, symptoms of irritation of the mucous membranes of the eyes, respiratory tract appear, headaches, fainting are possible. Sometimes there is an increase and soreness of the liver, yellowness of the sclera.

Perhaps the appearance of signs of acute renal failure (decreased diuresis, the appearance of protein and red blood cells in the urine). Bronchitis and pneumonia often develop.

First aid. Remove the victim to fresh air. When fainting, inhale ammonia. Peace. Hot tea, coffee. For emergency and severe treatment, see Ethyl alcohol (Poisoning by alcohol and its surrogates).

In addition, the prevention of acute renal failure, oxygen therapy (oxygen), antibiotics, including inhalation.

Dichloroethane, carbon tetrachloride, trichlorethylene belong to the group of chlorinated hydrocarbons, widely used as solvents in many industries, in everyday life for gluing plastic products, cleaning clothes, etc. The toxic effect of these substances is associated with a narcotic effect on the nervous system, sharp dystrophic changes in the liver and kidneys. Dichloroethane is the most toxic. The lethal dose when taken orally is 20 ml. Poisoning is possible when the poison enters through the respiratory tract, skin.

There are four leading clinical syndromes:

Toxic damage to the central nervous system manifests itself in the early stages after poisoning in the form of dizziness, gait instability, and pronounced psychomotor agitation. In severe cases, a coma develops, a frequent complication of which is respiratory failure by the type of mechanical asphyxia (bronchorrhea, retraction of the tongue, profuse salivation).

Syndrome of acute gastritis and gastroenteritis, in which there is repeated vomiting with a significant admixture of bile, in severe cases, frequent loose stools, flaky with a specific odor.

The syndrome of acute cardiovascular insufficiency is manifested by a persistent drop in blood pressure with no pulse in the peripheral arteries and is usually observed against the background of psychomotor agitation or coma. In some cases, a drop in blood pressure is preceded by a short-term increase in it and a sharp tachycardia. The development of cardiovascular insufficiency is characteristic of dichloroethane poisoning and is a poor prognostic factor, as it usually ends in death within the first 3 days.

Syndrome of acute toxic hepatitis with symptoms of hepatic and renal insufficiency. Toxic hepatitis develops in most patients 2-3 days after poisoning. The main clinical manifestations are liver enlargement, spastic pain in the liver, icterus of the sclera and skin. Impaired kidney function is manifested by the development of albuminuria of varying degrees. Some patients develop acute renal failure (azotemia, uremia) during the first week after poisoning, which is more typical for carbon tetrachloride poisoning.

Inhalation poisoning with dichloroethane and carbon tetrachloride can give a severe clinical picture; under the action of carbon tetrachloride vapors, liver and kidney failure often develops. Causes of death: early - cardiovascular failure (1-3 days) and late - hepatic coma, uremia.

First aid and treatment during a coma are exactly the same as for alcohol poisoning, since in both cases there is deep anesthesia with respiratory, circulatory and acidosis ("acidification of the blood"). Kidney damage is treated in the same way as similar disorders in case of antifreeze poisoning (see Alcohol poisoning and its surrogates). To restore liver function, vitamins of group B, C, glucocorticoids, insulin with glucose are prescribed, treatment is carried out in a hospital late after poisoning.

Turpentine. A solvent for varnishes, paints, a raw material for the production of camphor, terpiniol, etc. Toxic properties are associated with a narcotic effect on the central nervous system and a local cauterizing effect. The lethal dose is 100 ml.

Symptoms: sharp pains along the esophagus and in the abdomen, vomiting with blood, loose stools, frequent urination, severe weakness, dizziness. In severe poisoning - psychomotor agitation, delirium, disorientation, convulsions, loss of consciousness. In a deep coma, respiratory disturbances by the type of mechanical asphyxia are possible. Complications: bronchopneumonia, acute nephritis. Perhaps the development of acute renal failure.

First aid: gastric lavage, saline laxative (not castor oil).

Plentiful drink, mucous decoctions. Inside activated carbon, pieces of ice.

Treatment. Gastric lavage through a tube and other activities (see Acids).

Pararenal bilateral blockade with novocaine. In coma - alkalinization of urine. Cardiovascular agents. Vitamins of group B. With excitement and convulsions - chlorpromazine with barbamil.

Antifreeze. It is used in the production of dyes (chemical paints, pencils), pharmaceuticals, polymers. It enters through the respiratory tract, the digestive tract, and the skin.

Symptoms: Bluish coloration of the mucous membranes of the lips, ears, nails. Severe weakness, dizziness, tinnitus, headache, euphoria with motor excitement, vomiting, shortness of breath. In severe poisoning - impaired consciousness and coma. Acute hepatic-renal insufficiency.

First aid: gastric lavage with activated charcoal, vaseline oil, saline laxatives, egg whites, hot drinks. Body warming.

In case of contact with the skin, wash the affected areas with a solution of potassium permanganate (1: 1000), water and soap. Hot showers and baths are not recommended. When breathing is weakened - 40% glucose solution with ascorbic acid, sodium thiosulfate (100 ml of a 30% solution) intravenously. Repeated replacement of the sprinkle. Forced diuresis (urine alkalinization and water load). Alcohol and other alcohols are contraindicated. Treatment of acute renal failure. Oxygepotherapy (oxygen) constantly.

Antifreeze- see Alcohol poisoning and its surrogates.

Gasoline (kerosene). Toxic properties are associated with a narcotic effect on the central nervous system. Poisoning can occur when gasoline vapors enter the respiratory tract, when exposed to large areas of the skin. Toxic dose when taken orally 20-50 g.

Symptoms. In case of poisoning caused by inhalation of low concentrations of gasoline, phenomena similar to the state of intoxication are observed: mental agitation, dizziness, nausea, vomiting, reddening of the skin, increased pulse, in more severe cases, fainting with the development of convulsions and fever. In drivers, when gasoline is sucked into the hose, it sometimes penetrates into the lung, which leads to the development of "gasoline pneumonia": pains in the side, shortness of breath, cough with rusty sputum, and a sharp increase in temperature quickly appear. From the mouth a clear smell of gasoline. When gasoline gets inside, profuse and repeated vomiting, headache, abdominal pain, loose stools appear. Sometimes there is an increase in the liver and its soreness, icterus of the sclera.

Treatment. Remove the victim to fresh air, inhalation of oxygen, artificial respiration. If gasoline is ingested, rinse the stomach through a tube, give a laxative, hot milk, heating pads on the stomach. Antibiotics (2,000,000 units of penicillin and 1 g of streptomycin) intramuscularly, inhalation of antibiotics. Cardiovascular agents (cordiamin, camphor, caffeine). With the phenomena of "gasoline pneumonia" - ACTH (40 units daily), ascorbic acid (10 ml of a 5% solution) intramuscularly. Alcohol, emetics and adrenaline are contraindicated.

Benzene. The lethal concentration in the blood is 0.9 mg / l.

Rapidly absorbed in the lungs, gastrointestinal tract.

Symptoms: When inhaling benzene vapors - excitation similar to alcohol, convulsions, pallor of the face, red mucous membranes, dilated pupils. Dyspnea. Decreased blood pressure, bleeding from the nose, gums, uterine bleeding, paralysis of the respiratory center is possible. Death can occur from respiratory arrest and a drop in cardiac activity. When benzene is taken orally, abdominal pain, vomiting, and liver damage (jaundice, etc.) occur.

Treatment. Remove the victim from the danger zone. Gastric lavage through a probe, vaseline oil inside - 200 ml, saline laxative - 30 g of sodium sulfate (Glauber's salt). Forced diuresis. Blood replacement operation. 30% solution of sodium thiosulfate - 200 ml intravenously. oxygen inhalation. Symptomatic therapy.

Naphthalene. Lethal dose: for adults - 10 g, for children - 2 g. Poisoning is possible by inhalation of vapors or dust, penetration through the skin, ingestion.

Symptoms: numbness, soporous state. Dyspeptic disorders, abdominal pain. Kidney damage according to the type of excretory nephrosis (protein in the urine, hematuria, cylindruria). Possible damage to the retina.

Treatment. Gastric lavage, saline laxative. Alkalinization of urine. Calcium chloride (10 ml of 10% solution), ascorbic acid (10 ml of 5% solution) intravenously, inside rutin, riboflavin 0.02 g repeatedly. Treatment of acute renal failure.

The following pesticides are distinguished: insecticides (insecticides), weed killers (herbicides), drugs used against aphids (aficides), etc. Pesticides that can cause the death of insects, microorganisms, plants are not harmless to humans. They show their toxic effect regardless of the route of penetration into the body (through the mouth, skin or respiratory organs).

Phosphorus-organic compounds (FOS) - chlorophos, thiophos, karbofos, dichlorvos, etc. are used as insecticides.

Symptoms of poisoning.

Stage I: psychomotor agitation, miosis (pupil contraction to the size of a dot), chest tightness, shortness of breath, moist rales in the lungs, sweating, increased blood pressure.

Stage II: muscle twitching, convulsions, respiratory failure, involuntary stools, frequent urination predominate. Coma.

Stage III: respiratory failure increases to a complete stop of breathing, paralysis of the muscles of the limbs, a drop in blood pressure. Violation of the heart rhythm and conduction of the heart.

First aid. The victim must be immediately withdrawn or removed from the poisoned atmosphere. Remove contaminated clothing. Wash skin with plenty of warm water and soap. Rinse eyes with 2% warm solution of baking soda. In case of poisoning through the mouth, the victim is given a few glasses of water to drink, preferably with baking soda (1 teaspoon per glass of water), then vomiting is caused by irritation of the root of the tongue.

This manipulation is repeated 2-3 times, after which they give another half a glass of 2% soda solution with the addition of 1 tablespoon of activated charcoal. Vomiting can be induced by injection of a 1% solution of apomorphine.

Specific therapy is also carried out immediately, it consists in intensive atropinization. At stage 1, atropine poisoning (2-3 ml of 0.1%) is injected under the skin during the day until the mucous membranes are dry. In stage II, injection of atropine into a vein (3 ml in 15-20 ml of glucose solution) is repeated until bronchorrhea and dryness of the mucous membranes are relieved. In a coma, intubation, suction of mucus from the upper respiratory tract, atropinization for 2-3 days. In stage III, life support is possible only with the help of artificial respiration, atropine into a vein drip (30-50 ml). cholinesterase reactivators. With the collapse of norepinephrine and other measures. In addition, early administration of antibiotics and oxygen therapy are indicated in the first two stages.

With bronchospastic phenomena - the use of aerosols of penicillin with atropine. metacin and novocaine.

Organochlorine compounds (OCs) - hexachlorane, hexabenzene, DDT, etc. are also used as insecticides. All CHOS dissolve well in fats and lipids, therefore they accumulate in nerve cells, block respiratory enzymes in cells. Lethal dose of DDT: 10-15 g.

Symptoms. If the poison gets on the skin, dermatitis occurs. With inhalation intake - irritation of the mucous membrane of the nasopharynx, trachea, bronchi. There are nosebleeds, sore throat, cough, wheezing in the lungs, redness and pain in the eyes.

Upon ingestion - dyspeptic disorders, abdominal pain, after a few hours, cramps in the calf muscles, unsteadiness of gait, muscle weakness, weakening of reflexes. At high doses of poison, the development of a coma is possible.

There may be damage to the liver and kidneys.

Death occurs with symptoms of acute cardiovascular insufficiency.

First aid is the same for FOS poisoning (see above). After gastric lavage, it is recommended to inside the GUM mixture: 25 g of tannin, 50 g of activated carbon, 25 g of magnesium oxide (burnt magnesia), stir to a paste consistency. After 10-15 minutes, take a saline laxative.

Treatment. Calcium gluconate (10% solution), calcium chloride (10% solution) 10 ml intravenously. Nicotinic acid (3 ml of 1% solution) under the skin again. Vitamin therapy. With convulsions - barbamil (5 ml of a 10% solution) intramuscularly. Forced diuresis (alkalinization and water load). Treatment of acute cardiovascular and acute renal failure. Therapy of hypochloremia: in a vein 10-30 ml of 10% sodium chloride solution.

Arsenic and its compounds. Calcium arsenate, sodium arsenite, Parisian greens, and other arsenic-containing compounds are used as pesticides for seed dressing and pest control, they are physiologically active and poisonous. The lethal dose when taken orally is 0.06-0.2 g.

Symptoms. After the poison enters the stomach, a gastrointestinal form of poisoning usually develops. After 2-8 hours, vomiting, a metallic taste in the mouth, and severe abdominal pain appear. Greenish vomit, watery frequent stools resembling rice water. There is a sharp dehydration of the body, accompanied by convulsions. Blood in the urine, jaundice, anemia, acute renal failure. collapse, coma. Respiratory paralysis. Death can occur in a few hours.

First aid. If it enters the stomach, immediate vigorous washing with water with a suspension of laxatives - magnesium oxide or sulfate (20 g per 1 liter of water), emetic: support vomiting with warm milk or a mixture of milk with beaten egg whites. After washing inside - freshly prepared "arsenic antidote" (every 10 minutes, 1 teaspoon until vomiting stops) or 2-3 tablespoons of the antidote mixture "GUM: dilute in 400 ml of water to a paste consistency 25 g of tannin, 50 g of activated charcoal, 25 g of magnesium oxide - burnt magnesia.

In possibly early terms, intramuscular injection of unitiol or dicaptol, replacement blood transfusion. With sharp pains in the intestines - platifillin, atropine subcutaneously, pararenal blockade with novocaine. Cardiovascular drugs according to indications. collapse treatment. Hemodialysis on the first day after poisoning, peritoneal dialysis, forced diuresis. symptomatic treatment.

In the national economy and in everyday life, various concentrated and weak acids are used: nitric, sulfuric, hydrochloric, acetic, oxalic, hydrofluoric and a number of their mixtures ("aqua regia").

General symptoms. Inhalation of strong acid vapors causes irritation and burns of the eyes, mucous membranes of the nasopharynx, larynx, nosebleeds, sore throat, hoarseness of voice due to spasm of the glottis. Edema of the larynx and lungs is especially dangerous.

When acids come into contact with the skin, chemical burns occur, the depth and severity of which are determined by the concentration of the acid and the area of ​​the burn.

When acid enters, the digestive tract is affected: the sharpest pains in the oral cavity, along the esophagus and stomach. Repeated vomiting with an admixture of blood, esophageal-gastric bleeding. Significant salivation (profuse salivation), leading to mechanical asphyxia (suffocation) due to the painful act of coughing and swelling of the larynx. By the end of the first day, in severe cases, especially in case of poisoning with vinegar essence, yellowness of the skin appears. Urine becomes pink to dark brown in color. The liver is enlarged and painful on palpation. The phenomenon of reactive peritonitis. For 2-3 days, pain in the abdomen increases, perforation of the stomach is possible.

Frequent complications are purulent tracheobronchitis and pneumonia, burn asthenia, cachexia, cicatricial narrowing of the esophagus and stomach. Death can occur in the first hours with the effects of burn shock.

First aid and treatment. If the poisoning occurred from the inhalation of vapors, the victim must be removed from the polluted atmosphere, rinse the throat with water, soda solution (2%) or furacilin solution (1:5000). Inside - warm milk with soda or alkaline mineral (Borjomi) water, mustard plasters on the larynx. Rinse eyes and drip 1-2 drops of 2% novocaine solution or 0.5% dicaine solution.

If poisoning occurred when poison was ingested, then immediate gastric lavage with copious amounts of water through a tube or tubeless method is necessary. Inside - milk, egg whites, starch, mucous decoctions, magnesium oxide (burnt magnesia) - 1 tablespoon per glass of water, swallow pieces of ice, drink vegetable oil (100 g).

The main principles of symptomatic treatment after hospitalization are the fight against pain shock. With the appearance of dark urine - the introduction of sodium bicarbonate into the vein, cardiovascular agents, novocaine blockade. In cases of significant blood loss - repeated blood transfusions. Early use of massive doses of antibiotics, hydrocortisone or ACTH. Vitamin therapy. Hemostatic agents - vikasol intramuscularly, calcium chloride in a vein.

With laryngeal edema, inhalation of penicillin aerosols with ephedrine. In case of failure of this event - a tracheotomy.

Fasting for 2-3 days, then diet N 1a up to 1.5 months.

Nitric acid. Symptoms: pain and burns of the lips, mouth, throat, esophagus, stomach. Yellow coloration of the oral mucosa. Vomiting of yellowish bloody masses. Difficulty swallowing. Soreness and bloating. Urine contains protein and blood. In severe cases, collapse and loss of consciousness.

First aid: gastric lavage, burnt magnesia or lime water after 5 minutes, 1 tablespoon. Drink plenty of water, ice water, milk (glasses), raw eggs, raw egg white, fats and oils, mucous decoctions.

Boric acid. Symptoms: vomiting and diarrhea. Headache. Eruptions on the skin beginning on the face. Decline of cardiac activity, collapse.

First aid: gastric lavage, alkaline drink. With a decline in cardiac activity, stimulating.

Sulfuric acid. Symptoms: burns of the lips are blackish in color, mucous membranes are white and brown. Vomit brown, chocolate color. First aid - see Nitric acid.

Hydrochloric acid. Symptoms: burns of the oral mucosa of a blackish color. First aid - see Nitric acid.

Acetic acid, acetic essence.

Symptoms: bloody vomiting, grayish-white color of the oral mucosa, the smell of vinegar from the mouth.

First aid - see Nitric acid.

Phenols (carbolic acid, lysol, guaiacol). Lethal dose of carbolic acid: 10 g.

Symptoms: dyspeptic symptoms, pain behind the sternum and in the abdomen, vomiting with blood, loose stools. For mild poisoning, dizziness, stupor, headache, severe weakness, cyanosis, and increasing shortness of breath are characteristic. In severe poisoning, a coma quickly develops, which is characterized by constriction of the pupils, respiratory failure by the type of mechanical asphyxia (aspiration of vomit, retraction of the tongue. The phenomena of narcotic damage to the central nervous system predominate. After 2-3 days, acute renal failure may develop, especially with extensive burns of the skin with lysol or a solution of carbolic acid.Dark urine is typical as a result of oxidation of phenol products released with it in air.Death occurs from respiratory paralysis and a drop in cardiovascular activity.

First aid. Restoration of impaired breathing - oral toilet, etc. Careful gastric lavage through a tube with warm water with the addition of 2 tablespoons of activated charcoal or burnt magnesia. Salt laxative. Fats, including castor oil, are contraindicated! If phenol gets on the skin, remove clothing that comes into contact with the poison, wash the skin with olive (vegetable) oil.

Treatment. Unitiol (10 ml of 5% solution) intramuscularly. Sodium thiosulfate (100 ml of a 30% solution) drip with glucose into a vein. Bilateral pararenal blockade with novocaine. Vitamin therapy: ascorbic acid (10 ml of 5% solution) intramuscularly. Forced diuresis (urine alkalinization and water load). Cardiovascular agents. Antibiotics.

Alkalis are bases that are highly soluble in water, aqueous solutions of which are widely used in industry, medicine, and everyday life. Caustic soda (caustic soda), caustic potash, ammonia (ammonia), slaked and quicklime, potash, liquid glass (sodium silicate).

Symptoms: burns of the mucous membrane of the lips, mouth, esophagus, stomach. Bloody vomiting and bloody diarrhea. Sharp pains in the mouth, pharynx, esophagus and abdomen. Salivation, swallowing disorders. Strong thirst. Kidney damage, alkaline urine. Convulsions, collapse. Sometimes swelling of the larynx. Death can occur from pain shock, at a later date - from complications (gastric perforation, peritonitis, pneumonia, etc.).

First aid: gastric lavage immediately after poisoning. Abundant drinking of weak solutions of acids (0.5-1% solution of acetic or citric acid), orange or lemon juice, milk, mucous liquids, oil emulsions. Swallow pieces of ice, ice on the stomach. With sharp pains subcutaneously morphine and other painkillers. Urgent hospitalization: symptomatic treatment.

Barium. It is used in vacuum technology, in alloys (printing, bearing). Barium salts - in the production of paints, glasses, enamels, medicine.

All soluble barium salts are toxic. The insoluble barium sulfate used in radiology is practically non-toxic. The lethal dose of barium chloride when taken orally is 0.8-0.9 g, barium carbonate - 2-4 g.

Symptoms. When toxic barium salts are ingested, there is a burning sensation in the mouth, pain in the stomach, salivation, nausea, vomiting, loose stools, dizziness. The skin is pale, covered with cold sweat, after 2-3 hours there is a pronounced muscle weakness (flaccid paralysis of the muscles of the upper limbs and neck). The pulse is slow, weak, there are cardiac arrhythmias, a drop in blood pressure. Shortness of breath, cyanosis of the mucous membranes.

Treatment: gastric lavage, laxatives, siphon enemas. Symptomatic therapy.

Copper and its compounds (copper oxide, copper sulfate, Bordeaux liquid, copper carbonate, etc.) A lethal dose of copper sulfate is 10 ml.

Symptoms. Copper taste in the mouth, blue-green vomiting, bloody diarrhoea, great thirst, sharp pains in the abdomen. Headache, weakness, dizziness, shortness of breath, convulsions, collapse.

Reduced urine, it is black, a lot of protein. Acute renal failure (anuria, uremia). The phenomena of hypochromic anemia are frequent. Complications: nephritis, enterocolitis. When copper compounds enter the upper respiratory tract, the phenomena of "acute foundry fever" develop: chills, dry cough, temperature up to 40 ° C, headache, weakness, shortness of breath, allergic phenomena - a small red rash on the skin and itching.

First aid. If it enters the stomach, vomiting is induced, then repeated gastric lavages are carried out, preferably with a 0.1% solution of yellow blood salt, the same solution is given orally 1-3 tablespoons every 15 minutes. Assign 1 tablespoon of activated charcoal to a glass of warm water, saline laxative, drink plenty of water, protein water, egg whites. Do not give fats (butter, milk, castor oil). For pain in the abdomen - heat (heating pad) and injection of a 0.1% solution of atropine sulfate subcutaneously. Inside - complexones such as unitiol, disodium salt of EDTA, BAL. With "copper fever" - heavy drinking, diaphoretics and diuretics, as well as antipyretics and bromides. Antibiotics, vitamin therapy, treatment of kidney failure and other symptomatic treatment.

Mercury and its compounds (mercuric chloride, calomel, cinnabar, etc.). Metallic mercury is slightly toxic if ingested. The lethal dose of sublimate when ingested is 0.5 g, which is the most toxic of the inorganic mercury salts, of the organic ones - novurite, promeran, merkusal.

Symptoms. When the poison enters the gastrointestinal tract, it has a cauterizing effect on tissues: sharp pains in the abdomen along the esophagus, vomiting, after a few hours, loose stools with blood. Copper-red coloration of the mucous membrane of the mouth and pharynx. Swelling of the lymph nodes, metallic taste in the mouth, salivation, bleeding of the gums, later a dark rim of mercuric sulphide on the gums and lips. From 2-3 days, symptoms of damage to the central nervous system appear - excitability, convulsions of the calf muscles, epileptiform seizures, clouding of consciousness. Characterized by ulcerative colitis. During this period, there are shock states and collapse.

First aid: the simplest antidotes - magnesium oxide (burnt magnesia), raw eggs in milk, protein water, warm milk in large quantities, mucous decoctions, laxatives. Gastric lavage is carried out with the addition of activated charcoal and followed by the introduction of 80-100 ml of Strzhizhevsky's antidote (a solution of magnesium sulfate, sodium bicarbonate and caustic soda in a supersaturated solution of hydrogen sulfide). After 5-10 minutes, the stomach is washed again with 3-5 liters of warm water mixed with 50 g of activated carbon. As an antidote, a 5% solution of unithiol in warm water is used, which is injected in an amount of 15 ml through a probe. After 10-15 minutes, the stomach is washed again with a solution of unithiol (20-40 ml of a 5% solution of unithiol per 1 liter of water) and the initial dose is given again. At the same time put high siphon enemas with warm water and 50 g of activated charcoal.

In the absence of unithiol, the poison is neutralized with dicaptol, 1 ml intramuscularly (on the 1st day - 4-6 times, from the 2nd day - 3 times a day, from the 5th - 1 time), 30% sodium thiosulfate solution (50 ml intravenous drip). Showing anti-shock therapy, infusion resuscitation, the fight against acute renal failure.

Lead and its compounds. Used for the manufacture of plates for batteries, shells of electrical cables, protection against gamma radiation, as a component of printing and anti-friction alloys, semiconductor materials, paints. Lethal dose of white lead: 50 g.

Symptoms: Acute intoxication is characterized by gray staining of the gum mucosa, a metallic taste in the mouth. Dyspeptic disorders are noted. Characterized by sharp cramping pain in the abdomen, constipation. Increase in blood pressure. There are persistent headaches, insomnia, in especially severe cases - epileptiform convulsions, acute cardiovascular insufficiency. More often there is a chronic course of the disease. There are phenomena of toxic hepatitis, accompanied by a pronounced violation of the liver.

First aid: gastric lavage with 0.5-1% solution of Glauber's or Epsom salts. Inside - Epsom salt as a laxative. Abundant drinking of protein water, milk, mucous decoctions. For lead colic, warm baths, hot water bottle, hot drinks, hot magnesium sulfate (epsom salt) enemas. Subcutaneously - 1 ml of 0.1% atropine solution, intravenously - glucose solution with ascorbic acid, 10% sodium bromide solution, 10 ml each with 0.5% novocaine solution. Specific means of treatment - EDTA, tetacin-calcium, complexones. Unithiol is ineffective.

Zinc and its compounds (oxide, chloride, sulfate, etc.). They are widely used in electroforming, printing, medicine, etc. Penetrate into the body through the respiratory system, digestive tract, rarely through the skin.

Symptoms. Exposure to the respiratory organs of vapors or particles of zinc causes a "casting" fever: a sweetish taste in the mouth, thirst, fatigue, weakness, nausea and vomiting, chest pains, redness of the conjunctiva and pharynx, dry cough. After 2-3 hours, severe chills, the temperature rises to 38-40 ° C, after a few hours it drops sharply, accompanied by heavy sweat. In severe cases, pneumonia and pulmonary edema may develop.

When zinc compounds enter through the mouth - a burn of the mucous membrane of the mouth and digestive tract: sharp pain in the abdomen, persistent vomiting with blood, cramps of the calf muscles, signs of kidney failure. Collapse.

First aid. With "foundry" fever - alkaline inhalations, drinking plenty of water, rest, warmth and oxygen. Intravenously 20 ml of 40% glucose solution with ascorbic acid (5 ml of 5% solution), EDTA preparation.

In case of poisoning through the mouth - gastric lavage, inside - 1% sodium bicarbonate solution (soda), activated charcoal, saline laxative, milk, mucous decoctions. Intravenously - glucose with ascorbic acid, intramuscularly - unitiol.

These include a large group of chemical compounds - derivatives of hydrocyanic (hydrocyanic) acid. There are inorganic cyanides (hydrocyanic acid, sodium and potassium cyanides, cyanogen chloride, cyanogen bromide, etc.) and organic cyanides (esters of cyanoformic and cyanoacetic acids, nitriles, etc.). They are widely used in industry, including pharmaceuticals, agriculture, photography, etc. Cyanides enter the body through the respiratory and digestive organs, rarely through the skin.

Symptoms: labored, slow breathing. The smell of bitter almonds from the mouth.

Scraping in the throat, tightness in the chest. Dizziness, convulsions, loss of consciousness.

The mucous membranes and skin are bright red.

With severe poisoning, sudden death.

Under the action of smaller doses, a sharp headache, nausea, vomiting, and abdominal pain occur (especially in case of poisoning with potassium cyanide, which has a cauterizing effect on the mucous membranes). There is an increase in general weakness, severe shortness of breath, palpitations, psychomotor agitation, convulsions, loss of consciousness. Death can occur in a few hours with symptoms of acute cardiovascular insufficiency and respiratory arrest.

First aid. When exposed to poison on the respiratory system, it is necessary to immediately remove the victim from the gassed area. Quickly remove contaminated clothing and create conditions of rest and warmth; the victim is allowed to inhale amyl nitrite from an ampoule on a cotton swab every 2-3 minutes. Intravenously (urgently!) Inject 10 ml of 2% sodium nitrite solution, then 50 ml of 1% methylene blue solution in 25% glucose solution and 30-50 ml of 30% sodium thiosulfate solution. An hour later, the infusion is repeated.

If the poison is ingested - abundant gastric lavage with 0.1% potassium permanganate solution or 2% hydrogen peroxide solution, or 2% baking soda solution, or 5% sodium thiosulfate solution. Salt laxative, plentiful warm sweet drink, emetics. The antidote therapy described above, symptomatic treatment,

Under production conditions, gaseous chemicals are widely used - nitrogen oxides, ammonia, bromine vapor, hydrogen fluoride, chlorine, sulfur dioxide, phosgene, etc. These substances at a certain concentration cause irritation of the respiratory tract, therefore they are classified as "irritating", and since they can cause oxygen deficiency, they are also called "suffocating".

General symptoms. The main clinical manifestations of acute poisoning are toxic laryngotracheitis, pneumonia, and pulmonary edema. Regardless of what kind of toxic substance we are talking about, the complaints of the victims are basically the same: shortness of breath, reaching suffocation, painful excruciating cough, initially dry, and then with the release of mucopurulent or foamy sputum, often stained with blood. General weakness, headache. Increasing pulmonary edema is characterized by severe cyanosis of the mucous membranes and skin (blue lips, ears and fingers), difficult, sharply rapid breathing, an abundance of dry and moist rales in the lungs.

First aid. The victim must be provided with complete rest, warmth, oxygen therapy. Intravenously - 20 ml of 40% glucose solution, 10 ml of 10% calcium chloride solution, 1 ml of cordiamine. If there is a violation of the airway, it is necessary to suck the mucus from the pharynx, remove the tongue with a tongue holder and insert the airway. Periodically change the position of the patient in bed, subcutaneously - 1 ml of a 0.1% solution of atropine.

In the absence of respiration, artificial respiration is carried out by the "mouth-to-mouth" method, followed by transfer to hardware respiration. Urgent tracheotomy is performed with suffocation resulting from a burn of the upper respiratory tract and laryngeal edema. With pulmonary edema - inhalation of aerosols with diphenhydramine, ephedrine, novocaine. Intravenously - prednisolone, urea, lasix, cardiovascular drugs according to indications.

Nitrogen. Acute poisoning occurs when working with concentrated nitric acid, in the production of fertilizers, during blasting, in all cases where high temperatures are generated (welding, explosions, lightning), etc.

Symptoms: shortness of breath, vomiting, dizziness, intoxication, loss of consciousness and deep coma. Death can occur in the first hours after poisoning.

First aid. It should be carried out in a state of complete rest of the patient according to the principles described above (rest, warmth, continuous inhalation of oxygen). To reduce a painful cough - codeine or dionine. Intravenously - 1 ml of a 10% solution of calcium gluconate. Banks on the back.

Ammonia. Acute poisoning is possible when cleaning cesspools, sewer pipes, in the production of soda, fertilizers, organic dyes, sugar, etc.

Symptoms. In mild cases of poisoning, irritation of the nasopharynx and eyes, sneezing, dryness and irritation in the throat, hoarseness, cough and chest pain are noted. In more severe cases, a burning sore throat, a feeling of suffocation, swelling of the larynx, lungs, toxic bronchitis, pneumonia is possible.

When concentrated solutions enter the gastrointestinal tract, deep necrosis is formed, which in the acute stage leads to pain shock. Massive esophageal-gastric bleeding, asphyxia as a result of burns and swelling of the larynx, severe burn disease, reactive peritonitis. In later periods, a narrowing of the esophagus, antral and pyloric sections of the stomach develops. Death can occur in the first hours and days from pain shock, and in later periods from burn disease and associated complications (massive bleeding, aspiration pneumonia, perforation of the esophagus and stomach, mediastinitis).

First aid. Remove the victim from the toxic environment and wash the affected skin and mucous membranes of the eyes with plenty of water. Drink warm milk with Borjomi or soda. Silence mode. With spasm of the glottis and the phenomenon of laryngeal edema - mustard plasters and a warming compress on the neck, hot foot baths. Inhalation of parovcitric or acetic acids, oil inhalations and inhalations with antibiotics. Instill 30% sodium sulfacyl solution, 12% novocaine solution or 0.5% dicaine solution into the eyes every 2 hours. In the nose - vasoconstrictors (3% solution of ephedrine). Inside - codeine (0.015 g), dionine (0.01 g). Intravenously or subcutaneously - morphine, atropine, with suffocation - tracheotomy.

Bromine. Acute bromine vapor poisoning is possible in the chemical, photo, film, and leather industries, in the production of a number of dyes, etc.

Symptoms: when bromine vapor is inhaled, a runny nose, lacrimation, salivation, conjunctivitis occur. Brown coloration of the tongue, oral mucosa and conjunctiva is characteristic. Sometimes there are significant nosebleeds and allergic phenomena (rash, urticaria, etc.). Acute bronchitis and pneumonia, possible pulmonary edema.
First aid. Remove the victim from the poisoned area. Remove clothes, wash the affected skin with alcohol. Inhalation of oxygen. Alkaline inhalations and with 2% sodium thiosulfate solution. Drink warm milk with Borjomi or soda. Inside with food 10-20 g per day of sodium chloride (table salt). Intravenous 10 ml of 10% calcium chloride. Inside - diphenhydramine, pipolfen - 0.025 g each. Heart remedies.
Sulphur dioxide. Acute poisoning is possible in the production of sulfuric acid, in the metallurgical industry, food, oil refining, etc.
Symptoms: runny nose, cough, hoarseness, sore throat. If sulfur dioxide is inhaled at a higher concentration - suffocation, speech disorder, difficulty swallowing, vomiting, acute pulmonary edema is possible.
First aid - see Nitrogen.
Hydrogen sulfide. Acute poisoning is possible in the production of carbon disulfide, in the leather industry, in mud baths, coke plants and oil refineries. Hydrogen sulfide is found in sewage, in cesspool gases. Lethal concentration in air: 1.2 mg/l.
Symptoms: runny nose, cough, pain in the eyes, headache, nausea, vomiting, agitation. In severe cases - coma, convulsions, toxic pulmonary edema.
First aid. Remove the victim from the poisoned atmosphere. Rinse eyes with warm water, drip sterile vaseline oil (2-3 drops), with a sharp pain - 0.5% dicaine solution. Rinse the nasopharynx with a 2% solution of baking soda. When coughing inside - codeine (0.015 g). With respiratory and cardiac arrest, chest compressions and artificial respiration (see Chapter 1 Internal Diseases, Section 2, Sudden Death). Treatment of pulmonary edema (see above).
Carbon monoxide, lighting gas (carbon monoxide). Poisoning is possible in production, where carbon monoxide is used to synthesize a number of organic substances (acetone, methyl alcohol, phenol, etc.), in garages with poor ventilation, in unventilated newly painted rooms, as well as at home when lighting gas leaks and with untimely closed stove dampers in rooms with stove heating (houses, baths).
Symptoms: loss of consciousness, convulsions, dilated pupils, sharp cyanosis (blue) of the mucous membranes and skin of the face.
Death usually occurs at the scene as a result of respiratory arrest and a drop in cardiac activity. At a lower concentration of carbon monoxide, headache, pounding in the temples, dizziness, chest pain, dry cough, lacrimation, nausea, and vomiting appear. Visual and auditory hallucinations are possible. Reddening of the skin, carmine-red coloration of the mucous membranes, tachycardia, and increased blood pressure are noted. In the future, drowsiness develops, motor paralysis is possible with preserved consciousness, then loss of consciousness and a coma with severe clonic-tonic convulsions, involuntary discharge of urine and feces. The pupils are sharply dilated with a weakened reaction to light. There is an increase in respiratory failure, which becomes continuous, sometimes of the Cheyne-Stokes type. When leaving a coma, the appearance of a sharp motor excitation is characteristic. Possible re-development of coma. Severe complications are often noted: cerebrovascular accident, subarachnoid hemorrhage, polyneuritis, cerebral edema, visual impairment. Perhaps the development of myocardial infarction, skin-trophic disorders (blisters, local edema with swelling and subsequent necrosis), myoglobinuric nephrosis are often observed. With prolonged coma, severe pneumonia is constantly noted.

First aid. First of all, immediately remove the poisoned person from this room; in the warm season, it is better to take it outside. If breathing is weak or has stopped, begin artificial respiration (see Chapter 1, Internal Medicine, Section 2, Sudden Death). Contribute to the elimination of the consequences of poisoning by rubbing the body, heating pads to the feet, short-term inhalation of ammonia. Patients with severe poisoning are subject to hospitalization, as complications from the lungs and nervous system are possible at a later date.

It is necessary to know for sure that since the lack of oxygen due to the intake of carbon monoxide into the body is leading in the development of poisoning, the main attention should be paid to oxygen therapy, best of all under high pressure. Therefore, if the poisoning occurred near the oxygen barotherapy center. every effort should be made to ensure that the patient in the first hours after poisoning is delivered to such a medical institution. To stop seizures and psychomotor agitation, antipsychotics can be used, such as chlorpromazine (1-3 ml of a 2.5% solution intramuscularly, previously diluted in 5 ml of a 0.5% sterile solution of novocaine) or chloral hydrate in an enema. Bemegrid, corazole, analeptic mixture, camphor, caffeine are contraindicated in these phenomena. In case of respiratory failure - 10 ml of a 2.4% solution of eufillin into a vein again. With a sharp cyanosis (blue) in the 1st hour after poisoning, intravenous administration of a 5% solution of ascorbic acid (20-30 ml) with glucose is indicated. Intravenous infusion of 5% glucose solution (500 ml) with 2% novocaine solution (50 ml), 40% glucose solution into a vein drip (200 ml) with 10 units of insulin under the skin.

Fluorine. Sodium fluoride (included in enamels, used to preserve wood). Hydrogen fluoride, hydrofluoric acid, fluorine-containing salts. Lethal dose: 10 g of sodium fluoride.

Symptoms: abdominal pain occurs, lacrimation develops, salivation (abundant salivation), severe weakness, vomiting, loose stools. Breathing quickens, muscle twitching and convulsions appear, constriction of the pupils. The pulse is speeded up, blood pressure is reduced, atrial fibrillation is possible. Death occurs with symptoms of general cardiovascular insufficiency. Sometimes there is damage to the kidneys.

First aid. Under the action of fluorine and hydrogen fluoride, see Bromine. For hydrofluoric acid poisoning, see Acids. In case of poisoning with fluorine-containing salts - gastric lavage through a probe, preferably with lime water or 1% calcium chloride solution, saline laxative. Atropine (1 ml of 0.1% solution) under the skin repeatedly, cardiovascular agents. Dimedrol (2 ml of 1% solution) subcutaneously. Calcium chloride or calcium gluconate (10 ml of a 10% solution) into a vein again. The fight against dehydration of the body - intravenous drip of saline and glucose solution up to 3000 ml per day. collapse treatment. Vitamin therapy: vitamins B1 (3 ml of a 5% solution) into the vein again, Wb (2 ml of a 5% solution), B 12 (up to 500 mcg). Treatment of renal failure.

Chlorine. Inhalation of concentrated vapors can lead to rapid death as a result of chemical burns and reflex inhibition of the respiratory center. In less severe cases, pain in the eyes, lacrimation, excruciating paroxysmal cough, chest pain, headache, and dyspeptic disorders appear. A lot of dry and wet rales are heard, acute pulmonary emphysema, severe shortness of breath and cyanosis of the mucous membranes develop. Possible severe bronchopneumonia with a rise in temperature and the development of toxic pulmonary edema. With minor poisoning, the phenomena of acute laryngitis, tracheitis, and tracheobronchitis predominate. Feeling of tightness in the chest, dry cough, dry rales in the lungs.

First aid - see Nitrogen.

Diseases resulting from the use of poor-quality food - see in detail Botulism, Food poisoning, ch. infectious diseases.

Symptoms: vomiting, diarrhea, abdominal pain. Dizziness, headache, general weakness. Pupil dilation. In severe cases - swallowing disorder, ptosis, collapse.

First aid: gastric lavage with a solution of potassium permanganate (0.04%), tannin (0.5%) or water mixed with activated carbon. Inside laxative, cleansing enemas, then disinfectants: salol, urotropin. Abundant drink: slimy drinks (starch, flour).

It is forbidden to take any food for 1-2 days. In the acute period (after gastric lavage), hot tea and coffee are indicated. The patient must be warmed by overlaying heating pads (to the legs, arms). Significantly contributes to recovery taking sulfonamides (sulgin, fthalazol) 0.5 g 4-6 times a day or antibiotics (for example, chloramphenicol 0.5 g 4-6 times a day). An ambulance should be called to the victim or taken to a medical facility.

Treatment: saline solution under the skin. With a decline in cardiac activity - injections of caffeine, camphor, with sharp pains - painkillers. For botulism, anti-botulinum serum.

The toadstool is pale. Symptoms: after 68 hours and later there are indomitable vomiting, colicky abdominal pain, diarrhea with blood. On the 2-3rd day, there are signs of liver and kidney failure, jaundice, enlargement and soreness of the liver, anuria. A coma develops. Mortality reaches 50%.

Fly agaric. Symptoms: not later than 2 hours later, vomiting occurs, increased sweating, salivation, abdominal pain, sharp constriction of the pupils. In more severe cases of poisoning, severe shortness of breath, bronchorrhea, slowing of the pulse and a drop in blood pressure appear, convulsions and delirium, hallucinations and coma are possible.

Lines. When well cooked, they are non-toxic. In case of poisoning, vomiting and diarrhea occur. After 6-12 hours, jaundice appears, dark urine due to hemoglobinuria, liver enlargement and tenderness.

Poisonous russula, volushki, etc. The phenomena of acute gastroenteritis as a result of lesions of the gastrointestinal tract prevail.

First aid for mushroom poisoning often plays a decisive role in saving the patient. It is necessary to immediately begin gastric lavage with water, preferably with a probe with a weak solution (pink) of potassium permanganate or by artificial vomiting. It is useful to add activated carbon (carbolene) to the solution. Then they give a laxative (castor oil and saline), put cleansing enemas several times. After this, the patient is warmly covered and covered with heating pads, they are allowed to drink hot sweet tea, coffee. The patient should be taken to a medical institution where he will be provided with the medical assistance he needs.

specific treatment. In case of poisoning with red fly agaric, the antidote is atropine, injections of which 0.1% solution of 1 ml under the skin should be repeated 3-4 times at intervals of 30-40 minutes. To relieve bronchospasm - isadrin (novodrin, euspirin), eufillin in usual doses. Of the analeptics, caffeine is useful. Acids and acidic foods are contraindicated inside, which contribute to the absorption of the alkaloid muscarine contained in the red fly agaric.

Treatment for poisoning with panther fly agaric (similar to champignon and edible umbrella) is similar to treatment for poisoning with plants containing atropine and scopolamine (see Black henbane).

In case of poisoning with a pale toadstool, as well as false mushrooms, gall fungus, satanic, lactic mushrooms (milks, bitters, pigs, volushki), treatment is primarily aimed at eliminating dehydration and collapse. Various plasma substitutes are used: Ringer's solution, isotonic sodium chloride solution, saline infusion, polyglucin, etc. in a volume of at least 3-5 liters per day in a vein drip. Use norepinephrine or mezaton to increase blood pressure, to prevent or reduce liver damage - hydrocortisone or similar drugs, broad-spectrum antibiotics. With developed heart failure - strophanthin, corglicon. The prognosis for poisoning with pale toadstool is very unfavorable. It should be borne in mind that the poisonous substances of the pale toadstool are not afraid of high temperature and drying, do not pass into a decoction and cause degeneration of the kidneys, liver and heart.

Black henbane, dope, belladonna belong to the same Solanaceae family. Atropine and scopolamine, which block the parasympathetic nerves, are considered to be poisonous in these plants. The whole plant is considered poisonous. Poisoning with henbane is possible either by eating young sweet sprouts (April-May), or by eating seeds. Demoiselle poisoning is most often associated with the consumption of berries that look like wild cherries. Datura poisoning also occurs when eating seeds.

Symptoms. With mild poisoning, dry mouth, speech and swallowing disorders, dilated pupils and impaired near vision, photophobia, dryness and redness of the skin, agitation, sometimes delirium and hallucinations, tachycardia appear. In severe poisoning, a complete loss of orientation, a sharp motor and mental excitement, sometimes convulsions with subsequent loss of consciousness and the development of a coma. A sharp increase in body temperature, cyanosis (blue) of the mucous membranes, shortness of breath with the appearance of periodic breathing of the Cheyne-Stokes type, the pulse is incorrect, weak, a drop in blood pressure. Death occurs with symptoms of paralysis of the respiratory center and vascular insufficiency. A specific complication of atropine poisoning is trophic disorders - significant swelling of the subcutaneous tissue of the face, in the area of ​​​​the forearms and legs.

First aid.
Gastric lavage, followed by the introduction of 200 ml of vaseline oil or 200 ml of a 0.2-0.5% tannin solution through a probe. For the relief of acute psychosis - chlorpromazine intramuscularly. At high body temperature - cold on the head, wrapping in wet sheets. Of the more specific means - the introduction of 1-2 ml of a 0.05% solution of prozerin under the skin.

Stone garden plants. These include the seeds of apricot, almond, peach, cherry, plum, containing amygdalin glycoside, which is capable of releasing hydrocyanic acid (hydrogen cyanide) in the intestine. Poisoning is possible either by eating a large amount of seeds contained in the seeds, or by drinking alcohol prepared on them. Children are more sensitive to hydrocyanic acid than adults. Sugar weakens the effect of the poison.

Symptoms, first aid, treatment - see cyanide poisoning.

Milestones are poisonous (hemlock), hemlock (omega spotted) are very similar to each other, they grow in damp places near water everywhere, even experts often confuse them.

Milestone poisonous contains tar-like substance cicutoxin in the rhizomes. Poisoning is accidental, more common in children.

Symptoms: after a few minutes, vomiting, salivation, abdominal cramps begin. Then there is dizziness, unsteady gait, foam at the mouth. The pupils are dilated, convulsions are replaced by paralysis and death.

Treatment purely symptomatic - gastric lavage with the introduction of sodium sulfate (20-30 g) through a probe in a half glass of water and 200 ml of liquid paraffin, for the relief of seizures - 1 g of chloral hydrate in an enema with mucus or 5-10 ml of a 5% solution of barbamyl intramuscularly. Due to convulsions, the use of analeptics is undesirable; in case of respiratory failure, artificial respiration is used. To stimulate cardiac activity - strophanthin or similar drugs.

Hemlock. Poisoning occurs when mistakenly used instead of parsley or horseradish leaves, as well as when using its fruits instead of anise fruits.

Symptoms: salivation, nausea, vomiting, diarrhea. The pupils are dilated, the body temperature is lowered, the extremities are cold, immobilized, breathing is difficult.

Treatment. Gastric lavage, saline laxative, vaseline oil through a tube. The main attention is the fight against respiratory failure: inhalation of oxygen, apaleptics in normal doses. When breathing stops - artificial, for accelerated removal of poison - osmotic diuretics, furosemide.

Wrestler (Aconite). Poisoning is possible with self-medication, with accidental use instead of horseradish or celery, as well as with a suicide attempt.

Symptoms: burning sensation in the mouth, salivation, nausea, vomiting, diarrhea. Numbness and discomfort in the tongue, face, fingers, headache, weakness quickly join. Hearing and vision are impaired. Loss of consciousness and convulsions. Death from paralysis of the heart and breathing.

Treatment. Gastric lavage with 0.5% tannin, saline laxative, tannin. Compulsory bed rest, sogreianpe patient. To prevent heart weakness - strophanthin, atropine in normal doses, analeptics, strong tea or coffee. Anticonvulsant treatment.

Wolf's bast (daphne)- found everywhere. The cause of poisoning is its bright red berries or the bark of branches that are cut off for the sake of beautiful, reminiscent of lilac flowers. Symptoms, treatment. When the juice of the plant gets on the skin, irritation occurs: pain, redness, swelling, then blisters and ulcers. Treatment is carried out as for burns: lubrication with a solution of dikain (mucous membranes), dressings with liniment of syntomycin, chloramphenicol or streptocide, Vishnevsky ointment.

In case of poisoning with berries or juice - a burning sensation in the mouth and throat, difficulty swallowing, salivation, stomach pain, diarrhea, vomiting. Blood in the urine. Death can come from cardiac arrest.

Treatment- symptomatic; Gastric lavage followed by the introduction of vaseline oil. Laxatives are contraindicated. Therapy is aimed at eliminating irritation of the mucous membranes of the digestive tract (ice pieces inside, lubrication of the mucous membranes with dikain, anesthesin - inside), the fight against acute heart failure (strophanthin and other summary preparations).

Acacia yellow (broom, golden rain) and mouseweed (thermopsis) contain the alkaloid cytisine. Poisoning is possible when eating acacia fruits (bean pods) and an accidental overdose of infusions of the thermopsis herb, used against coughs.

Symptoms: nausea, vomiting, dizziness, weakness, cold sweat. The mucous membranes are pale, then cyanotic. In the midst of poisoning, diarrhea occurs. In severe poisoning - clouding of consciousness, agitation, hallucinations, convulsions. Death comes from respiratory arrest or heart failure.

First aid. Gastric lavage through a tube, saline laxative, tannin through a tube. The fight against convulsions - chloral hydrate in an enema, barbamil intramuscularly, with excitement - chlorpromazine intramuscularly, with heart weakness - strophanthin. At the beginning of poisoning, atropine is useful (1-3 ml of a 0.1% solution under the skin).

Ergot (uterine horns). Contains alkaloids - ergometrine, ergotoxin, as well as acetylcholine, histamine, etc. Lethal: a dose of about 5 g.

Symptoms. Dyspeptic disorders (vomiting, abdominal pain, diarrhea, thirst), dizziness, dilated pupils, disorientation. There may be a delirious syndrome, uterine bleeding. During pregnancy, an abortion is possible. In severe poisoning - convulsions, acute cardiovascular failure. After poisoning - long-term neurological disorders, endarteritis, trophic ulcers, impaired blood supply to the limbs.

Treatment. Gastric lavage, saline laxative. Sedative therapy: chlorpromazine (2 ml of 1.5% solution), diphenhydramine (2 ml of 1% solution) intramuscularly. Inhalation of amyl nitrite, 5% glucose solution, sodium chloride (up to 3000 ml of isotonic solution) subcutaneously, lasix - 40 ml intramuscularly. water load. Cardiovascular agents. Treatment of acute cardiovascular insufficiency.

Wormseed. Toxic dose: 15-20 g.

Symptoms. When large doses of drugs are ingested, dyspeptic disorders appear - nausea, vomiting, abdominal pain, diarrhea. Possible xanthopsia (yellow vision, yellow-red urine). In severe poisoning, convulsions, loss of consciousness, collapse develop, kidney damage is possible by the type of toxic necronephrosis.

Treatment. Gastric lavage, saline laxative. Forced diuresis (urine alkalinization). With convulsions - 3 ml of a 10% solution of barbamil in a vein or chloral hydrate in an enema. Calcium gluconate (10 ml of 10% solution) intramuscularly. Vitamin therapy: 5% solution of vitamin B1 - 2 ml. Treatment of cardiovascular insufficiency.

Hellebore is a herbaceous plant. Its rhizome contains the alkaloid veratrin. Lethal dose of it: about 0.02 g.

Symptoms. Often the only sign of poisoning is dyspeptic disorders (nausea, vomiting, loose stools) and a sharp slowing of the pulse with a drop in blood pressure.

First aid is similar to previous poisonings. Specific treatment - 0.1% solution of atropine up to 2 ml subcutaneously, cardiovascular agents.

Bites of snakes. As a rule, snakes do not attack people first and bite people when they are disturbed (touched, stepped on, etc.).

Symptoms and course. In the first minutes, there is a slight pain and a burning sensation, the skin turns red, swelling increases. The consequences depend on the type of snake, season, age and, especially, on the place of the bite. A bite to the head and neck is much more severe than to the limbs: the concentration of poison in the blood is higher, which affects the nervous system and can cause death from paralysis of the respiratory center. General symptoms of poisoning: muscle weakness, dizziness, nausea, vomiting, fever, numbness and aching pain in the affected area.

First aid should begin with a vigorous suction of the poison. Best of all, with the help of a medical jar or its substitute (thin glass, glass), into the cavity of which an ignited wick is inserted and quickly applied with the edges to the wound.

It is possible to suck out poison by mouth only in the absence of cracks in the lips and oral cavity, as well as carious teeth. In this case, it is necessary to constantly spit out the suctioned liquid, as well as rinse the oral cavity. Suction produce 15-20 minutes. Then the bite site is treated with iodine, alcohol and the limb is immobilized. The patient is given complete rest, given plenty of fluids, vodka or alcohol is contraindicated (alcohol intoxication is added). It is recommended to use a specific serum in the first 30 minutes: polyvalent (if the type of snake is not established), "antigyurza" (against the bite of all vipers) or "anticobra", "antief". Immediately after the bite, 10 ml of serum is enough, after 20-30 minutes 2-3 times more, and so on, but not more than 100-120 ml. Serum is injected under the skin, between the shoulder blades, in severe cases intravenously.

A tourniquet, incisions are harmful, since they do not have time to prevent the absorption of the neurotoxic part of the poison, and the manifestations of necrosis after these events intensify. In extreme cases, you can resort to pricking with a long needle 2-3 times at the site of the bite, if the fluid from the wound is poorly sucked out. Novocaine blockade at the site of the bite is needed only in the absence of serum. Novocaine and alcohol weaken the effect of the serum.

The limb must be immobilized with a splint or improvised means, provide the patient with rest, transport only lying down. Hot strong tea or coffee should be given in large quantities. Mandatory introduction of heparin (5000-10000 IU under the skin or in a vein), anti-allergic treatment - hydrocortisone acetate suspension of 150-200 mg per day intramuscularly or similar drugs (prednisolone, etc.) in equivalent doses, 30% sodium thiosulfate solution, 10% a solution of calcium chloride, 5-20 ml into a vein. In violation of cardiac activity - caffeine (camphor, cordiamine, etc.), strophanthin, norepinephrine, mezaton in the usual way.

Insect stings (bees, wasps, bumblebees, hornets), as well as the introduction of toxic doses of medical preparations of bee venom (venapiolin, toxapin, virapin). The toxic effect depends on the histamine contained in the poison and other potent enzymes.

Symptoms. At the bite site - pain, burning, swelling, local fever. With multiple bites - weakness, dizziness, headache, chills, nausea, vomiting, fever. With increased sensitivity to poison - urticaria, palpitations, pain in the lower back and joints, convulsions and loss of consciousness. An attack of bronchial asthma or anaphylactic shock is possible.

First aid. Remove the sting with tweezers, ice on the affected area, prednisolone ointment. Rest, warming of the extremities, hot plentiful drink, inside amidopyrine (0.25 g each), analgin (0.5 g each), cardiac drugs, antihistamines, antiallergic drugs (diphenhydramine 0.0250.05 g inside). Injections of 2 ml of 0.5% novocaine solution and 0.3 ml of 0.1% adrenaline solution at the bite site. Treatment of anaphylactic shock with such. Forced diuresis.

In severe cases, calcium chloride (10 ml of a 10% solution) intravenously, prednisolone 0.005 g orally or hydrocortisone intramuscularly.

Dangerous stings in the mouth, which happens when eating fruit, jam, when the insect enters the mouth with food. In such cases, death can occur very quickly not from general intoxication, but from laryngeal edema and suffocation - an urgent tracheotomy is necessary.

Poisoning is a painful condition caused by the introduction of toxic substances into the body.

Poisoning should be suspected in cases where a completely healthy person suddenly feels ill immediately or after a short time after eating or drinking, taking medication, as well as cleaning clothes, dishes and plumbing with various chemicals, treating the room with substances that destroy insects or rodents, etc. P. Suddenly, general weakness may appear, up to loss of consciousness, vomiting, convulsive states, shortness of breath, the skin of the face may turn pale or turn blue. The suggestion of poisoning is reinforced if one of the described symptoms or a combination of them occurs in a group of people after a joint meal or work.

The causes of poisoning can be: medicines, food products, household chemicals, poisons of plants and animals. A toxic substance can enter the body in various ways: through the gastrointestinal tract, respiratory tract, skin, conjunctiva, when the poison is injected (subcutaneously, intramuscularly, intravenously). The disturbance caused by the poison may be limited only to the place of the first direct contact with the body (local effect), which is very rare. Most often, the poison is absorbed and has a general (resorptive) effect on the body, manifested by a predominant lesion of individual organs and body systems.

General principles of first aid for poisoning

1. Call an ambulance.

2. Resuscitation measures.

3. Measures to remove from the body, not absorbed poison.

4. Methods for accelerating the removal of already absorbed poison.

5. Use of specific antidotes (antidotes).

1. In case of any acute poisoning, you must immediately call an ambulance. To provide qualified assistance, it is necessary to determine the type of poison that caused the poisoning. Therefore, it is necessary to save all the secretions of the affected person for presentation to the ambulance personnel, as well as the remains of the poison found near the victim (tablets with a label, an empty vial with a characteristic odor, opened ampoules, etc.).

2. Resuscitation measures are necessary in case of cardiac and respiratory arrest. They proceed to them only in the absence of a pulse on the carotid artery, and after the removal of vomit from the oral cavity. These measures include mechanical ventilation (ALV) and chest compressions. But not all poisonings can be done. There are poisons that are released with exhaled air (FOS, chlorinated hydrocarbons) from the respiratory tract of the victim, so resuscitators can be poisoned by them.

3. Removal from the body of poison that has not been absorbed through the skin and mucous membranes.

A) When the poison enters through the skin and conjunctiva of the eye.

If poison gets on the conjunctiva, it is best to rinse the eye with clean water or milk so that the washing water from the affected eye does not get into the healthy one.

If the poison enters through the skin, the affected area should be washed with a stream of tap water for 15–20 minutes. If this is not possible, the venom should be removed mechanically with a cotton swab. It is not recommended to intensively treat the skin with alcohol or vodka, rub it with a cotton swab or washcloth, as this leads to the expansion of skin capillaries and increased absorption of poisons through the skin.

B) When poison enters through the mouth, it is urgent to call an ambulance, and only if this is not possible, or if it is delayed, only then can you start washing the stomach with water without using a probe. The victim is given several glasses of warm water to drink and then vomits by irritating the root of the tongue and throat with a finger or spoon. The total volume of water should be large enough, at home - at least 3 liters, when washing the stomach with a probe, use at least 10 liters.

For gastric lavage, it is better to use only clean warm water.

Tubeless gastric lavage (described above) is ineffective, and in case of poisoning with concentrated acids and alkalis it is dangerous. The fact is that the concentrated poison contained in the vomit and gastric lavage re-contacts with the affected areas of the mucous membrane of the oral cavity and esophagus, and this leads to a more severe burn of these organs. It is especially dangerous to carry out gastric lavage without a tube for small children, since there is a high probability of aspiration (inhalation) of vomit or water into the respiratory tract, which will cause suffocation.

It is forbidden: 1) to induce vomiting in an unconscious person; 2) induce vomiting in case of poisoning with strong acids, alkalis, as well as kerosene, turpentine, as these substances can additionally cause burns of the pharynx; 3) wash the stomach with an alkali solution (baking soda) in case of acid poisoning. This is due to the fact that when acids and alkalis interact, gas is released, which, accumulating in the stomach, can cause perforation of the stomach wall or pain shock.

In case of poisoning with acids, alkalis, heavy metal salts, the victim is given enveloping agents to drink. This is jelly, an aqueous suspension of flour or starch, vegetable oil, egg whites whipped in boiled cold water (2-3 proteins per 1 liter of water). They partially neutralize alkalis and acids, and form insoluble compounds with salts. With subsequent gastric lavage through a tube, the same means are used.

A very good effect is obtained when activated charcoal is injected into the stomach of a poisoned person. Activated carbon has a high sorption (absorbing) ability to many toxic substances. The victim is given it at the rate of 1 tablet per 10 kg of body weight or coal suspension is prepared at the rate of 1 tablespoon of coal powder per glass of water. But it must be remembered that sorption on carbon is not strong, if it is in the stomach or intestines for a long time, the toxic substance can be released from the microscopic pores of activated carbon and begin to be absorbed into the blood. Therefore, after taking activated charcoal, it is necessary to introduce a laxative. Sometimes, in first aid, activated charcoal is given before gastric lavage, and then after this procedure.

Despite gastric lavage, part of the poison can enter the small intestine and be absorbed there. To speed up the passage of the poison through the gastrointestinal tract and thereby limit its absorption, saline laxatives (magnesium sulfate - magnesia) are used, which are best administered through a tube after gastric lavage. In case of poisoning with fat-soluble poisons (gasoline, kerosene), vaseline oil is used for this purpose.

To remove poison from the large intestine, cleansing enemas are indicated in all cases. The main fluid for bowel lavage is pure water.

4. The implementation of methods for accelerating the removal of absorbed poison requires the use of special equipment and trained personnel, therefore they are used only in a specialized department of the hospital.

5. Antidotes are used by the medical staff of the ambulance or the toxicological department of the hospital only after determining the poison that poisoned the victim

Children get poisoned mainly at home, all adults should remember this!

More on the topic First aid for acute poisoning:

1. LESSON 10 First aid for acute poisoning. The concept of "food poisoning". First aid for vomiting, hiccups, diarrhea, constipation. Clinic of botulism.

Basic principles of first aid for poisoning(at the stage of first aid) :

1. Stop, and if possible immediately, further exposure to the toxic agent on the victim.
2. Remove the poisonous substance from the body.
3. Maintaining the basic vital functions of the body (central nervous and cardiovascular systems, respiratory organs) until the arrival of medical workers.

First aid for inhalation poisoning (general requirements):

1. Remove or remove the victim from the poisoned atmosphere to a warm, ventilated, clean room or fresh air.
2. Call an ambulance.
3. Remove clothing that makes it difficult to breathe.
4. Take off clothes that adsorb harmful gas or are contaminated with poisonous substances.
5. If a toxic substance comes into contact with the skin, thoroughly wash the contaminated area with warm water and soap.
6. With symptoms of irritation of the mucous membranes of the eyes and upper respiratory tract (lacrimation, sneezing, nasal discharge, coughing):
rinse eyes with warm water or 2% soda solution;
rinse the throat with a 2% soda solution;
Wear dark glasses if you have photophobia.
7. Warm the victim (using heating blankets).
8. Create physical and mental peace.
9. Give the victim an easier breathing position - half-sitting.
10. When coughing, drink warm milk with Borjomi mineral water or soda in small sips.
11. In case of loss of consciousness - ensure the patency of the respiratory tract (prevent suffocation with the root of the tongue or vomit).
12. When breathing stops, start artificial lung ventilation (IVL).
13. With the beginning of pulmonary edema:
apply venous tourniquets on the arms and legs;
make hot foot baths (legs up to the middle of the lower leg are placed in a container of hot water).
14. Ensure constant monitoring of the condition of the victim until the arrival of medical workers.

First aid for carbon monoxide poisoning (carbon monoxide):

1. Remove the victim to fresh air.
2. Loosen tight clothing.
3. When breathing stops, perform artificial respiration.
4. In the absence of a pulse on the carotid artery, perform an indirect heart massage.
5. With simultaneous cessation of breathing and blood circulation (heartbeat), carry out cardiopulmonary resuscitation measures.
6. Urgently deliver the victim to a medical facility by transport.

First aid for food poisoning (toxic infections):

1. Rinse the stomach, giving the victim plenty to drink and induce a gag reflex.
2. Take activated charcoal inside at the rate of 1 gram per kilogram of the victim's weight or 1 tablespoon of enterodez dissolved in water (small amount).
3. Give a laxative to drink (for example, castor oil, an adult - 30 grams).
4. Give plenty of fluids.
5. Cover warmly and give hot sweet tea/coffee.
6. In severe cases, urgently transport the victim to a medical facility.

Transportation of the victim should be carried out in the position of the patient sitting or lying down - depending on his condition.
Tubeless gastric lavage technique:
1) fractionally (in several doses) drink 6-10 glasses of a warm, weak solution of sodium bicarbonate (dissolve 2 teaspoons of baking soda in 1 liter of water) or warm water, slightly tinted with potassium permanganate (potassium permanganate);
2) induce vomiting (press with two fingers on the root of the tongue and induce a gag reflex);
3) free the stomach from the contents (up to clean washings);
4) give hot strong tea to drink, a caffeine tablet - 0.1 g, 20 drops of cordiamine solution.
Before and after gastric lavage, you can use activated charcoal in the form of gruel.
It is forbidden to use the tubeless method of gastric lavage in case of poisoning with aggressive substances (acids and alkalis) !

Attention ! Removal of chemicals from the stomach is carried out only with the help of a probe and only by medical professionals.