General principles of emergency care for oral poisoning, treatment of acute poisoning, antidotes and antagonists.

Acute oral poisoning is associated with the use of toxic, potent and toxic substances inside. In this connection, the main stages of emergency care for oral poisoning with various substances are similar. It is necessary to stop the absorption of the poisonous substance and accelerate its excretion from the body. 

General principles of emergency care for oral poisoning, treatment of acute poisoning, antidotes and antagonist substances.

To neutralize the poisonous substance with oral poisoning in the body, drugs are used – antidotes. They conduct treatment aimed at eliminating the symptoms of acute poisoning and maintaining the activity of vital organs. Acute oral poisoning often occurs in everyday situations. Prior to the arrival of the ambulance crew, victims need emergency care, which is often provided by lay people. Basic knowledge of emergency care for acute poisoning is essential for almost everyone.

In acute oral poisoning, it is important to find out what the victim ate or drank. If a person is unconscious, then you need to examine everything around and look for the source of poisoning. In some cases, you can find packaging for medicines, containers for household chemicals, the remains of poisonous plants, and more. Everything found must be kept until the arrival of an ambulance.

This will help determine the poisonous substance and correctly assess the condition of the victim, make a forecast regarding his condition in the near future and prescribe the correct treatment. Sometimes the remnants of drugs and chemical fluids are sent for examination to accurately determine their composition. Of particular importance is the discovery of empty packages of drugs and household chemicals in the event that a child is injured.

Often acute oral poisoning occurs in children under 5 years old if adults leave drugs, toxic fluids, and more in an accessible place for them. If a child is found in an unconscious state, a thorough examination of the room can help to find out its cause. If the child is conscious, but he has drowsiness, nausea, vomiting, inappropriate behavior, salivation or other symptoms that make it possible to suspect poisoning, you need to ask him about what is happening.

If you find empty packages of drugs or reduce the amount of contents of the package, you need to find out if the child took them. Children are not always, but can answer these questions. Call an ambulance for any suspected child poisoning. Prior to the arrival of health workers it is necessary to provide feasible emergency assistance depending on the situation.

First aid for oral poisoning.

To reduce the absorption of the toxic substance and its removal from the body, the stomach is washed and a cleansing enema is made. If these manipulations are not possible, then the victim is given emetic and laxative drugs, enterosorbents. The latter must be given in many cases and after cleansing the gastrointestinal tract. First of all, it is necessary to empty the stomach from its contents – cause vomiting. Why do you need to help the victim lean down and put pressure on the root of the tongue with fingers or a spatula. Then the stomach is washed with cool water – the patient drinks 1-2 glasses, and he is vomited. At the final stage of gastric lavage, enterosorbents and laxatives are given to the victim. This can be done if he is conscious..

In the unconscious state of the patient, the release of the stomach from the contents and rinsing is carried out using a thick rubber probe. Through it, laxatives or enterosorbents are then administered. The stomach is always rinsed until clean rinsing water appears. Care must be taken to ensure that vomit or flushing water does not enter the respiratory tract. To empty the stomach, you can use drugs that cause vomiting (1% solution of apomorphine, copper sulfate, zinc sulfate, water with a small amount of ammonia solution). It should be remembered that emetics are contraindicated in children under 5 years of age, injured, in an unconscious state, with poisoning by acids and alkalis.

The use of enterosorbents for oral poisoning.

Enterosorbents absorb various substances (including toxins) from the intestines. These drugs include activated charcoal, polyphepan, carbolene. They help to remove some of the toxins in the blood. This is especially necessary if a potent substance has a toxic effect on the kidneys and liver and leads to metabolic disorders..

Activated carbon is effective in case of poisoning with sleeping pills, including barbiturates, as well as cardiac glycosides, alkaloids, anesthetics, salts of heavy metals, sulfonamides. It is recommended to take it with food toxic infections, poisoning with hydrocyanic acid, gases, phenol derivatives. In the event that the poisonous substances are methyl alcohol, acids or alkalis, it is ineffective.

If to cause vomiting or gastric lavage to the victim failed, then activated charcoal is given in a larger dose (8-15 tablets). Carbolen is taken in a dose of 5-10 tablets. Depending on the type of poisonous substance, repeated administration of enterosorbents may be necessary. It should be borne in mind that they reduce the effectiveness of other drugs, since they partially absorb them.

The use of activated carbon in large doses can lead to constipation. If the medicine is administered through a probe, then the tablets should be crushed and diluted with water. When using enterosorbents through the mouth, it is advisable to pre-crush them too and add a little water until gruel.

The use of laxatives for oral poisoning.

Laxatives for acute oral poisoning are recommended if the expected poison is absorbed for a long time. Usually this occurs with poisoning by poisonous mushrooms and plants, with the intentional use of tablets in the shell, foodborne diseases. As a laxative for acute poisoning, use paraffin oil, 30% sodium sulfate solution (100-150 ml each).

Comprehensive first aid measures for oral poisoning.

In the provision of emergency care, it is better to use comprehensive measures even with a satisfactory condition of the victim. With prolonged absorption of the poisonous substance or the slow development of its action, the condition of the victim may worsen after a while, so do not wait. In a specialized hospital for the removal of toxic substances from the body, as well as in the development of renal and hepatic insufficiency, artificial blood purification is performed (hemodialysis, hemosorption, peritoneal dialysis).

Intensive therapy also includes infusion therapy in the regime of forced diuresis. In some cases, a replacement blood transfusion is performed. Infusion therapy in the regime of forced diuresis (intravenous infusion of drug solutions in large volumes in combination with diuretics) begins at the prehospital stage with ambulance medical personnel.

It is necessary for poisoning with substances that are excreted from the body by the kidneys. In the future, it is also carried out to remove toxins from the body that accumulate in renal and liver failure. First, 1.5–2 L of 0.9% sodium chloride solution, 5% glucose solution, and hemodesis are poured into a vein. Then, 80–200 mg of furosemide or mannitol solution is administered intravenously at a dose of 1–1.5 g / kg body weight. Then they proceed to the infusion of solutions containing glucose, sodium chloride, potassium chloride.

Treatment of acute poisoning, antidotes and antagonist substances.

General principles of emergency care for oral poisoning, treatment of acute poisoning, antidotes and antagonists.

The volume of infused solutions depends on the amount of urine excreted (determined every hour). In the course of infusion therapy, 10–20 ml of a 10% solution of calcium chloride or calcium gluconate is administered. If within 5-6 hours the volume of urine excreted does not correspond to the volume of infused solutions (significantly less), then a diuretic drug (200-400 mg of furosemide) is administered intravenously. In the absence of effect, infusion therapy is stopped due to the development of acute renal failure and hemodialysis is performed..

When poisoning with substances that cause a shift of the acid base state to the acid side, a 4% sodium bicarbonate solution is introduced. When the acidic ground state changes, a solution of ammonium chloride is introduced into the alkaline side. Obligatory laboratory monitoring of the acid state and the level of blood electrolytes. It is also necessary to calculate the ratio of the volume of infused fluid and excreted urine.

When providing emergency care for acute poisoning, antidotes are used – antidotes (they bind the poisonous substance and remove it from the body) and antagonists (have the opposite effect). Antidotes are administered in the first hours, rarely – within 1-2 days after the poisonous substance gets inside.

Based on the book “Quick help in emergency situations”.
Kashin S.P..

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