急危重症护理学英文版课件第十二章-急性中毒.ppt

1、考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Chapter TwelveChapter TwelveAcute ToxicationAcute Toxication.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照

2、考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Severe Food PoisoningIn the evening of August 11th,2010,the Ruichang City in Jiangxi Province held the first Lobster Festival,opening the“Ten Thousand People Lobster Feast”.About 4000 local people joined this activity.More than 110 peo

3、ple suffered the food poisoning.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分The Lead ingot smelter in Wei County of Gansu has The Lead ingot smelter in Wei County of Gansu has made about 300 c

4、hildren suffering lead poisoningmade about 300 children suffering lead poisoningThe little patient is only 14 months old,his level of Lead in blood exceed standard for several times.The villagers seeing the doctors are showing their laboratory test reports,the level of Lead in blood of most people e

5、xceeds standard.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分The leaked liquid nitrogen happened in Yinchuan The leaked liquid nitrogen happened in Yinchuan resulted in intoxication of more tha

6、n 160 peopleresulted in intoxication of more than 160 people.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Yangxin in Hubei一一the leaked ammonia gas in the medical the leaked ammonia gas in the m

7、edical corporation caused the intoxication of more than 200 peoplecorporation caused the intoxication of more than 200 people.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Professional chemical

8、compounds poisoning For being diagnosed with professional chemical compounds poisoning,ten employees threatened to jump from buildings to get the compensation.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该

9、考评类目的考评实际得分.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际

10、得分之和为该考评类目的考评实际得分The reason of acute poisoningThe reason of acute poisoningProfessional poisoning toxic material,accessory,intermediate products,finished products.Custody,use,transport Living poisoningTaking or contacting accidentally toxic substancesTaking excess drugs,suicide or murder.考评项目赋标准分，对照

11、考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分The pathway of poisoningThe pathway of poisoningMechanism of poison Mechanism of poison transporttransport1.1.Respiratory tractRespiratory tract The fastest wa

12、y of poison functioning2.2.Digestive tractDigestive tract Taking the poison through mouth3.3.Skin and mucosaSkin and mucosa Liposoluble and corrosive poison,permeating through skin,having local skin injury4.4.othersothersBeing bitten by insects or snakes.injection.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评

13、项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Metabolism and excretion of poisonv Absorption of poisonAbsorption of poison respiratory tract:smoke,fog,steam,gas,carbon monoxide Digestive tract：Taking varieties of poison through m

14、outh Skin and mucosa：aniline,nitrobenzene,tetraethyl lead,organophosphorus pesticidev Detoxication through metabolism Detoxication through metabolism Reducing the toxicity through oxidation,deoxidization,hydrolyzation,combination in the liver.The toxicity of a few substances increase after metabolis

15、m instead.(parathion is oxidized to mintacol.)v Excretion of poisonExcretion of poison Most poison is excreted from the kidney.Being excreted form digestive tract in the way of excrement.Some is excreted from respiratory tract.Being excreted form the skin Being excreted from milk.考评项目赋标准分，对照考评内容和考评办

16、法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Absorption,metabolism and excretion of poisonAbsorption,metabolism and excretion of poisonPoisonRespiratory tractDigestive tractSkin and mucosaHuman bodyfunctioning on

17、 target organ and tissue,causing poisoning.LiverLiver：After After oxidation,deoxidation,oxidation,deoxidation,hydrolyzation or combination and the hydrolyzation or combination and the like,toxicity of most poison decreases,like,toxicity of most poison decreases,but a few may increase their toxicity

18、or but a few may increase their toxicity or maintain their prototypemaintain their prototypeIntestinal tractSweat glandkidney saliva milkGas and volatile poison is excreted from respiratory tract in prototype.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容

19、和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，

20、对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Idea to diagnoseIdea to diagnosevPreliminary evaluationpoisoned or notPreliminary evaluationpoisoned or not？vAsk for case historyto know what type of Ask for case historyto know what type of poisoning it ispoisoning it is？vEvaluating

21、 again-Judging clinical Evaluating again-Judging clinical manifestation relating to this poisoning manifestation relating to this poisoning vLaboratory testif there is some evidence Laboratory testif there is some evidence relating to some poison relating to some poison .考评项目赋标准分，对照考评内容和考评办法对考评项目进行考

22、评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Preliminary evaluationPreliminary evaluationvSudden disturbance of Sudden disturbance of consciousnessDysphoria,delirium,consciousnessDysphoria,delirium,confusion of consciousn

23、ess,comaconfusion of consciousness,coma Liver disease in a coma,diabetic coma,Liver disease in a coma,diabetic coma,intracranial lesions,severe electrolyte intracranial lesions,severe electrolyte disturbancedisturbancevSudden dyspnea,cyanosis with Sudden dyspnea,cyanosis with unknown cause.unknown c

24、ause.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Ask for medical historyAsk for medical historySuspecting of carbon monoxide poisoning：Getting to know if there is stove or chimney,condition of

25、 people staying together.Suspecting professional poisoning：Ask about profession,type of work,working age,type of poison and time they contact with,environmental conditions,protective measures and if they have suffered poisoning before.For those having unsure contacting history,we should consider poi

26、soning if they have tic with unknown reasons,coma,shock,dyspnea and the like.Suspecting of taking excess drugsAsk about disease history,kind of drugs taken and the dosage.Suspecting of food poisoningAsk about kind of food taken in,the source and the condition of people eating togetherSuspecting taki

27、ng drugs for suicideAsk about the mental state before illness.If there is empty medicine bottle,bag or remained drugs and lable at the scene.Attention.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实

28、际得分Evaluating againEvaluating again Checking poisoned patients from following aspectsIf there is drug(poison)blot,color and special smell.If there is dermatitis lesions,would and bleeding,sweating.If there are changes of the color of lips.(cyanosis,cerise,pale or hoary)Pay attention to the size of p

29、upil,reaction to light.Pay attention to the rate of respiration,rhythm,if there is dyspnea,rale in lung,special odor when breathing.Pay attention to the color and smell of vomitus and excreta(excrement,urine).If there is abdominal pain.Pay attention to see if there is muscle twitch and spasm,.考评项目赋标

30、准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Laboratory tests as accessory diagnosisLaboratory tests as accessory diagnosisQualitative and quantitative examinations of poisontests of metabolite of po

31、ison in the bodyTests of poisoning mechanism of poisonTests of the injury caused by poison to organs.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Principles of first-aidvStop contacting poison

32、timelyStop contacting poison timelyvClear the poison unabsorbedClear the poison unabsorbedvPromote the absorbed poison to be excreted.Promote the absorbed poison to be excreted.vUse special antidoteUse special antidotevSymptomatic treatmentSymptomatic treatment.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的

33、考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Stop contacting poison instantly&Clear unabsorbed poisonv Infection through respiratory tractInfection through respiratory tract：Leave Leave the contaminative environment,take in fresh a

34、ir or the contaminative environment,take in fresh air or oxygen.oxygen.v Infection through skinInfection through skin：Take off clothes,drain Take off clothes,drain off the poisonous fluid using cotton or paper.Wash the off the poisonous fluid using cotton or paper.Wash the body using large amount of

35、 water.Cant use hot water body using large amount of water.Cant use hot water or alcohol.or alcohol.v Infection through eyesInfection through eyes：Wash off using normal Wash off using normal saline or large amount of water.saline or large amount of water.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，

36、考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Clear off unabsorbed poisonPrecondition of use：noncrrosive poisonMethods:promoting emesis gastric lavage catharsis clyster.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的

37、考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分promote emesispromote emesisv Adaptation diseaseAdaptation disease：early stageearly stage（within2within23h after taking poison3h after taking poison）in ones right sence.in ones right sence.v MethodMethod：Mechanical way

38、：After Drinking water about 300500ml,stimulate the retropharyngeal.Repeat for several times Drug way：Drink Alkali ipecac syrup 1520ml and water 200ml together,emesis will occur after 1530 minutes.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考

39、评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分 gastric lavage gastric lavagev Adaptation disease Adaptation disease：most effective within 6h after most effective within 6h after taking in poison.taking in poison.v PositionPosition：head lowing left lying position or horizontal head lowing left lyin

40、g position or horizontal position with head tilting to on side.position with head tilting to on side.v Washing liquor infused each time Washing liquor infused each time v VolumeVolume：300400ml300400ml，TemperatureTemperature：25382538v PrinciplePrinciple：first in and later outfirst in and later out，fa

41、st-in and fast-outfast-in and fast-out，in primary balance between in and out.Leave some specimen in primary balance between in and out.Leave some specimen for identification of poison when first suction.for identification of poison when first suction.v Fluid of Fluid of gastric lavage gastric lavage

42、：rinsing or normal saline.rinsing or normal saline.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法

43、对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分 Catharsis and clyster Catharsis and clysterv We usually use sodium sulfate for 15-30g or magnesium We usually use sodium sulfate for 15-30g or magnesium sulfate for 15-20g mixtured with water 200ml,making up sulfate for 15-20g mixtured with wa

44、ter 200ml,making up 10%solution for patients to take orally.If the poison 10%solution for patients to take orally.If the poison has caused severe diarrhea,catharsis is not necessary.has caused severe diarrhea,catharsis is not necessary.v We often use warm water or 1%warm suds for continuous high cly

45、ster,promoting poison to be excreted.Activated carbon can also be added to absorb poison.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Promote absorbed poison to be eliminated Promote absorbed p

46、oison to be eliminated v Strengthen diuresisStrengthen diuresis：1 1）fluid infusionfluid infusion，supplement fluid in a large dosage quickly.supplement fluid in a large dosage quickly.2 2）use diureticuse diuretic，furosemide or mannitol.furosemide or mannitol.3 3）alkalize urine,change PH value of urin

47、e to promote the alkalize urine,change PH value of urine to promote the poisoned enzyme to be excreted.poisoned enzyme to be excreted.4 4）Pay attention to the water,electrolyte,acid-base balance Pay attention to the water,electrolyte,acid-base balance while conducting diuresis.while conducting diure

48、sis.v Provide oxygenProvide oxygen：carbon monoxide poisoningcarbon monoxide poisoningv Blood purificationBlood purification：1 1）HematodialysisHematodialysis：Using when the poisoning is severe,level Using when the poisoning is severe,level of poison in the blood is high,normal therapy is ineffective,

49、of poison in the blood is high,normal therapy is ineffective,companied with renal failure and respiratory panied with renal failure and respiratory depression.2 2）Blood perfusionBlood perfusion：This way can absorb fat-soluble or This way can absorb fat-soluble or chemicals combined with proteins,cle

50、aring out the poison.chemicals combined with proteins,clearing out the poison.考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分考评项目赋标准分，对照考评内容和考评办法对考评项目进行考评，评出各考评项目的考评实际得分，考评类目下各考评项目考评实际得分之和为该考评类目的考评实际得分Symptomatic treatmentSymptomatic treatmentv Conduct protective and sym