Principles of Providing Emergency Care

The peculiarity of emergency care for acute exogenous poisoning is the need for a combined implementation of the following therapeutic measures: accelerated removal of toxic substances from the body (methods of active detoxification); urgent use of specific (antidote) pharmacotherapy that favorably changes the metabolism of a toxic substance in the body or reduces its toxicity; symptomatic therapy aimed at protecting and maintaining the body function that is predominantly affected by a given toxic substance.

At the scene of the incident, it is necessary to establish the cause of poisoning, the type of toxic substance, its quantity and route of entry into the body, and, if possible, find out the time of poisoning, the concentration of the toxic substance in the solution or the dosage in medications. Ambulance workers must report this information to the hospital doctor.

It should be taken into account that the entry of a toxic substance into the body is possible not only through the mouth (oral poisoning), but also through the respiratory tract (inhalation poisoning), through unprotected skin (percutaneous poisoning), after injection of toxic doses of drugs (injection poisoning) or during introduction of toxic substances into various cavities of the body (rectum, vagina, external auditory canal, etc.).

Diagnosis of acute poisoning is based on determining the type of chemical drug that caused the disease by clinical manifestations of “selective toxicity” and its subsequent identification by laboratory chemical-toxicological analysis.

All victims with clinical signs of acute poisoning are subject to urgent hospitalization in specialized poison treatment centers or emergency hospitals.

Methods of active detoxification of the body. In case of poisoning by toxic substances taken orally, a mandatory and emergency measure is gastric lavage through a tube.

To lavage the stomach, use 12-15 liters of water at room temperature (18-20 °C) in portions of 300-500 ml. In case of severe intoxication in patients who are unconscious (poisoning with sleeping pills, organophosphate insecticides, etc.), the stomach is washed again 2-3 times in the first day after poisoning, since due to a sharp slowdown in resorption in a state of deep coma in the digestive tract a significant amount of unabsorbed toxic substance can be deposited.

After lavage is completed, 100-150 ml of a 30% solution of sodium sulfate or petroleum jelly is injected into the stomach as a laxative. To adsorb toxic substances in the digestive tract, use activated carbon with water (in the form of a slurry, 1 tablespoon orally before and after gastric lavage) or 5-6 carbolene tablets. In a comatose patient in the absence of cough and laryngeal reflexes, in order to prevent aspiration of vomit into the respiratory tract, the stomach is washed after preliminary intubation of the trachea with a tube with an inflatable cuff.

The administration of emetics (apomorphine) and induction of vomiting by irritation of the posterior pharyngeal wall is contraindicated in patients of early childhood (under 5 years), in a stuporous or unconscious state, as well as in persons poisoned by cauterizing poisons. To adsorb toxic substances in the gastrointestinal tract, use activated carbon with water in the form of a slurry, 1 tablespoon orally before and after gastric lavage or 5-10 carbolene tablets.

For snake bites, subcutaneous or intramuscular administration of toxic doses of drugs, cold is applied topically for 6-8 hours. Injection of 0.3 ml of 0.1% adrenaline solution into the injection site and a circular novocaine blockade of the limb above the site of toxin entry are also indicated. Application of a tourniquet to a limb is contraindicated.

In case of inhalation poisoning, you should first of all take the victim out into clean air, lay him down, ensure airway patency, and free him from stifles.