Categorías
blog

In the clinical picture of carbon monoxide poisoning there are 3 degrees of severity: mild, moderate and severe.

In the clinical picture of carbon monoxide poisoning there are 3 degrees of severity: mild, moderate and severe.

Occurrence of carbon monoxide. Carbon monoxide (carbon monoxide) is a colorless and odorless gas. Under production conditions, carbon monoxide is formed as a result of reproduction and incomplete combustion. It is most often formed in foundries, thermal shops, smithies, during drilling, in boiler houses, especially those that run on coal fuel. Carbon monoxide is a component of the exhaust gases of cars, tractors, etc.

Carbon monoxide (carbon monoxide) poisoning can occur in industries where carbon monoxide is used to synthesize a number of organic compounds, in garages with poor ventilation, spring gas leaks or early closure of furnace dampers.

Carbon monoxide entered the human body according to the law of gas diffusion. It passes to the blood through the lungs due to the difference between the partial pressure of blood and alveolar air. The greater this difference, the more the blood is saturated with carbon monoxide.

Carbon monoxide (CO) is a colorless and odorless gas. Formed by incomplete combustion of carbonaceous materials. It is the most important component of the gases of all fuels used in industry. It contains 8–14% in light gas and up to 31% in blast furnace gas. Exhaust gases contain up to 3.5% CO, with single engine running – 12% – engine repair and testing workers, pilots, drivers and other professionals can be poisoned by carbon monoxide, although poisoning is sometimes diagnosed as caused by gasoline.

The most important are generator gases containing 19% (wood) and 30.5% CO (coal). A significant amount of carbon monoxide is formed during the explosion of explosives; in the ceramic industry; in brick and cement plants, gases containing carbon monoxide are used for drying. Especially great danger in blast furnace production, when repairing damage to gas pipelines. There were deaths in the landfill – slag.

Penetrating through the respiratory tract, carbon monoxide is released by them without change. Carbon monoxide has a high affinity for hemoglobin in the blood, to form carboxyhemoglobin, unable to carry oxygen. The toxic effect of gas is due, on the one hand, to oxygen starvation of tissues, especially the brain, on the other hand – its inherent specific organotropic action. It is now established that not only acute but also chronic poisoning is possible.

Degrees of carbon monoxide poisoning and characteristic signs. Symptoms of poisoning are headache, throbbing in the temples, dizziness, nausea, vomiting, tinnitus, palpitations. A little later there is muscle weakness, decreased tendon reflexes, drowsiness, dizziness, shortness of breath, pale skin, sometimes bright red spots on. skin. Upon further stay in a poisoned atmosphere, breathing becomes shallow, convulsions occur and death occurs from paralysis of the respiratory center. After care and withdrawal from the coma there is psychosis, swallowing disorders, for a long time – muscle weakness.

Carbon monoxide is poisonous, it has a selective neurotoxic (hypoxic) effect. Once in the body, it binds to hemoglobin to form carboxyhemoglobin, which is unable to transport oxygen. This results in hypoxemia and, in severe cases, anoxia. However, the mechanism of action of carbon monoxide is not limited to the violation of oxygen transport).

In the presence of carboxyhemoglobin, unblocked oxygen in the blood increases its affinity for hemoglobin, which complicates the cleavage of oxygen from oxyhemoglobin and its return to tissues.

Thus, hypoxemia increases, which is due to the formation of carboxyhemoglobin.

Of great importance in the mechanism of action is anoxia caused by carbon monoxide, ie a disorder of tissue respiration due to inhibition of the enzymes cytochrome oxidase, catalase, peroxidase.

As a result of hypoxia and hypoxemia, first of all, the metabolism is disturbed, and the blood sugar content rises sharply, lactic acid accumulates, and acidosis occurs.

Significant changes occur in the CNS, namely: hyperemia of the brain, hemorrhage, cerebral edema and its softening.

In the clinical picture of carbon monoxide poisoning there are 3 degrees of severity: mild, moderate and severe.

In the case of mild carbon monoxide poisoning, there is headache, dizziness, lethargy, tinnitus, incoordination, nausea, sometimes vomiting, chest pain. During the study, 20-30% of carboxyhemoglobin is found in the blood.

If there is moderate poisoning, there is a short-term fainting, severe weakness, inhibition, shortness of breath, tachycardia, facial flushing, convulsions. 30 – 35% of carboxyhomoglobin is determined in the blood.

In severe cases of poisoning note coma, neurological symptoms of diffuse brain damage (stiff neck muscles, pendulum movements of the eyeballs, convulsions, pathological reflexes, possible paresis, paralysis, hemodynamic disorders). 50-60% of carboxyhemoglobin is found in the blood.

In some cases, severe poisoning develops acute toxic pulmonary edema, coronary heart disease, conduction disorders until complete blockade.

In the case of exposure to large doses of carbon monoxide, death can occur at the site of poisoning due to respiratory arrest and severe hemodynamicances.

Complications – aspiration pneumonia, various trophic changes, focal myocardial lesions.

Chronic carbon monoxide poisoning is characterized by nonspecific symptoms that are not always clearly expressed: headache, dizziness, insomnia, irritability, loss of appetite, nausea, palpitations, anemia, and so on.

First aid: to remove the victims from the affected area; continuous inhalation of oxygen for several hours.

Persons suffering from moderate and severe SDOR poisoning should be hospitalized.

In the clinic of acute poisoning, the severity of which is determined not only by the concentration of gas, but also the duration of action, the predominant symptoms of the central nervous system and cardiovascular system.

The symptoms of carbon monoxide poisoning are very varied. Acute cases are mild, moderate and severe. First of all there are headaches (in the temples and forehead), they are joined by dizziness, lethargy, nausea, vomiting, tinnitus, flickering in the eyes, palpitations, sensitivity disorders, weakness in the legs. At poisoning of the average loss of consciousness passing in a comatose state, oppression of tendon reflexes, lack of reaction of pupils to light. When coming out of a coma, the state of stun remains.

The severe form is characterized by a severe coma that can lead to death. At it tonic and clonic spasms, sharp rigidity of muscles, disturbances of respiratory and cardiac activity – pulse of arrhythmic, accelerated, bad filling, frequent falling of arterial pressure are observed. Sometimes there is a mental disorder, visual and auditory hallucinations. Death occurs with paralysis of the respiratory center. If recovery occurs, there are disorders of the central nervous system, memory impairment, attention, functional neurosis, possible paralysis, contractures, concentric narrowing of the visual field, retinal hemorrhage.

In anemic individuals and in individuals with a labile autonomic nervous system, the process of binding of hemoglobin to carbon monoxide proceeds faster and the severity of intoxication is greater.

Chronic poisoning, caused by low concentrations, is expressed in the symptom complex of headaches, dizziness, insomnia, lethargy, sometimes irritability, blinking and transient diplopia, memory impairment, apathy, drowsiness. Complaints are characteristic of neurasthenic syndrome, often a disease of the cardiovascular system.

First aid for carbon monoxide poisoning is to immediately remove the victim from the poisoned atmosphere, preferably on the street. At superficial breath or absence of breath it is necessary to begin artificial ventilation of lungs and to carry out it from emergence of independent breath.

To eliminate the effects of poisoning, use an energetic body massage, apply warmers to the feet, allow short-term inhalation of ammonia vapors.

Patients with severe poisoning should be hospitalized, as the possible development of severe complications of the lungs and central nervous system in the late period. Carbogen inhalations (oxygen from 5% of carbon dioxide) are carried out, in case of respiratory disturbance – tracheal intubation with transfer of the patient to mechanical respiration.

Respiratory and vascular analeptics are administered: 0.5 – 1.0 ml of 1% solution of lobeline intravenously slowly, 1 ml of 10% solution of caffeine-sodium benzoate, with excitation and convulsions 10 – 20 ml of 10% solution of sodium oxybutyrate intravenously, 200 – 300 ml of 5% sodium bicarbonate solution, 400-500 ml of 10% glucose solution with insulin, 30 ml of 3% potassium chloride solution or 10 ml of panangin, 40-50 ml of 0.5% solution of novocaine intravenously, 10 ml of 2.4% solution euphyllin intravenously. As an antidote to carbon monoxide, use a 1% solution of methylene blue in 100 ml of 5% glucose solution intravenously.

Measures of specific therapy (artificial respiration, methods). Victims sometimes have impaired breathing and heart function. Breathing can stop when a person faints, and due to muscle sinks, the root of the tongue sinks into it, blocking the entrance to the larynx; in case of dysfunction of the respiratory center due to severe traumatic brain injury, hemorrhage into the brain, a large number of rib fractures; with damage to the lungs and pleura. The victim first appears pale, then cyanosis of the skin. Respiratory movements accelerate compare and contrast essay buy, become irregular (sometimes less frequent), and after a while, if the necessary help is not provided, they stop completely.

First of all, check the oral cavity and try to restore patency of the upper respiratory tract. To do this, the index finger, wrapped in a bandage or handkerchief, free the mouth from vomit, mucus, blood clots, remove removable dentures. When the tongue is sunken, the victim’s head should be turned to the side and the jaw should be supported.

If the victim is not breathing, it is necessary to check whether his heart activity has stopped and immediately start artificial respiration. To do this, it is placed with its back on a hard surface (on the floor of the car, on the road), tucked under the shoulder blades made of clothing roller.