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

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

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

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

Symptoms

Symptoms of acute intoxication

Mild degree of carbon monoxide intoxication - headache, mainly in the temples and forehead, "pulsation in the temples", dizziness, tinnitus, vomiting, muscle weakness. Increased respiration and pulse. Fainting, especially when performing physical work. One of the earliest symptoms is a decrease in the speed of reactions, a violation of color perception.

Symptoms of moderate intoxication

Loss of consciousness for several hours or significant memory lapses. Loss of criticism. Sharp adynamia. Disturbance of coordination of movements, trembling. Upon the return of consciousness - a pronounced asthenic state.

Symptoms of a severe form of intoxication

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

visual impairment

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

Skin and hair damage

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

Changes in the circulatory and respiratory system

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

Changes in the bronchopulmonary apparatus

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

X-ray data

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

1. Emphysema and increased lung pattern. The shadows of the gates of the lungs are expanded, consist of small-focal and linear formations. After 1-3 days - full recovery.

2. Along with the above, changes focal character with indistinct contours, occupying the basal region, densely spaced, without a tendency to merge. On the 3-4th day, the normal pulmonary pattern is restored.

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

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

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

In a small number of cases, a moderate fever joins the 2nd week, general state worsens again, and when listening, wet and scattered dry rales are determined (the so-called post-carbon pneumonia). These bronchopulmonary changes favorable course soon disappear, and normal pneumatization of the lungs is restored.

Particular attention should be paid to hemodynamic disturbances in carbon monoxide intoxication. Almost half of the victims radiologically observed an acute total increase in the heart with a predominance of the right sections. Normalization after 3-5 days. Pulmonary edema and acute expansion of the heart sharply exacerbate intoxication. For early diagnosis of changes in the lungs and heart, X-ray examination should be performed as early as possible.

Blood changes

High content of hemoglobin and erythrocytes. With toxic pulmonary edema - neutrophilic leukocytosis, stab shift; ESR is not increased (if years of infection); an increase in the level of sugar, lactic acid, acetone bodies, urea, transferase activity, a decrease in the alkaline reserve. Sometimes the rapid development of anemia.

Possible consequences of acute intoxication

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

There is the development of psychoses, opto-vestibular, endocrine disorders. In case of poisoning in the first 3 months of pregnancy, fetal deformities are possible.

There are arrhythmias, disorders of intracardiac conduction, up to blockade, degenerative changes in the heart muscle, coronary thrombosis: focal nephritis, thyrotoxicosis, a tendency to infections.

Chronic intoxication

Complaints of headaches, noise in the head, dizziness, fatigue, irritability, bad dream, memory impairment, short-term orientation disorder, palpitations, pain in the heart, shortness of breath, fainting, disorders of skin sensitivity, smell, hearing, functions of the vestibular apparatus, vision (violation of color perception, narrowing of the field of vision, disturbance of accommodation). Nutritional decline. Functional Disorders central nervous system - asthenia, autonomic dysfunction with angiodistonic syndrome, a tendency to vascular spasms, hypertension, further development is possible hypertension. Myocardial dystrophy, angina phenomena. ECG shows focal and diffuse changes, coronary disorders.

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

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

Sometimes there are vascular cerebral, diencephalic crises. The development of toxic encephalopathy is rare. Exacerbation of the tuberculous process, reduced resistance to infections.

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

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

When in air environment some other toxic substances- gasoline, benzene, nitrogen oxides, cyanides, hydrogen sulfide - there is a summation, potentiation of the toxic effect.

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

First aid and treatment

Remove the patient in a supine position (even if it is possible to move independently) to fresh air. Peace. Warming is obligatory (hot-water bottles, mustard plasters to the feet). Early and prolonged inhalation of oxygen.

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

During oxygen therapy, drug therapy. In mild cases - ammonia, tea, coffee.

With the simultaneous absence of a pulse and respiratory arrest - massage of the heart area, artificial respiration. emergency therapy must be carried out before full recovery functions of the cardiovascular and respiratory systems.

Treatment of chronic poisoning

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

Working capacity examination

After treatment of acute carbon monoxide poisoning in moderate and severe form with release from work (in a hospital) - the provision of a sick leave. Subsequent close medical supervision. Depending on the presence and severity of complications, the ability to work can be permanently limited. At initial signs chronic intoxication - transfer to another job (temporarily) for a period of 2 months. In case of ineffectiveness of the carried out therapeutic and preventive measures or the severity of symptoms of chronic poisoning - a permanent transfer to another job with a possible definition of disability.

Prevention

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

Individual protection: work, if necessary, in gas masks, respirators.

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

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

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

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

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

How CO affects the body?

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

Carbon monoxide in the body binds to myoglobin (it's protein skeletal muscle and heart muscle). As a result, the pumping function of the heart decreases, and severe muscle weakness develops.

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

Where can carbon monoxide poisoning occur?

Many situations can occur in which carbon monoxide poisoning is possible:

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

Who can suffer from hypersensitivity to CO?

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

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

Signs of carbon monoxide poisoning

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

Concentration up to 0.009%

Clinical manifestations are noted after 3-5 hours:

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

Concentration up to 0.019%

Clinical manifestations are noted after 6 hours:

performance decreases;
shortness of breath with moderate physical exertion;
headache , slightly pronounced;
visual impairment;
the death of those who suffer from severe heart failure is possible, and fetal death can also occur.

Concentration 0.019-0.052%

severe throbbing headache;
irritability, instability of the emotional state;
nausea;
impaired attention, memory;
fine motor problems.

Concentration up to 0.069%

Clinical manifestations are noted after 2 hours:

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

Concentration 0.069-0.094%

Clinical manifestations are noted after 2 hours:

severe dysmotility (ataxia);
appearance;
strong rapid breathing.

Concentration 0.1%

Clinical manifestations are noted after 2 hours:

weak pulse;
a state of fainting;
convulsions;
breathing becomes rare and superficial;
condition .

Concentration 0.15%

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

Concentration 0.17%

Clinical manifestations are noted after 0.5 hours.

Manifestations are similar to the previous description.

Concentration 0.2-0.29%

Clinical manifestations are noted after 0.5 hours:

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

Concentration 0.49-0.99%

Clinical manifestations are noted after 2-5 minutes:

no reflexes;
pulse thready;
deep coma;
death.

Concentration 1.2%

Clinical manifestations are noted after 0.5-3 minutes:

convulsions;
lack of consciousness;
vomit;
death.

Symptoms of carbon monoxide poisoning

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

The mechanism of development of symptoms

The manifestation of symptoms of various types is associated with exposure to carbon monoxide. Let us consider in more detail the symptoms of various types and the features of the mechanisms of their manifestation.

neurological

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

Respiratory

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

Cardiovascular

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

Dermal

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

If carbon monoxide poisoning or poisoning has occurred natural gas mild or moderate, then for a long time a person may manifest: dizziness and headaches. He also has memory impairment. intellectual ability, emotional fluctuations are noted, since gray and white matter brain.

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

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

First aid for carbon monoxide poisoning

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

Before the start of PMP, it is necessary to take out or remove the one who suffered from the room in which the concentration of carbon monoxide is increased. You need to clearly understand what CO is what kind of gas, and how quickly it can harm the body. And as each breath of poisoned air will only intensify negative symptoms, take the victim to fresh air as soon as possible.

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

If the degree of poisoning is mild, the victim should be given strong tea, warm it up and ensure complete rest.

If confusion is noted, or it is absent at all, you should lay the person on his side on a flat surface, make sure that he receives an influx of fresh air by unbuttoning his belt, collar, underwear. Give a sniff of ammonia, holding the cotton at a distance of 1 cm.

In the absence of a heartbeat and breathing, artificial respiration should be carried out, a sternum massage should be done in the projection of the heart.

In an emergency, you can't act rashly. If there are still people in a burning building, you cannot save them on your own, as this can lead to an increase in the number of victims. It is important to immediately call the Ministry of Emergency Situations.

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

Treatment for carbon monoxide poisoning

Do not practice after poisoning treatment at home. A person in such a situation needs the help of specialists.

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

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

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

In order to prevent natural gas and CO poisoning, it is important to follow very carefully those rules that will help prevent dangerous situations.

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

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

The sooner Acizol is administered intramuscularly in case of poisoning, the greater the chances of a person to survive. Also, this medicine increases the effectiveness of those measures that will subsequently be taken for resuscitation and treatment.

conclusions

Thus, carbon monoxide poisoning is a very dangerous condition. The higher the gas concentration, the more likely fatal outcome. Therefore, it is very important to be extremely careful to comply with all the rules of prevention, and at the first suspicion of such poisoning, immediately call for emergency care.

Carbon monoxide poisoning (from the colloquial "to burn") is an extremely dangerous human condition that can even lead to death. According to statistics, CO poisoning is one of the most common causes of domestic accidents. And since first aid for carbon monoxide poisoning can be decisive, everyone needs to know the basic rules for its provision.

Carbon monoxide poisoning can occur:

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

That insidious carbon monoxide

Carbon monoxide is indeed very insidious: it is odorless and at the same time is formed wherever the combustion process can occur in conditions of lack of oxygen. Carbon monoxide replaces carbon dioxide gas, so poisoning occurs completely unnoticed.

Getting into the human blood during respiration, CO binds hemoglobin cells and forms carboxyhemoglobin. Bound hemoglobin is unable to carry oxygen to tissue cells.

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

Carbon monoxide poisoning causes the following symptoms in sequence:

muscle weakness;
tinnitus and pounding in the temples;
dizziness;
chest pain, nausea and vomiting;
drowsiness or, conversely, increased motor activity;
disorder of coordination of movements;
delirium, auditory and visual hallucinations;
loss of consciousness;
convulsions;
dilated pupils with a weakened reaction to a light source;
involuntary discharge of urine and feces;
coma and death due to respiratory arrest or cardiac arrest.

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

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

In the event of an exit from a coma, serious complications are possible, since hemoglobin cells are restored and cleared for quite a long time. That is why it is extremely important to provide first aid in case of carbon monoxide poisoning in a timely and correct manner.

First aid for carbon monoxide poisoning

First aid for carbon monoxide poisoning involves the following measures:

it is necessary to eliminate the flow of CO (turn off the source), while breathing through gauze or a handkerchief yourself, so as not to become a victim of poisoning;
the victim should be urgently withdrawn or taken out to clean air;
if the degree of poisoning is not great - wipe whiskey, face and chest with vinegar, give a solution baking soda(1 teaspoon to 1 glass of water), offer hot coffee or tea;
if the victim received large dose SO, but is conscious, he needs to be laid down and provided with peace;
the victim in an unconscious state must be brought to the nose (distance - no more than 1 cm!) ammonia, on the chest and head you need to put a container with cold water or ice, and feet, on the contrary, warm;
if a person does not recover, then before the ambulance arrives, it may be necessary to give the victim a closed heart massage and artificial respiration.

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

What is carbon monoxide and where does it form?

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

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

Why is carbon monoxide dangerous?

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

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

How to protect yourself from carbon monoxide poisoning?

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

Carbon monoxide poisoning

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

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

Poisoning is possible:

during fires;

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

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

when you stay on a busy road or near it for a long time. On major highways, the average concentration of CO exceeds the poisoning threshold;

at home in case of leakage of lighting gas and in case of untimely closed stove dampers in rooms with stove heating (houses, baths);

when using low-quality air in breathing apparatus.

General information

Carbon monoxide poisoning ranks fourth in the list of the most frequently observed poisonings (after alcohol, drug and drug poisoning). Carbon monoxide, or carbon monoxide (CO), is found wherever conditions exist for the incomplete combustion of carbon-containing substances. CO is a colorless gas that has no taste, its smell is very weak, almost imperceptible. Burns with a bluish flame. A mixture of 2 volumes of CO and 1 volume of O2 explodes on ignition. CO does not react with water, acids and alkalis. Carbon monoxide is colorless and odorless, so carbon monoxide poisoning most often goes unnoticed. The mechanism of action of carbon monoxide on a person is that when it enters the blood, it binds hemoglobin cells. Then hemoglobin loses its ability to carry oxygen. And than longer man breathes carbon monoxide, the less efficient hemoglobin remains in his blood, and the less oxygen the body receives. A person begins to suffocate, a headache appears, consciousness is confused. And if you do not go out into the fresh air in time (or do not take out the already unconscious person into the fresh air), then a lethal outcome is not ruled out. In case of carbon monoxide poisoning, sufficient for a long time so that hemoglobin cells can completely clear themselves of carbon monoxide. The higher the concentration of carbon monoxide in the air, the faster the life-threatening concentration of carboxyhemoglobin in the blood is created. For example, if the concentration of carbon monoxide in the air is 0.02-0.03%, then for 5-6 hours of inhalation of such air, a concentration of carboxyhemoglobin of 25-30% will be created, if the concentration of CO in the air is 0.3-0.5% , then the lethal content of carboxyhemoglobin at the level of 65-75% will be reached after 20-30 minutes of a person's stay in such an environment. Carbon monoxide poisoning can appear abruptly or slowly, depending on the concentration. At very high concentrations, poisoning occurs quickly, characterized by rapid loss of consciousness, convulsions and respiratory arrest. In the blood taken from the region of the left ventricle of the heart or from the aorta, a high concentration of carboxyhemoglobin is found - up to 80%. With a low concentration of carbon monoxide, symptoms develop gradually: muscle weakness appears; dizziness; noise in ears; nausea; vomit; drowsiness; sometimes, on the contrary, short-term increased mobility; then a disorder of coordination of movements; rave; hallucinations; loss of consciousness; convulsions; coma and death from paralysis of the respiratory center. The heart may still beat for some time after breathing has stopped. There have been cases of people dying from the consequences of poisoning even 2-3 weeks after the poisoning event.

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

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

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

The concentration of CO in the air, carboxyhemoglobin HbCO in the blood and symptoms of poisoning.
% about. (20°С)	mg/m 3	Time impact, h	in blood, %	The main signs and symptoms of acute poisoning
				Decrease in the rate of psychomotor reactions, sometimes a compensatory increase in blood flow to vital important bodies. In persons with severe cardiovascular insufficiency - chest pain with physical activity, shortness of breath
				Minor headache, decreased mental and physical performance, shortness of breath with moderate exertion. Visual disturbances. May be fatal to the fetus, those with severe heart failure

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

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

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

				Coma, convulsions, respiratory and cardiac depression. Possible lethal outcome

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

Symptoms:

For mild poisoning:

headache appears

knocking in the temples,

dizziness,

chest pain,

dry cough,

lacrimation,

possible visual and auditory hallucinations,
redness of the skin, carmine-red color of the mucous membranes,
tachycardia,
increase in blood pressure.

for moderate poisoning:

drowsiness,

possible motor paralysis with preserved consciousness

for severe poisoning:

loss of consciousness, coma

convulsions,

involuntary discharge of urine and feces,

respiratory failure that becomes continuous, sometimes of the Cheyne-Stokes type,

dilated pupils with a weakened reaction to light,

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.

Help with carbon monoxide poisoning

The first symptoms of poisoning can develop after 2 - 6 hours of exposure to an atmosphere containing 0.22-0.23 mg CO2 per 1 liter of air; severe poisoning with loss of consciousness and fatal can develop in 20 - 30 minutes at a CO concentration of 3.4 - 5.7 mg / l and after 1-3 minutes at a poison concentration of 14 mg / l. The first symptoms of poisoning are headache, heaviness in the head, tinnitus, nausea, dizziness and palpitations. With further stay in a room whose air is saturated with carbon monoxide, the victim begins to vomit, general weakness increases, severe drowsiness and shortness of breath appear. Skin turn pale. If a person continues to inhale carbon monoxide, his breathing becomes shallow, convulsions occur. Death occurs from respiratory arrest due to paralysis of the respiratory center.

First aid for carbon monoxide poisoning

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

Treatment of carbon monoxide poisoning

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

Carbon monoxide analysis

To diagnose acute carbon monoxide poisoning, the content of either carboxyhemoglobin (HbCO) in the blood or carbon monoxide CO in exhaled air should be immediately determined.

Qualitative Definition

For analysis, whole blood treated with heparin or other stabilizer that prevents it from clotting is used. Approximately three times the volume of 1% tannin solution is added to diluted samples (1: 4) of the studied and normal blood. Normal blood acquires a gray color, and blood containing carboxyhemoglobin does not change. A similar test is carried out with the addition of formalin. Wherein normal blood takes on a dirty brown color, and the test blood containing carboxyhemoglobin retains its color for several weeks. In the absence of these reagents in the laboratory, a 30% sodium hydroxide solution can be used, which is added to blood samples diluted 1: 100 with water. Blood that does not contain carboxyhemoglobin acquires a green-black color. In the presence of carboxyhemoglobin, pink color blood. Carboxyhemoglobin can be detected in the blood using the microdiffusion method based on the reaction with palladium chloride and spectrophotometrically.

quantitation

The quantitative determination of carboxyhemoglobin (Hb CO) in the blood is based on the fact that both oxyhemoglobin (Hb O 2) and methemoglobin can be reduced by sodium dithionite, and Hb CO does not interact with this reagent. For the determination, an aqueous solution of ammonia (1 ml/l) is required; solid sodium dithionite Na 2 S 2 O 4 2H 2 O (stored in a desiccator); cylinder with pure gaseous CO or a mixture of CO and nitrogen; cylinder with gaseous oxygen or compressed air. It is possible to obtain CO by the interaction of concentrated sulfuric and formic acids. For determination, 0.2 ml of blood is added to 25 ml of ammonia solution and mixed thoroughly. The sample is divided into 3 approximately equal portions A, B and C. Portion A is stored in a stoppered tube. A portion of blood B is saturated with carbon monoxide until oxygen is completely replaced by CO (i.e., to obtain 100% Hb CO), blowing gas through the solution for 5–10 minutes. Portion C is saturated with oxygen by blowing pure oxygen or compressed air through the solution for 10 minutes to completely replace CO with oxygen (0% HbCO). To each solution (A, B, C) add a small amount (about 20 mg) of Na 2 S 2 O 4 2H 2 O and 10 ml of ammonia solution and mix. Remove the spectrum in the visible region or measure the absorption at 540 and 579 nm. As a reference solution, a solution of sodium dithionite in an aqueous solution of ammonia is used. The percentage of saturation with carboxyhemoglobin can be calculated using the following formula: HbCO (%) \u003d ( (A 540 / A 579 solution A) - (A 540 / A 579 solution C) * 100%) / ( (A 540 / A 579 solution B) - (A 540 / A 579 solution C)), taking into account that (A 540 / A 579 solution B) = 1.5, which corresponds to 100% HbCO, (A 540 / A 579 solution C) = 1.1, which corresponds to 0% HCO. The measurements are carried out in the region of maximum difference between the absorption of Hb CO [λ max (Hb*CO) =540 nm] and the point of equal absorption of Hb CO and Hb O 2 (579 nm, isosbestic point). The presence on the spectrum of solution A of two almost symmetrical peaks ("rabbit ears") - feature carbon monoxide poisoning. Conclusion

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