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Lecture notes, cheat sheets
Anesthesiology and resuscitation. Acute poisoning (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) Lecture number 10. Acute poisoning Acute poisoning - diseases of chemical etiology, the clinical picture of which develops with a single ingestion of chemicals into the human body in a toxic dose that can cause violations of vital functions and endanger life. According to the cause and place of occurrence, the following types of poisoning are distinguished. 1. Accidental poisoning (accidents) at work - exposure to industrial poisons during an accident or in violation of technical safety rules during the period of work with harmful substances; in everyday life - when there is an erroneous or incorrect use of household chemicals, in case of self-medication with medicinal drugs, their overdose or their erroneous use, with alcohol and drug intoxication, bites of poisonous insects and snakes; medical errors. 2. Deliberate poisoning - suicidal poisoning (true or demonstrative) and criminal poisoning (with the aim of killing or bringing to a helpless state); "police" (when using chemicals and poisons to restore public order) and combat poisoning (when using chemical weapons), including as a result of terrorist acts. According to the number of victims, individual, group and mass acute intoxications are distinguished. The intake of a toxic substance is possible through the mouth (incorporated, oral), through the respiratory tract (inhalation), unprotected skin (percutaneous), by parenteral injection, or when injected into the rectum, vagina, external auditory canal. In the clinical course of acute poisoning, two stages are distinguished: toxicogenic and somatogenic. The essence of the toxic stage is that the active substance in the body has a dose that can cause a specific toxic effect. The somatogenic stage occurs after the elimination or destruction of the toxic substance and manifests itself in the form of "trace" or residual violations of the structural and functional state of organs and systems. General principles for the diagnosis of acute poisoning 1. Clinical diagnosis is based on the following data: 1) inspection of the scene for the discovery of material evidence of poisoning; 2) anamnesis from the words of the victim or others - you can find out what toxic substance the victim took, the time of taking the toxic substance, the dose of the toxic substance taken, the route of penetration of the toxic substance into the body, the circumstances that accompanied the development of poisoning, etc .; 3) studying the clinical picture of the disease to identify specific symptoms of poisoning that are characteristic of a certain toxic substance or group of substances according to the principle of "selective toxicity". 2. Laboratory toxicological diagnostics is aimed at the qualitative or quantitative determination of toxic substances in the biological media of the body (blood, urine, etc.). 3. Pathological diagnostics consists in the detection of specific post-mortem signs of poisoning and is carried out by forensic experts. 1. Methyl alcohol poisoning Methyl alcohol is absorbed by all routes - respiratory, digestive and percutaneous. The lethal dose of methanol when taken orally ranges from 40-250 ml, but taking even 10-20 ml can cause blindness. Poisoning also occurs after taking various alcoholic mixtures containing from 1,5 to 2,5% methanol. After absorption, methanol is distributed throughout all tissues due to its water solubility. The largest amount accumulates in the kidneys and gastrointestinal tract, the smallest in the brain, muscles and adipose tissue. Pathological anatomical lesions include cerebral edema and damage to the initially inflammatory, and later dystrophic, nature of retinal ganglion cells. In some cases, in addition to damage to the nervous system, degenerative lesions of the liver, kidneys, lungs and heart muscle are found. clinical picture In the toxic effect of methanol, two-phase action can be distinguished. In the initial period (phase I), methanol acts on the body as a whole molecule and has a predominantly narcotic effect, but weaker than that of ethyl alcohol. Subsequently (phase II), the harmful effect of oxidation products is manifested. In the clinical picture, periods are distinguished: intoxication, latent, or relative well-being (lasting from several hours to 1-2 days), the main manifestations of intoxication and, with a favorable outcome, reverse development. According to the severity, mild, moderate (or ophthalmic) and severe (or generalized) are distinguished. With mild poisoning, rapid fatigue, headache, nausea, and a state of slight intoxication are noted, which occur after a latent period of 30 minutes to several hours. The simultaneous absorption of ethyl and methyl alcohol increases the latent period and reduces the severity of poisoning. In case of moderate poisoning, after a short latent period, the patient develops a headache, dizziness, acute pain in the abdomen (mainly in the epigastric region), vomiting, restlessness, delirium, convulsions. Ultimately, a deep coma sets in. The patient has hypothermia, in some cases, cyanosis, when respiratory failure of a central nature develops, followed by cardiovascular failure. At this stage, the pupils dilate, and the study of the fundus indicates the presence of retinal edema. Typical visual disturbances, such as reduced visual acuity, narrowing of the field, dilated pupils, loss of reflex to light, pain in the eyeball occur on the 2nd-6th day. Examination of the fundus reveals signs of optic nerve atrophy. The most severe complication is complete blindness. Treatment Treatment includes the following points. 1. Stopping the entry of poison into the body. Cessation of the use of poison, removal from the contaminated atmosphere, removal of poison from the skin. 2. Removal of non-absorbed poison (from the gastrointestinal tract): 1) probe gastric lavage; 2) the use of adsorbents or saline laxatives; 3) cleansing or siphon enema. 3. Removal of absorbed poison: 1) forcing diuresis; 2) methods of extracorporeal detoxification (hemosorption, hemodialysis, peritoneal dialysis, blood replacement operation). 4. Antidote therapy, i.e. neutralization of the poison due to physical or chemical neutralization, as well as competition with the poison for application points. 6. Maintaining the vital functions of the body. 7. Normalization of the water-electrolyte, acid-base state of the body. 8. Treatment of long-term consequences and complications. Gastric lavage with water or 2% sodium bicarbonate solution, followed by ingestion of 30 g of magnesium sulfate (sodium) in 100 ml of water. Subcutaneously 2 ml cordiamine, 1 ml 20% caffeine solution. In coma, intravenously, a 5% solution of ethyl alcohol in a 5% glucose solution at the rate of 1,5-2 g of alcohol per 1 kg of the patient's weight per day. Intravenously 400 ml of polyglucin (rheopolyglucin), 50-100 mg of prednisolone, glucosone-vocaine mixture (400 ml of 5% glucose solution with 25 ml of 2% novocaine solution), 80-120 mg of furosemide (lasix), 40 ml of 40% - glucose solution with 8 IU of insulin. 2. Ethyl alcohol poisoning Clinic When taking toxic doses - agitation, ataxia, stupor, coma with inhibition of reflexes, the smell of alcohol from the mouth, flushing of the face, conjunctivitis, "play" of the pupils, vomiting, involuntary urination, tachycardia, "hoarse" breathing, collapse, vomiting with possible aspiration of emetic wt. Treatment Gastric lavage through a thick probe, followed by the introduction of a saline laxative, siphon enema. Subcutaneously 1 ml of a 0,1% solution of atropine, 2 ml of cordiamine, 1 ml of a 20% solution of caffeine, with collapse - intramuscularly 1 ml of a 1% solution of mezaton. In the absence of pharyngeal reflexes - tracheal intubation and mechanical ventilation. Forcing diuresis with the simultaneous administration of a 4% sodium bicarbonate solution in a volume calculated according to the Astrup formula, hypertonic (10- and 20%) glucose solutions with insulin, B and C vitamins, cocarboxylase, nicotinic acid. With respiratory depression - intravenously slowly 3-5 ml of a 1,5% solution of etimizole, 10 ml of a 2,4% solution of aminophylline, 1 ml of a 5% solution of ephedrine, oxygen inhalation. With aspiration - emergency sanitation bronchoscopy. Parenteral antibiotics. 3. Ethylene glycol (antifreeze) poisoning The mean lethal dose is approximately 100 ml. It is rapidly absorbed in the digestive tract and distributed to all tissues, creating a maximum concentration in the brain. The main toxic effect is observed in the renal parenchyma, where necrosis of the tubular epithelium develops, interstitial edema, and foci of hemorrhagic necrosis in the cortical layer. Edema is found in the brain. Clinic In the clinic of intoxication, 3 periods are distinguished: 1) initial - lasting up to 12 hours, symptoms of CNS damage by the type of alcohol intoxication predominate; 2) neurotoxic - when the symptoms of CNS damage progress and respiratory and cardiovascular system disorders join; 3) nephrotoxic - on the 2nd-5th day, kidney damage predominates in the clinical picture of intoxication. The duration and severity of periods of intoxication depends on the severity of poisoning. In mild cases, after a period of intoxication (10-15 hours), a slight malaise, headache, and nausea develop. Consciousness remains clear, kidney damage is not observed. In case of poisoning of moderate severity, against the background of symptoms of intoxication, vomiting, diarrhea, pain in the epigastric region, and headache occur. On the 3-5th day, symptoms of kidney damage appear. In severe poisoning, loss of consciousness quickly occurs, stiff neck, clonic-tonic convulsions, fever, noisy deep breathing, collapse, and pulmonary edema occur. If the patient does not die on the first day, then from the 2-3rd day symptoms of renal failure develop: thirst appears, back pain, the amount of urine decreases, up to anuria. The liver is enlarged, painful. Death comes from uremia. Treatment Gastric lavage with water or 2% sodium bicarbonate solution, followed by the introduction of 30 g of magnesium sulfate in 200 ml of water. Inside 200 ml of a 30% solution of ethyl alcohol. 3-5 g of sodium bicarbonate in 100 ml of water. Plentiful drink. Intramuscularly 1-2 ml of cordiamine, 1 ml of a 20% caffeine solution. Intravenously 400 ml of 5% glucose solution with 5 ml of 5% ascorbic acid solution and 8 units of insulin, glucosone-vocaine mixture, 400 ml of polyglucin, 400 ml of hemodez, 80-120 g of furosemide, 60-100 mg of prednisolone. 4. Dichloroethane poisoning The main routes of entry are the digestive tract, respiratory tract, and skin. The lethal dose of DCE for humans when administered orally is 10-20 ml. The toxic effect of DCE is due to the narcotic effect on the central nervous system, damage to the liver, kidneys, gastrointestinal tract, and a pronounced effect on the cardiovascular system. Clinic In the clinical picture, the leading symptoms are: toxic encephalopathy, acute toxic gastritis and gastroenteritis, impaired external respiration, toxic hepatitis, impaired renal function. In the first hours after administration, dizziness, ataxia, psychomotor agitation, clonic-tonic convulsions, depression of consciousness, up to a coma, appear. One of the early signs of poisoning are gastrointestinal disorders in the form of nausea, repeated vomiting with an admixture of bile. Violation of the function of external respiration often occurs according to the obstructive-aspiration type and is associated with increased salivation, bronchorrhea, and aspiration. Inhibition of the function of the respiratory center, the development of hypertonicity of the respiratory muscles and rigidity of the chest are noted. A severe complication is exotoxic shock, which is manifested by cooling and cyanosis of the skin, cold sweat, shortness of breath, tachycardia and hypovolemia. Decreased excretory function of the kidneys. According to the severity of DCE poisoning are divided into the following. 1. Mild poisoning, characterized by the development of dyspeptic disorders, mild neurological symptoms and mild hepatopathy. 2. Moderate poisoning. Occur with symptoms of toxic gastritis, gastroenteritis, toxic encephalopathy, moderate hepatopathy, mild nephropathy. 3. Severe poisoning occurs with severe manifestations of toxic encephalopathy, severe hepatopathy, toxic nephropathy, gastroenteritis. In case of vapor poisoning, headache, drowsiness, a sweetish taste in the mouth, the smell of poison from the mouth, irritation of the mucous membranes, loss of consciousness, acute hepatic-renal failure with yellowness of the sclera and skin, enlarged liver, anuria occur. When ingested - repeated vomiting, abdominal pain, loose stools with the smell of poison, hyperemia of the sclera, psychomotor agitation, followed by depression and coma, collapse, toxic shock, hemorrhagic syndrome, acute hepatic-renal failure. When the poison gets on the skin, dermatitis develops. Treatment In case of vapor poisoning - the removal of the victim from the affected area, with respiratory depression of the ventilator. If the poison gets inside - gastric lavage through a thick probe, followed by the introduction of 3-4 tablespoons of powdered activated carbon in 200 ml of water and 150-200 ml of vaseline oil, siphon enema. Intravenously 20-40 ml of a 30% solution of sodium thiosulfate, intramuscularly 5 ml of a 5% solution of unitiol. intravenously 400 ml of polyglucin, 400 ml of hemodez, 400 ml of 5% glucose solution, 80-120 mg of furosemide (lasix), 6-8 ml of 5% solution of ascorbic acid. Intramuscularly 2 ml of cordiamine, with collapse - 1 ml of a 1% solution of mezaton, 1 ml of a 20% solution of caffeine, 100-150 mg of prednisolone. With an increase in hepatic-renal failure, specific therapy is carried out. Intravenously bolus 400 ml of polyglucin, 400 ml of gemodez, 400 ml of 5% glucose, 80-120 mg of furosemide, 6-8 ml of 5% ascorbic acid, 100-150 mg of prednisolone, with collapse 1 ml of 1% mezaton . Intramuscularly 2-4 ml of 6% thiamine bromide and 2-4 ml of 5% pyridoxine. With psychomotor agitation, 1 ml of a 3% solution of fenozepam. Oxygen inhalation, with respiratory depression - IVL through a breathing tube. During the first day, the most effective and sparing method is peritoneal dialysis. The composition of the standard dialysis solution includes: potassium chloride 0,3 g, sodium chloride 8,3 g, magnesium chloride 0,1 g, calcium chloride 0,3 g, glucose 6 g per 1 liter of water. At the same time, up to 2 liters of electrolyte solution with the addition of 500 thousand units of penicillin and 1000 units of heparin are injected into the patient's abdominal cavity. In the somatogenic phase of poisoning, the main therapy is aimed at treating the developed complications: pneumonia, hepatopathy, etc. 5. Poisoning with poisonous mushrooms (fly agaric, false mushrooms, morels, pale grebe) Clinic After a latent period lasting from 1-2 to 36 hours, cramping abdominal pain, salivation, nausea, indomitable vomiting, diarrhea, dehydration, collapse, delirium, hallucinations, convulsions appear. On the 2-3rd day - the phenomena of renal and hepatic insufficiency with anuria, azotemia, jaundice. In severe poisoning with lines and morels, hemolysis is possible. Treatment Gastric lavage through a thick tube, followed by the introduction of 3-4 tablespoons of powdered activated carbon in 200 ml of water and 30 g of magnesium sulfate (sodium) in 100 ml of water, siphon enema. Subcutaneously 1 ml of a 0,1% solution of atropine, 2 ml of cordiamine. In morel poisoning, atropine is not used as an antidote. Intravenously 400 ml of polyglucin, 400 ml of hemodez, 400 ml of 5% glucose solution with 4-6 ml of 5% ascorbic acid solution, 80-120 mg of furosemide (lasix). Intramuscularly 1-2 ml of a 6% solution of thiamine bromide and 2 ml of a 5% solution of pyridoxine hydrochloride (do not inject in one syringe). Relief of pain syndrome intramuscularly with the introduction of 1 ml of a 0,2% solution of platifillin, 2 ml of a 2% solution of papaverine. With convulsions, psychomotor agitation - intramuscularly 1-2 ml of a 3% solution of fenozepam or a lytic mixture (1-2 ml of a 2,5% solution of chlorpromazine, 1-2 ml of a 1% solution of dimedrol, 5-10 ml 25 % solution of magnesium sulfate) under the control of blood pressure. Forcing diuresis. In severe cases - hemosorption, early hemodialysis. In case of severe poisoning with strings and morels, in the case of severe hemolysis and the absence of the possibility of hemodialysis, blood replacement surgery is performed. Correction of acidosis by intravenous administration of a 4% solution of sodium bicarbonate in a volume determined according to the Astrup formula. Antibiotics - benzylpenicillin up to 10 million units per day. Symptomatic therapy. With increasing hepatic and renal insufficiency - infusion therapy with a 5-10% glucose solution with insulin, vitamins of group B and C, 20-30 thousand IU of heparin, aminophylline. 6. Snake venom poisoning Clinic Pain and rapidly spreading swelling at the site of the bite, drowsiness, respiratory depression, collapse, intravascular hemolysis with hemoglobinuria, severe subcutaneous hemorrhages, sometimes convulsions. Possibly kidney failure. With a cobra bite, local changes are less pronounced, bulbar disorders (speech and swallowing disorders, ptosis, paralysis of the motor muscles) and respiratory depression predominate. Shows complete rest in a horizontal position. Squeezing out the first drops of blood from the wound. Immobilization of the injured limb. In place of the bite - cold. Plentiful drink. Treatment Suction of blood and lymph from the wound (no later than 30-60 minutes after the bite), formed at the site of the bite, using a blood-sucking jar. Washing the wound with 1% potassium permanganate solution. Introduction to the wound 0,3-0,5 ml of a 0,1% solution of adrenaline. If possible, urgent introduction of a specific mono- or polyvalent anti-snake serum after a preliminary intravenous injection of 100-150 ml of hydrocortisone or 50-100 ml of prednisolone. In case of cobra bites - intravenous Anticobra serum at a dose of 300 ml in combination with 1 ml of a 0,05% solution of prozerin and repeated administration every 30 minutes with 1 ml of a 0,1% solution of atropine. Prophylactically - anti-tetanus serum according to Bezredka, intravenous polarizing mixture, 10-15 thousand units of heparin, 1-2 ml of 1% diphenhydramine solution, 10 ml of 10% calcium chloride (gluconate) solution, 5-10 ml of 5% - ascorbic acid solution, 50-100 mg of prednisolone or 100-150 mg of hydrocortisone, 400 ml of gemodez, 400 ml of polyglucin, 40-80 mg of lasix. Pain relief by intravenous administration of 1 ml of a 2% solution of promedol. In acute respiratory failure - mechanical ventilation through a breathing tube, oxygen inhalation. In severe toxicosis - hemosorption, with the progression of hepatic-renal failure - hemodialysis in combination with hemosorption. Symptomatic therapy. 7. Poisoning with concentrated acids (nitric, acetic, sulfuric) Clinic Inhalation of vapors causes irritation of the eyes and upper respiratory tract (lacrimation, runny nose, cough, shortness of breath). Reflex respiratory arrest is possible. After a latent period (from 2 to 24 hours), toxic pneumonia or toxic pulmonary edema is formed. At hit in eyes, on skin - chemical burns. When ingested - a chemical burn of the oral cavity, pharynx, esophagus, stomach, possible swelling of the larynx with respiratory failure. Repeated vomiting with blood, peritoneal irritation, and occasionally perforation of the esophagus or stomach. Collapse, shock, hemorrhagic syndrome. Possible intravascular hemolysis, hemoglobinuric nephrosis with acute renal (renal-hepatic) insufficiency. Tubeless gastric lavage and artificial vomiting are dangerous due to the possibility of re-burning the esophagus and acid aspiration. Do not inject saline laxative and alkaline solutions. Treatment Gastric lavage through a thick tube with cold water after a preliminary intravenous or intramuscular injection of 1-2 ml of a 2% solution of promedol. Inside pieces of ice, Almagel A 15-20 ml every hour. Intravenously 800 ml of polyglucin, 400 ml of hemodez, glucosone-vocaine mixture (400 ml of 5% glucose solution with 25 ml of 2% novocaine solution), 50-150 mg of prednisolone or 150-250 mg of hydrocortisone, 10 thousand units of heparin, 80-120 mg furosemide (Lasix). Relief of the pain syndrome is achieved intravenously with the introduction of 1-2 ml of a 0,005% solution of fentanyl and 2-4 ml of a 0,25% solution of droperidol, with persistent pain in the abdomen - intramuscularly 1-2 ml of a 0,2% solution of platyfillin, 2 ml of 2% papaverine solution. Inhalation of oxygen with a defoamer. With increasing laryngeal edema - intravenously 200-400 mg of prednisolone, 1-2 ml of a 1% solution of diphenhydramine, 10-20 ml of a 2,4% solution of aminophylline, 1-2 ml of a 5% solution of ephedrine. In the absence of effect - tracheostomy, oxygen inhalation, according to indications - mechanical ventilation. 8. Poisoning with arsenic and its compounds Clinic There is a metallic taste in the mouth, abdominal pain, vomiting, loose stools, severe dehydration, convulsions, tachycardia, lowering blood pressure, coma, acute renal failure. Arsenic hydrogen poisoning develops intravascular hemolysis, hemoglobinuria. Treatment Gastric lavage through a thick tube (2-3 times a day) with the introduction at the beginning and at the end of washing 50 ml of a 5% solution of unithiol, repeated siphon enemas with the addition of unithiol. Continuation of antidote therapy intravenously or intramuscularly with the introduction of a 5% solution of unitiol (up to 300 ml per day), intravenous drip of 20 ml of 10% calcium tetacine (ED1A) in 400 ml of a 5% glucose solution. In case of poisoning with arsenic hydrogen - intramuscularly, 1-2 ml of a 40% solution of mecaptide (up to 6-8 ml per day). Forcing diuresis with the simultaneous administration of hypertonic (10-20% glucose solution) polyionic solutions, 4% sodium bicarbonate solution in a volume calculated according to the Astrup formula, glucosone-vocaine mixture, aminophylline, B and C vitamins, cytochrome C. In severe poisoning - early hemodialysis. In the process of performing hemodialysis, a 5% unithiol solution is injected intravenously (30-40 ml / h for severe poisoning, 20-30 ml / h for moderate poisoning). In acute hemolysis and the impossibility of hemodialysis, a blood replacement operation is performed. 9. Lye poisoning Clinic When ingested, a chemical burn of the mucous membrane of the oral cavity, esophagus, and stomach develops. Pain along the esophagus and in the abdomen, vomiting with an admixture of blood, esophageal-gastric bleeding. Possible perforation of the esophagus, stomach with the development of mediastinitis, peritonitis. With a burn of the larynx - hoarseness of voice, aphonia, difficulty (stridor) breathing. In severe cases - burn shock, oliguria. Contact with skin causes chemical burns. Treatment Treat as in acid poisoning. 10. Atropine poisoning Clinic Dry mouth, hoarseness, dry, hyperemic skin, dilated pupils, shortness of breath, palpitations, tachycardia, thirst, nausea, difficulty urinating. In severe poisoning - psychomotor agitation, delirium, hallucinations, convulsions, heart rhythm disturbances, coma, collapse are possible. Treatment If necessary - gastric lavage through a thick probe, richly lubricated with vaseline oil, the introduction of 3-4 tbsp. l. powdered activated carbon in 200 ml of water and 30 mg of magnesium sulfate in 100 ml of water. intravenously 2-4 ml of 0,05% proserin solution, 400-800 ml of 5% glucose solution, 40-80 mg of furosemide (lasix). Plentiful drink. Relief of psychomotor agitation and convulsions intramuscularly with the introduction of 1-2 ml of a 3% solution of fenozepam or a lytic mixture (2 ml of a 2,5% solution of chlorpromazine, 2 ml of a 1% solution of diphenhydramine and 10 ml of a 25% solution of magnesium sulfate ) or 1-2 g of chloral hydrate in an enema with 1-2 g of starch per 25-50 ml of water, intravenously 10-15 ml of a 20% sodium hydroxybutyrate solution, 2-4 ml of a 0,5% solution of seduxen. With severe tachycardia, extrasystole - intravenously anaprilin (1-2 ml of a 0,25% solution) or an anaprilin tablet (40 mg) under the tongue. With collapse - intravenously 1 ml of a 1% solution of mezaton in 10 ml of a 0,9% solution of sodium chloride. With a sharp hyperthermia - intramuscularly 2 ml of a 50% solution of analgin, ice packs on large vessels and the head, wet wraps. 11. Hemp poisoning (hashish, marijuana, marijuana, plan) Clinic There is euphoria, psychomotor agitation, vivid visual hallucinations, dilated pupils, tinnitus. Subsequently, weakness, lethargy, depression of mood, drowsiness, bradycardia, hypothermia. Treatment In case of oral poisoning - gastric lavage through a thick probe, followed by the introduction of 3-4 tablespoons of powdered activated carbon in 200 ml of water. Intravenously 400-800 ml of a 5% glucose solution with 5-10 ml of a 5% solution of ascorbic acid and 8-16 units of insulin, 40-80 mg of furosemide (lasix), intramuscularly 2 ml of a 6% solution of thiamine bromide. With a sharp excitation - intramuscularly 3-5 ml of a 2,5% solution of chlorpromazine or a lytic mixture (2 ml of a 2,5% solution of chlorpromazine, 1-2 ml of a 1% solution of diphenhydramine and 5-10 ml of 25% - a solution of magnesium sulfate) under the control of blood pressure. oxygen inhalation. Forcing diuresis. In severe cases resort to hemosorption. 12. Cocaine and dicaine poisoning Clinic Clinically manifested by general agitation, headache, flushing of the face, dilated pupils, tachycardia, increased respiration, increased blood pressure, hallucinations. In severe cases - convulsions, coma, respiratory paralysis, collapse. Treatment Repeated gastric lavage through a thick probe with a 0,1% solution of potassium permanganate, followed by the introduction of 3-4 tbsp. l. powdered activated carbon in 200 ml of water and 30 g of magnesium sulfate in 100 ml of water. Intravenously 400 ml of gemodez, 400 ml of 5% glucose solution with 5-10 ml of 5% ascorbic acid solution, 40-80 mg of furosemide (lasix). When excited - fixing the victim, intramuscularly 1-2 ml of a 3% solution of fenozepam or a lytic mixture (1-2 ml of a 2,5% solution of chlorpromazine, 2 ml of a 1% solution of diphenhydramine and 5-10 ml of 25% - a solution of magnesium sulfate) under the control of blood pressure. With convulsions, 1-2 g of chloral hydrate is administered in an enema with 1-2 g of starch in 25-50 ml of water, slowly intravenously 15-20 ml of a 20% sodium oxybutyrate solution, if there is no effect, slowly intramuscularly up to 20 ml of 2,5% solution of sodium thiopental or hexenal. With the development of a coma - an ice pack on the head, intravenously 40 ml of a 40% glucose solution with 4-6 ml of a 5% solution of ascorbic acid and 8 units of insulin, intravenously slowly or intramuscularly 2-4 ml of a 6% solution of thiamine bromide and 2-4 ml of a 5% solution of pyridoxine hydrochloride, 80-120 mg of furosemide. With severe respiratory depression, mechanical ventilation is carried out, intravenously slowly 2 ml of cordiamine, oxygen inhalation. 13. Poisoning with narcotic analgesics (morphine, omnopon, droperidol) Clinic Drowsiness or unconsciousness, pupillary constriction, muscle hypertonicity (sometimes convulsions), respiratory depression, bradycardia, collapse. Respiratory paralysis is possible with the patient's consciousness preserved. Treatment Gastric lavage through a thick probe (while maintaining consciousness), followed by the introduction of 3-4 tablespoons of powdered activated carbon and 30 g of sodium sulfate, siphon enema. Intravenously 400 ml of gemodez, 400 ml of polyglucin, 400 ml of 5% glucose solution, 60-80 mg of furosemide (lasix). Subcutaneously 1-2 ml of a 0,1% solution of atropine, 1-2 ml of cordiamine, 1 ml of a 20% solution of caffeine. With the development of a coma, an ice pack on the head, intravenously 40 ml of a 40% glucose solution with 5-10 ml of a 5% solution of ascorbic acid and 8 units of insulin, intravenously slowly or intramuscularly 2-4 ml of a 6% solution of thiamine bromide and 2-4 ml of a 5% solution of pyridoxine hydrochloride, 80-120 mg of furosemide (lasix). If necessary - bladder catheterization and urine extraction. With respiratory depression - IVL, oxygen inhalation. Hemosorption (2-3 times a day until consciousness is restored). Author: Kolesnikova M.A. << Back: Shock >> Forward: Pain and analgesics (Pain. Analgesic drugs)
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