1、Chapter TwelveChapter TwelveAcute ToxicationAcute ToxicationSevere 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 people s
2、uffered the food poisoning.The Lead ingot smelter in Wei County of Gansu has The Lead ingot smelter in Wei County of Gansu has made about 300 children suffering lead poisoningmade about 300 children suffering lead poisoningThe little patient is only 14 months old,his level of Lead in blood exceed st
3、andard for several times.The villagers seeing the doctors are showing their laboratory test reports,the level of Lead in blood of most people exceeds standard.The leaked liquid nitrogen happened in Yinchuan The leaked liquid nitrogen happened in Yinchuan resulted in intoxication of more than 160 peo
4、pleresulted in intoxication of more than 160 people.Yangxin in Hubei一一the leaked ammonia gas in the medical the leaked ammonia gas in the medical corporation caused the intoxication of more than 200 peoplecorporation caused the intoxication of more than 200 people.Professional chemical compounds poi
5、soning For being diagnosed with professional chemical compounds poisoning,ten employees threatened to jump from buildings to get the compensation.SummarySummary Foreign substances being able to causing Foreign substances being able to causing poisoning are called poison.poisoning are called poison.-
6、Industrial poison,drug,pesticide,toxic flora Industrial poison,drug,pesticide,toxic flora and faunaand faunaDefinition：Acute poisoning refers to that toxic chemicals enter humans body in a short time or with excess amount at a time,causing organic or functional injury of tissues and organs.The conce
7、ption of poison is relative,the dosage of them is critical factor.Poisoning includes the acute ones and the chronic onesAcute poisoningAbsorbing too much poison in a short time,its urgent,the symptom is severe,the state of illness changes rapidly.It can threaten lives without timely treatment.Chroni
8、c poisoningResults of absorbing small amounts of poison for a long time,beginning slowly,the course of disease is long,lacking specific diagnostic indexes,not belonging to the category of emergency.The reason of acute poisoningThe reason of acute poisoningProfessional poisoning toxic material,access
9、ory,intermediate products,finished products.Custody,use,transport Living poisoningTaking or contacting accidentally toxic substancesTaking excess drugs,suicide or murderThe pathway of poisoningThe pathway of poisoningMechanism of poison Mechanism of poison transporttransport1.1.Respiratory tractResp
10、iratory tract The fastest way 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.injectionMetaboli
11、sm and excretion of poisonv Absorption of poisonAbsorption of poison respiratory tract:smoke,fog,steam,gas,carbon monoxide Digestive tract：Taking varieties of poison through mouth Skin and mucosa：aniline,nitrobenzene,tetraethyl lead,organophosphorus pesticidev Detoxication through metabolism Detoxic
12、ation through metabolism Reducing the toxicity through oxidation,deoxidization,hydrolyzation,combination in the liver.The toxicity of a few substances increase after metabolism instead.(parathion is oxidized to mintacol.)v Excretion of poisonExcretion of poison Most poison is excreted from the kidne
13、y.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.Absorption,metabolism and excretion of poisonAbsorption,metabolism and excretion of poisonPoisonRespiratory tractDigestive tractSkin and mucosaH
14、uman bodyfunctioning on 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 i
15、ncrease their toxicity 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 prototypeIdea to diagnoseIdea to diagnosevPreliminary evaluationPreliminary ev
16、aluationpoisoned or notpoisoned or not？vAsk for case historyAsk for case historyto know what type of to know what type of poisoning it ispoisoning it is？vEvaluating againEvaluating again-Judging clinical Judging clinical manifestation relating to this poisoning manifestation relating to this poisoni
17、ng vLaboratory testLaboratory testif there is some evidence if there is some evidence relating to some poison relating to some poison Preliminary evaluationPreliminary evaluationvSudden disturbance of Sudden disturbance of consciousnessconsciousnessDysphoria,delirium,Dysphoria,delirium,confusion of
18、consciousness,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
19、.unknown cause.Ask for medical historyAsk for medical historySuspecting of carbon monoxide poisoning：Getting to know if there is stove or chimney,condition of people staying together.Suspecting professional poisoning：Ask about profession,type of work,working age,type of poison and time they contact
20、with,environmental conditions,protective measures and if they have suffered poisoning before.For those having unsure contacting history,we should consider poisoning if they have tic with unknown reasons,coma,shock,dyspnea and the like.Suspecting of taking excess drugsAsk about disease history,kind o
21、f drugs taken and the dosage.Suspecting of food poisoningAsk about kind of food taken in,the source and the condition of people eating togetherSuspecting taking drugs for suicideAsk about the mental state before illness.If there is empty medicine bottle,bag or remained drugs and lable at the scene.A
22、ttention Evaluating againEvaluating againChecking 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
23、 of pupil,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,La
24、boratory tests as accessory diagnosisLaboratory tests as accessory diagnosisQualitative and quantitative examinations of poisontests of metabolite of poison in the bodyTests of poisoning mechanism of poisonTests of the injury caused by poison to organsPrinciples of first-aidvStop contacting poison t
25、imelyStop 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 treatmentStop contacting poison instantly&Clear u
26、nabsorbed poisonv Infection through respiratory tractInfection through respiratory tract：Leave Leave the contaminative environment,take in fresh air or the contaminative environment,take in fresh air or oxygen.oxygen.v Infection through skinInfection through skin：Take off clothes,drain Take off clot
27、hes,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 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 of
28、f using normal Wash off using normal saline or large amount of water.saline or large amount of water.Clear off unabsorbed poisonPrecondition of use：noncrrosive poisonMethods:promoting emesis gastric lavage catharsis clysterpromote emesispromote emesisv Adaptation diseaseAdaptation disease：early stag
29、eearly stage（withinwithin2 23h 3h after taking poisonafter taking poison）in ones right sence.in ones right sence.v MethodMethod：Mechanical way：After Drinking water about 300500ml,stimulate the retropharyngeal.Repeat for several times Drug way：Drink Alkali ipecac syrup 1520ml and water 200ml together
30、,emesis will occur after 1530 minutes.gastric lavagegastric 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 lying position o
31、r 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，fast-in and fa
32、st-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：rinsing or
33、normal saline.rinsing or normal saline.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 water 200ml,making u
34、p 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 clyster,promoting poi
35、son to be excreted.Activated carbon can also be added to absorb poison.Promote absorbed poison to be eliminated Promote absorbed poison to be eliminated v Strengthen diuresisStrengthen diuresis：1 1）fluid infusionfluid infusion，supplement fluid in a large dosage quickly.supplement fluid in a large do
36、sage quickly.2 2）use diureticuse diuretic，furosemide or mannitol.furosemide or mannitol.3 3）alkalize urine,change PH value of urine 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,elect
37、rolyte,acid-base balance Pay attention to the water,electrolyte,acid-base balance while conducting diuresis.while conducting diuresis.v Provide oxygenProvide oxygen：carbon monoxide poisoningcarbon monoxide poisoningv Blood purificationBlood purification：1 1）HematodialysisHematodialysis：Using when th
38、e poisoning is severe,level Using when the poisoning is severe,level of poison in the blood is high,normal therapy is ineffective,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 p
39、erfusionBlood perfusion：This way can absorb fat-soluble or This way can absorb fat-soluble or chemicals combined with proteins,clearing out the poison.chemicals combined with proteins,clearing out the poison.Symptomatic treatmentSymptomatic treatmentv Conduct protective and symptomatic treatment to
40、the injured organs and tissues.v Circulatory failure:pressor agentv Heart failure:digitalis preparations洋地黄制剂v Convulsions:phenobarbital sodiumv encephaledema:mannitolv central inhibition made by poisoning with hypnotic:bemegrideCase oneCase one femalefemale，2828,found in coma by families half an,fo
41、und in coma by families half an hour ago,then sent to hospital.Healthy in the past.hour ago,then sent to hospital.Healthy in the past.Physical examinationPhysical examination：drowsinessdrowsiness，clammy skin,clammy skin,garlic odor can be smelled.garlic odor can be smelled.BPBP120/70mmHg120/70mmHg，P
42、 P 54 54 bpmbpm，R R20 20 bpmbpm，T T36.836.8.Being.Being isocoria,diameter isocoria,diameter 0.1cm0.1cm，cardiac physical cardiac physical examination(examination(一一).Moist).Moist rales can be heard in lungs.rales can be heard in lungs.Abdominal physical examination(-),limbs twitching Abdominal physic
43、al examination(-),limbs twitching occasionallyoccasionally，pathologic characters(-)pathologic characters(-)laboratory examinationslaboratory examinations：blood glucose blood glucose 6.0mmol/L6.0mmol/L，blood ammonia blood ammonia 20 mmol/L20 mmol/L，cholinesterase cholinesterase activity 5activity 50%
44、0%，COHb1%COHb1%。Diagnosis?Chapter two Chapter two organophosphorus pesticides poisoningorganophosphorus pesticides poisoningDiagnostic basisDiagnostic basisvSudden onsetSudden onset，comacoma，exclude the coma caused by liver exclude the coma caused by liver disease,diabetes,CO poisoning,central nervo
45、us disease,diabetes,CO poisoning,central nervous system disease.system disease.vAsk for medical history(the contact history of Ask for medical history(the contact history of organophosphorus pesticide.organophosphorus pesticide.vgarlic odorgarlic odorvclammy skin,contracted pupil,moist rales in clam
46、my skin,contracted pupil,moist rales in the lung.(M symptom)the lung.(M symptom)vactivity of cholinesterase decreases.activity of cholinesterase decreases.vmeasure the poison being in vomitus and gastric measure the poison being in vomitus and gastric content.content.SummarySummaryorganophosphorus p
47、esticide belongs to organophosphorus pesticide belongs to the organophosphorus ester or the organophosphorus ester or thiophosphoric esters compounds,thiophosphoric esters compounds,mostly presenting the character of mostly presenting the character of oilness or crystal.Its color is like oilness or
48、crystal.Its color is like faint yellow or brown.Its slightly faint yellow or brown.Its slightly volatile and smelled like garlic odor.volatile and smelled like garlic odor.Etiological factorEtiological factorv Productive poisoningv Usability poisoningv Living poisoningSkin,mucosa,respiratory tract,d
49、igestive tractMechanism of poisoningMechanism of poisoningPhosphorus acylation cholinesteraseACHOrganophosphorus pesticidecholinesterase胆碱能神胆碱能神经兴奋经兴奋Choline acetateHydroxycholine,nicotine and cetral Hydroxycholine,nicotine and cetral nervous system symptoms.nervous system symptoms.Phosphorus acylat
50、ion cholinesterase Phosphorus acylation cholinesterase will age within 72h,without recovery.will age within 72h,without recovery.Inhibit the activity of cholinesterase in nervous system,making the ACH accumulatingMain clinical manifestationMain clinical manifestationv M symptomsM symptoms:occurring
