11

First acute poisoning.

22

• Acute poisoningsAcute poisonings

• Acute poisoning is a pathologic Acute poisoning is a pathologic stage, which develops as a stage, which develops as a consequence of poison influence consequence of poison influence (which comes from the environment). (which comes from the environment). Depending on the quantity of poison Depending on the quantity of poison which come to the organism during which come to the organism during the time unit all poisonings are the time unit all poisonings are divided to acute and chronicle. Acute divided to acute and chronicle. Acute poisoning is a chemical injury.poisoning is a chemical injury.

33

Poison - is any chemical compounding that can disrupt biochemical processes in the functions of body and vital organs, creating danger to the life.

The main place among the causes of poisoning is ethanol (60%), carbon monoxide (15%), vinegar essence (16%), pharmaceuticals and pesticides (8 - 10%).

Nowdays is increasing in fatal alcohol poisoning and its substitutes, and FOS.

44

•According to WHO, in the According to WHO, in the countries of western Europe countries of western Europe the quantity of patients with the quantity of patients with poisoning is twice as big as poisoning is twice as big as the number of patients with the number of patients with MI and the lethality of this MI and the lethality of this reason is larger then the reason is larger then the lethality caused by infectious lethality caused by infectious diseases and transport diseases and transport injuries.injuries.

55

• Nearly 500 of the most common Nearly 500 of the most common poisoning agents are spreader in poisoning agents are spreader in our environment.our environment.

Acute poisoning is characterized Acute poisoning is characterized with:with:

Sudden beginning; brightness of Sudden beginning; brightness of the clinical presentation, grave the clinical presentation, grave complications. The consequences complications. The consequences of the poisoning often depend on of the poisoning often depend on the time and quality of medical the time and quality of medical aid.aid.

66

• Classification of poisonings according to Classification of poisonings according to their reasons and places of appearing:their reasons and places of appearing:

• Accidental poisonings:Accidental poisonings:

• industrialindustrial

• domesticdomestic

• medical mistakesmedical mistakes

• Intentional poisoningsIntentional poisonings

• criminalcriminal

• suicidalsuicidal

• The quantity of acute accidental The quantity of acute accidental poisonings is nearly 80%, suicidal – 18 %, poisonings is nearly 80%, suicidal – 18 %, industrial- 2% of all cases.industrial- 2% of all cases.

77

• There are two stages of acute There are two stages of acute poisoning:poisoning:

• Toxigenic- poison is in the body in Toxigenic- poison is in the body in dose, which might cause specific dose, which might cause specific influence (shock, asphyxia, coma influence (shock, asphyxia, coma gastro-intestinal bleeding).gastro-intestinal bleeding).

• Somatogenic- the poison leaves the Somatogenic- the poison leaves the organism, organs are injured and this organism, organs are injured and this stage lasts till the normalization of all stage lasts till the normalization of all body functions (pneumonia, sepsis).body functions (pneumonia, sepsis).

88

• There are 4 ways for poisons to enter the There are 4 ways for poisons to enter the body:body:

• InhalationInhalation• Through skinThrough skin• Through intestineThrough intestine• ParenteralParenteral• Removal of poison might be conducted Removal of poison might be conducted

through:through:• MetabolismMetabolism• BiotransformationBiotransformation• Renal and extra renal excretionRenal and extra renal excretion• Those, who are trying to perform first medical Those, who are trying to perform first medical

aid, should pay particular attention to the aid, should pay particular attention to the details and circumstances of the poisoning.details and circumstances of the poisoning.

99

• Immediate aid in case of Immediate aid in case of poisonings:poisonings:

• To stop the contact with the To stop the contact with the poison and usage of poison and usage of adsorbents.adsorbents.

• Antidotes.Antidotes.• Symptomatic treatment.Symptomatic treatment.• In case of poisonings with In case of poisonings with

bases and acids vomiting might bases and acids vomiting might cause the burnt of the cause the burnt of the esophagus. That is why gastric esophagus. That is why gastric sound is used.sound is used.

1010

•Forced diuresis is the most Forced diuresis is the most common method of common method of conservative therapy in case of conservative therapy in case of poisonings.poisonings.

Infusion therapy of electrolytes Infusion therapy of electrolytes is also used in such cases.is also used in such cases.

Acute ethanol poisoningAcute ethanol poisoning

The DL for clear alcohol is 12 The DL for clear alcohol is 12 g/kg, and mortal concentration g/kg, and mortal concentration in blood is from 5 to 6 grams.in blood is from 5 to 6 grams.

1111

Acute enteral ethanol Acute enteral ethanol poisoningpoisoning• Alcohol intoxication has a leading Alcohol intoxication has a leading

position in the number of fatal position in the number of fatal consequences. Approximately 98% of consequences. Approximately 98% of them become in the prehospital phase, them become in the prehospital phase, mostly because of the acute mostly because of the acute respiratory failure. Lethal dose of respiratory failure. Lethal dose of absolute alcohol is 4 - 12 g / kg and the absolute alcohol is 4 - 12 g / kg and the lethal concentration in the blood 5-6 lethal concentration in the blood 5-6 g/liter.g/liter.

1212

The majority of received ethanol is rapidly absorbed in the intestines, and by 1.5 years in the blood maximum concentration. Food supply in the stomach slows the absorption of alcohol. At the same time in the case of alcohol on an empty stomach or with a stomach illness rate of resorption increases. Ethanol is 90% oxidized in the liver. About 10% is excreted through the lungs and kidneys in unchanged form.

1313

• Alcohol comaAlcohol coma is divided into superficial and is divided into superficial and deep. The first is described with deep. The first is described with unconsciousness, inhibition or rising of unconsciousness, inhibition or rising of muscular tonus, pathological eyes muscular tonus, pathological eyes movements, trism e.t.c. The second means movements, trism e.t.c. The second means appearance of muscular atonya, appearance of muscular atonya, hypothermia, acute inhibition of corneal, hypothermia, acute inhibition of corneal, pupil and tendon reflexes.pupil and tendon reflexes.

• Another dangerous symptom is the violation Another dangerous symptom is the violation of the external breathing. That is why of the external breathing. That is why artificial lungs ventilation is necessary (with artificial lungs ventilation is necessary (with aspiration or intubation if such are aspiration or intubation if such are prescribed). prescribed).

• Analgetics are not used from the point of Analgetics are not used from the point of view of possible convulsions.view of possible convulsions.

1414

•CO poisoningCO poisoning

The source of CO in most The source of CO in most cases is incomplete burning of cases is incomplete burning of organic substances. Main organic substances. Main reasons are:reasons are:

Inhaling of Inhaling of exhaust gasexhaust gas in in closed area.closed area.

Inhaling of the smoke during Inhaling of the smoke during the fire.the fire.

1515

The serious poisoning of CO The serious poisoning of CO develops, when the level of develops, when the level of carboxyhemoglobin is 60-90%. carboxyhemoglobin is 60-90%. Among the symptoms are: Among the symptoms are: violation of external breathing, violation of external breathing, pathological reflexes, exotoxic pathological reflexes, exotoxic shock, hyperthermia, hypoxic shock, hyperthermia, hypoxic coma.coma.

1616

•Treatment.Treatment.

•1. To take the patient from the 1. To take the patient from the area of the injury.area of the injury.

•2. To conduct air pat, inhalate 2. To conduct air pat, inhalate Oxygen or use AVL if necessary.Oxygen or use AVL if necessary.

•3. To use antidote: hyperbaric 3. To use antidote: hyperbaric oxygenation (80-90 min. 1-4 oxygenation (80-90 min. 1-4 times a day).times a day).

1717

Gastric lavageGastric lavage

1818

Methanol (methyl alcohol) – alcohol that contains admixture of acetone, acid-methyl ester, allylic alcohol and other substances. Purified methanol according to its sight and smell is different from ethanol.Lethal dose ~ 100 - 150 ml.

1919

Symptoms of poisoning Symptoms of poisoning depends from the dose of depends from the dose of

adopted poison.adopted poison.•Mild poisoning (less than 50 ml methanol) -occurs headache, nausea, rapid fatigue, pain in the epigastric area; •Moderate poisoning - severe headache, nausea, vomiting, then within 6 - 10 h may be a period of relative improvement, then again can be headache, dizziness, thirst, asthma, blurred vision - "butterflies before the eyes, unclear vision.The violation of view may be temporary or permanent, even can be complete blindness.

2020

• Severe poisoningSevere poisoning has the same has the same beginning as the mild poisoning, beginning as the mild poisoning, there can be a period of relative there can be a period of relative improvement but then develops a improvement but then develops a coma. Sometimes coma can coma. Sometimes coma can occur immediately after occur immediately after inhalation of poison. Breathing inhalation of poison. Breathing becomes superficial, developing becomes superficial, developing acute cyanosis, pupils are dilatedacute cyanosis, pupils are dilated, , arterial pressurearterial pressure decreases. Death decreases. Death occurs due to respiratory damage occurs due to respiratory damage center on the background of center on the background of severe metabolic acidosis.severe metabolic acidosis.

2121

TreatmentTreatment• Flushing the stomach through the probe. Flushing the stomach through the probe.

• Ethanol as an antidote inside 100ml of Ethanol as an antidote inside 100ml of 30% solution, and then every 2 h for 50 30% solution, and then every 2 h for 50 ml - 5 times per night, in the following ml - 5 times per night, in the following days 100 ml 2 - 3 times a day. In a case days 100 ml 2 - 3 times a day. In a case of coma - ethanol intravenous drip in a of coma - ethanol intravenous drip in a 5% rate of 1 ml solution (kg • day) 96% 5% rate of 1 ml solution (kg • day) 96% solution. To speed up the withdrawal of solution. To speed up the withdrawal of formic acid is injected at high formic acid is injected at high folic acidfolic acid..

2222

Thank you for attention!