Algorithm of actions in case of carbon monoxide poisoning. What to do in case of carbon monoxide poisoning? Recipes of folk remedies

Carbon monoxide poisoning is one of the terminal (critical) conditions of a person, resulting in death. Usually occurs as a result of a malfunction furnace heating in rural areas, when a person is in a fire, in a closed car with the engine running. The process of carbon monoxide poisoning has been called carbon monoxide poisoning by the people, hence the common name for this gas - carbon monoxide.

Carbon monoxide is completely odorless, carbon monoxide poisoning can occur very imperceptibly, and carbon monoxide is formed wherever there is a combustion process, even in the oven. At a content of 0.08% CO in the inhaled air, a person feels a headache and suffocation. With an increase in CO concentration to 0.32%, paralysis and loss of consciousness occur (death occurs after 30 minutes). At a concentration above 1.2%, consciousness is lost after 2-3 breaths, a person dies in less than 3 minutes. Therefore, he is very dangerous. The main reason for its formation of carbon monoxide is the lack of oxygen in the combustion zone. And then, instead of completely harmless carbon dioxide - a product of full-fledged burning of fuel - the same carbon monoxide is formed.

Mechanism of influence carbon monoxide per person is that when it enters the bloodstream, it binds hemoglobin cells. Then hemoglobin loses its ability to carry oxygen. And than longer man breathes carbon monoxide, the less efficient hemoglobin remains in his blood, and the less oxygen the body receives. The person begins to choke, appears headache, confused consciousness. And if you don't get out in time Fresh air(or not take out to fresh air already unconscious), then a fatal outcome is not ruled out. In the case of carbon monoxide poisoning, it takes a long time for the hemoglobin cells to be completely cleared of carbon monoxide. The higher the concentration of CO in the air, the faster the life-threatening concentration of carboxyhemoglobin in the blood is created. For example, if the concentration of carbon monoxide in the air is 0.02-0.03%, then for 5-6 hours of inhalation of such air, a concentration of carboxyhemoglobin of 25-30% will be created, if the concentration of CO in the air is 0.3-0.5% , then the lethal content of carboxyhemoglobin at the level of 65-75% will be reached after 20-30 minutes of a person's stay in such an environment.

symptoms of carbon monoxide poisoning:
- there is muscle weakness

Dizziness

Noise in ears

Nausea

Drowsiness

sometimes, on the contrary, short-term increased mobility

then coordination disorder

hallucinations

Loss of consciousness

convulsions

Coma and death from paralysis of the respiratory center. The heart may still beat for some time after breathing has stopped. There have been cases of people dying from the consequences of poisoning even 2-3 weeks after the poisoning event.

The decisive moment in recognizing carbon monoxide poisoning may be the same manifestation of signs of poisoning in a large number of people at the same time in the same building, or the onset of improvement after the person left it.

The most common sources These are gas and oil stoves, wood burning stoves, gas appliances, pool water heaters and engines that emit exhaust gases. Cracked stoves, clogged chimneys, and blocked pipes can cause carbon monoxide to reach living quarters. Insufficient fresh air supply to the stove can contribute to the accumulation of carbon monoxide in the house. Cramped houses also increase the risk of carbon monoxide poisoning because they do not provide free ventilation.

First aid in carbon monoxide poisoning.

# In case of carbon monoxide poisoning, eliminate the supply of carbon monoxide

# remove victim to fresh air

# if the victim is conscious, it is necessary to lay him down, provide rest and continuous access to fresh air (fan with a newspaper, turn on a fan or air conditioner)

# if the victim is unconscious, start chest compressions and artificial respiration immediately until the ambulance arrives or regains consciousness.
# Remember that during the removal of the victim from a place where there is a dangerous concentration of carbon monoxide, first of all, you need to protect yourself so as not to get poisoned too. To do this, you need to act quickly and breathe through a handkerchief, gauze.

Carbon monoxide is a fairly common form of intoxication of the body, which is characterized by a rapid and extremely severe course, causes damage to all organs and systems, and often ends in death. If the victim is promptly and competently provided with first aid at the scene, the risk of developing severe complications can be significantly reduced. Adequate actions of others can save the victim from death.

Why is carbon monoxide dangerous?

Carbon monoxide is a poison of rapid and general toxic action. If its concentration in the air reaches 1.2% or more, then the death of the victim occurs within 3 minutes. The dangers of carbon monoxide are as follows:

1. It has neither color nor smell - a person simply will not feel his presence in the room.
2. Able to penetrate through soil layers, walls and any partitions.
3. It is not absorbed by porous materials, so even ordinary filtering gas masks do not protect against the toxic effects of carbon monoxide.

How carbon monoxide affects the body

First of all, the type of gas in question blocks the delivery of oxygen to organs and tissues - it is considered a blood poison, since erythrocytes are primarily affected. Normally, these blood cells carry oxygen to organs and systems with the help of hemoglobin, and when carbon monoxide enters the body, it binds to hemoglobin, forming carboxyhemoglobin, which is considered a compound that is detrimental to the whole body. As a result, erythrocytes are not able to deliver oxygen to organs and tissues, the whole body experiences acute oxygen starvation(hypoxia).

Since nerve cells are the most sensitive to a lack of oxygen, in case of carbon monoxide poisoning, characteristic symptoms of damage to the central nervous system appear first of all - impaired coordination,.

Another important point: carbon monoxide disrupts the work of the heart muscle and skeletal muscles. The fact is that this type of gas, when it enters the body, binds to the protein of the skeletal muscles and the heart muscle, and this is manifested by serious disturbances in the work of the heart - rapid breathing / heartbeat, weak pulse.

Symptoms of carbon monoxide poisoning

The intensity of the manifestations of symptoms depends only on how long carbon monoxide has affected the human body, and what was its concentration in the air - it is on the basis of these data that the degree of intoxication is established.

central nervous system

In mild to moderate poisoning, there will be:

• encircling nature with localization in the temples and forehead;
• nausea and;
• flickering of the image, "front sights";
• blurred consciousness;
• a sharp decrease in visual acuity and hearing;
• violation of coordination of movement;
• short term.

If there is a severe degree of carbon monoxide poisoning, then the victim will experience:

• loss of consciousness;
• coma;
• involuntary urination and defecation.

The cardiovascular system

Light and moderate degree of poisoning will be characterized by:

• increased heart rate and pulse;
• pressing pains in the anatomical location of the heart.

With severe poisoning, symptoms characteristic of a severe degree of carbon monoxide intoxication will appear:

• significantly accelerated pulse - up to 130 beats per minute, but at the same time it is practically not palpable;
• the highest risk of rapid development.

Respiratory system

This section of the body suffers precisely because of the acute lack of oxygen at the time of carbon monoxide poisoning. If intoxication occurs in a mild to moderate degree, then a person will also experience rapid breathing. But in the case of a severe degree of poisoning with the type of gas in question, the victim's breathing will be intermittent, superficial.

Skin and mucous membranes

It is almost impossible to notice any pronounced changes on the skin and mucous membranes during carbon monoxide poisoning. The only thing that can appear with a mild and moderate degree of intoxication is their bright red or pronounced pink hue. With a severe degree of the condition under consideration, on the contrary, the skin and mucous membranes will be pale, with a barely noticeable pink tint.

In medicine, atypical forms of carbon monoxide poisoning are also distinguished. In this case, the following symptoms will be present:

1. swoon form- intense, pronounced pallor of the skin and mucous membranes, loss of consciousness.
2. Euphoric form- the patient is agitated, there are hallucinations, there may be unmotivated actions, loss of consciousness, coupled with heart and respiratory failure.

Consequences of carbon monoxide poisoning

The condition under consideration entails a number of complications, which in medicine are usually divided into early and late.

Early complications of acute carbon monoxide poisoning (first 2 days after the incident):

Late complications of carbon monoxide poisoning (2-40 days):

1. From the side of the central nervous system: memory loss, decreased intelligence, impaired motor function, apathy, blindness, dysfunction of the pelvic organs, parkinsonism, paralysis.
2. From the side of the cardiovascular system:, cardiac asthma, mycoarditis different types, .
3. From the respiratory system: rapid.

To reduce the intensity of complications, to protect the victim from severe intoxication, you need to know how to act when a person who has been poisoned by carbon monoxide is detected.

First aid for carbon monoxide poisoning

The first thing to do when a victim is found is to call an ambulance team, and this must be done even if the victim himself speaks of his normal state of health. Remember important points:

And before the arrival of the ambulance brigade, you can and should provide the following assistance:

1. Stop the effect of carbon monoxide on the body of the victim. To do this, a person should be taken out to fresh air, cut off the source of carbon monoxide (if possible), put on an oxygen mask or a special gas mask with a hopcalite cartridge. The latest recommendations apply to those cases where such funds are "at hand".
2. Ensure the passage of oxygen through the respiratory tract. It is highly desirable to lay the victim on his side, after unbuttoning his tie, shirt, belt on his trousers, removing his sweater or jacket, jacket.
3. Bring to consciousness, provide a rush of blood to the brain. This goal can be achieved with the help of ammonia - drop it on a cotton swab and bring it to the victim's nose at a distance of at least 1 cm. hearts). Give the victim to drink hot tea or coffee, if there is such an opportunity and the poisoned person has already regained consciousness.
4. If there is a need, then you need to make the victim an indirect heart massage and artificial respiration. In this case, the cycle must be defined: 2 breaths and 30 chest compressions.
5. The victim should not waste his energy, he needs to provide peace. To do this, it is enough to lay the poisoned person on their side, cover them with a blanket or wrap them in a jacket / coat. Be sure to ensure that the victim does not overheat.

Carbon monoxide, or carbon monoxide (chemical formula CO) is an extremely toxic, colorless gas. It is an obligatory product of incomplete combustion of carbon-containing substances: it is determined in car exhaust gases, cigarette smoke, in smoke from fires, etc. Carbon monoxide has no smell, therefore, it is impossible to detect its presence and evaluate the concentration in the inhaled air without instruments.

Source: depositphotos.com

Getting into the blood, carbon monoxide displaces oxygen from the connection with the respiratory protein hemoglobin and inhibits the functioning of active centers responsible for the formation of new hemoglobin, thereby causing acute oxygen starvation of tissues. In addition, carbon monoxide disrupts the flow of oxidative processes in the body.

Carbon monoxide, which has a high affinity for the respiratory protein, attaches to it much more actively than oxygen. For example, if the concentration of CO in the inhaled air is only 0.1% of the total volume (the ratio of carbon monoxide and oxygen is 1:200, respectively), hemoglobin will bind equal amounts of both gases, i.e. half of the respiratory protein circulating in the systemic circulation will be occupied by carbon monoxide gas.

The breakdown of a carboxyhemoglobin molecule (hemoglobin-carbon monoxide) occurs approximately 10,000 times slower than an oxyhemoglobin molecule (hemoglobin-oxygen), which causes the danger and severity of poisoning.

The exhaust gases of a car contain a maximum of 13.5% carbon monoxide, an average of 6-6.5%. So, a low-power motor of 20 liters. With. produces up to 28 liters of CO2 per minute, creating a lethal concentration of gas in the air in a closed room (garage, repair box) for 5 minutes.

The characteristic symptoms of poisoning appear after 2-6 hours of inhalation of air containing 0.22-0.23 mg of carbon monoxide per 1 liter; severe poisoning with loss of consciousness and death can develop in 20-30 minutes at a concentration of carbon monoxide of 3.4-5.7 mg / l and after 1-3 minutes at a poison concentration of 14 mg / l.

Carbon monoxide poisoning most often occurs in the following cases:

• improper operation or malfunction of furnace equipment, gas heaters;
• stay in an unventilated enclosed space with the car engine running;
• fire;
• smoldering electrical wiring, household appliances, interior details and furniture;
• violation of safety regulations when working in a chemical industry where carbon monoxide is used.

The probability of poisoning is directly proportional to the concentration of carbon monoxide in the inhaled air and the time of its exposure to the body.

Symptoms of poisoning

The nervous system is most sensitive to changes in the level of oxygen in the blood. The degree of damage can vary from mild reversible to generalized, entailing temporary or permanent disability, and in especially severe cases, death of the victim.

In addition to the nervous system, the respiratory (tracheitis, tracheobronchitis, pneumonia) and cardiovascular (dystrophy and necrotization of the myocardium, degenerative changes in the walls of blood vessels) systems are most often involved in the pathological process.

Depending on the concentration of CO in the air and, accordingly, carboxyhemoglobin in the blood, several degrees of carbon monoxide poisoning are distinguished.

Symptoms of mild poisoning (the content of carboxyhemoglobin in the blood does not exceed 30%):

• consciousness is preserved;
• constricting, pressing headache, reminiscent of tightening with a hoop;
• dizziness, noise, ringing in the ears;
• lacrimation, copious nasal discharge;
• nausea, vomiting;
• slight transient visual disturbances are possible;
• difficulty breathing;
• sore throat, dry cough.

Poisoning of moderate severity (develops at a concentration of carboxyhemoglobin in the blood from 30 to 40%):

• short-term loss or other disturbances of consciousness (stunning, soporous state or coma);
• difficulty breathing, intense shortness of breath;
• persistent dilated pupils, anisocoria (pupils of different sizes);
• hallucinations, delusions;
• tonic or clonic convulsions;
• tachycardia, pressing pain behind the sternum;
• hyperemia of the skin and visible mucous membranes;
• discoordination;
• visual impairment (decrease in sharpness, flickering flies);
• hearing loss.

In severe poisoning (carboxyhemoglobin concentration 40-50%):

• coma different depth and duration (up to several days);
• tonic or clonic convulsions, paralysis, paresis;
• involuntary urination and / or defecation;
• weak thready pulse;
• superficial intermittent breathing;
• cyanosis of the skin and visible mucous membranes.

In addition to the classic manifestations of carbon monoxide poisoning, atypical symptoms may develop in one of the following forms:

• fainting - characterized by a sharp decrease in blood pressure (up to 70/50 mm Hg and below) and loss of consciousness;
• euphoric - a sharp psychomotor agitation, a decrease in criticism, a violation of orientation in time and space, hallucinations and delusions are possible;
• fulminant - develops when the concentration of CO in the inhaled air is 1.2% or more, the content of carboxyhemoglobin in the systemic circulation in this case exceeds 75%. The death of the victim occurs rapidly, in 2-3 minutes.

If poisoning occurs carbon monoxide , then we are talking about a serious pathological condition. It develops if a certain concentration enters the body carbon monoxide .

This condition is dangerous to health and life, and if you do not turn to specialists for help in a timely manner, death from carbon monoxide can occur.

Carbon monoxide (carbon monoxide, CO) is a product that is released during combustion and enters the atmosphere. Since poison gas has no smell or taste, and it is impossible to determine its presence in the air, it is very dangerous. In addition, it can penetrate soil, walls, filters. Many are interested in the question, carbon monoxide is heavier or lighter than air, the answer is that it is lighter than air.

That is why it is possible to determine that the concentration of carbon monoxide in the air is exceeded by using special devices. It is also possible to suspect CO poisoning if a person develops some signs rapidly.

In urban conditions, the concentration of carbon monoxide in the air is increased by vehicle exhaust gases. But car exhaust poisoning can only occur at high concentrations.

How CO affects the body?

This gas enters the blood very quickly and actively binds to. As a result, it produces carboxyhemoglobin , which is more closely related to hemoglobin than oxyhemoglobin (oxygen and hemoglobin). The resulting substance blocks the transfer of oxygen to tissue cells. As a result, it develops hemic type.

Carbon monoxide in the body binds to myoglobin (it is a protein of skeletal muscles and heart muscle). As a result, the pumping function of the heart decreases, and severe muscle weakness develops.

Also carbon monoxide enters into oxidative reactions, which disrupts the normal biochemical balance in the tissues.

Where can carbon monoxide poisoning occur?

Many situations can occur in which carbon monoxide poisoning is possible:

• poisoning by combustion products during a fire;
• in the premises where gas equipment, and at the same time there is no normal ventilation, there is not enough supply air, which is necessary for the normal combustion of gas;
• in those industries where CO is involved in the reactions of synthesis of substances ( acetone , phenol );
• in places where automobile exhaust gases can accumulate due to insufficient ventilation - in tunnels, garages, etc.;
• at home, when there is a leakage of lighting gas;
• when staying near very busy highways for a long time;
• with prolonged use of a kerosene lamp, if the room is not ventilated;
• if the stove damper of the home stove, fireplace, sauna stove was closed too early;
• when using breathing apparatus with low-quality air.

Who can suffer from hypersensitivity to CO?

• people who have been diagnosed with exhaustion of the body;
• those who suffer , ;
• future mothers;
• teenagers, children;
• those who smoke a lot;
• people who abuse alcohol.

You should know that organs and systems in case of carbon monoxide poisoning are more quickly affected in women. The symptoms of poisoning are very similar. methane .

Signs of carbon monoxide poisoning

The following describes the symptoms of carbon monoxide poisoning in humans, depending on the concentration of CO. Symptoms of household gas poisoning and poisoning from other sources manifest themselves in different ways, and by the way carbon monoxide (not carbon dioxide, as it is sometimes mistakenly called) acts on a person, one can assume how strong its concentration was in the air. However, carbon dioxide in high concentrations can also lead to poisoning and the manifestation of a number of alarming symptoms.

Concentration up to 0.009%

Clinical manifestations are noted after 3-5 hours:

• decrease in the speed of psychomotor reactions;
• increased blood flow in vital organs;
• in people with heart failure in severe form, chest pain is also noted.

Concentration up to 0.019%

Clinical manifestations are noted after 6 hours:

• performance decreases;
• shortness of breath with moderate physical exertion;
• headache , slightly pronounced;
• visual impairment;
• the death of those who suffer from severe heart failure is possible, and fetal death can also occur.

Concentration 0.019-0.052%

• severe throbbing headache;
• irritability, instability of the emotional state;
• nausea;
• impaired attention, memory;
• fine motor problems.

Concentration up to 0.069%

Clinical manifestations are noted after 2 hours:

• vision problems;
• worse headache pain;
• confusion;
• weakness;
• nausea, vomiting;
• runny nose.

Concentration 0.069-0.094%

Clinical manifestations are noted after 2 hours:

• severe dysmotility (ataxia);
• appearance;
• strong rapid breathing.

Concentration 0.1%

Clinical manifestations are noted after 2 hours:

• weak pulse;
• a state of fainting;
• convulsions;
• breathing becomes rare and superficial;
• condition .

Concentration 0.15%

Clinical manifestations are observed after 1.5 hours. Manifestations are similar to the previous description.

Concentration 0.17%

Clinical manifestations are noted after 0.5 hours.

Manifestations are similar to the previous description.

Concentration 0.2-0.29%

Clinical manifestations are noted after 0.5 hours:

• convulsions appear;
• there is respiratory depression and cardiac activity;
• coma ;
• death is likely.

Concentration 0.49-0.99%

Clinical manifestations are noted after 2-5 minutes:

• no reflexes;
• pulse thready;
• deep coma;
• death.

Concentration 1.2%

Clinical manifestations are noted after 0.5-3 minutes:

• convulsions;
• lack of consciousness;
• vomit;
• death.

Symptoms of carbon monoxide poisoning

The table below summarizes the signs that appear with different degrees of poisoning:

The mechanism of development of symptoms

Manifestation of symptoms different type associated with exposure to carbon monoxide. Let us consider in more detail the symptoms of various types and the features of the mechanisms of their manifestation.

neurological

The greatest sensitivity to hypoxia show nerve cells as well as the brain. That is why the development of dizziness, nausea, headache indicate that oxygen starvation of cells occurs. More severe neurological symptoms appear as a result of severe or irreversible damage to the nerve structures. In this case, convulsions, impaired consciousness occur.

Respiratory

When breathing quickens, the compensatory mechanism “turns on”. However, if the respiratory center is damaged after poisoning, the respiratory movements become superficial and ineffective.

Cardiovascular

Due to the lack of oxygen, more active cardiac activity is noted, that is, tachycardia . But due to hypoxia of the heart muscle, pain in the heart can also occur. If such pain becomes acute, it means that oxygen has completely stopped flowing to the myocardium.

Dermal

Due to a very strong compensatory blood flow to the head, the mucous membranes and skin of the head become blue-red.

If mild or moderate carbon monoxide poisoning or natural gas poisoning occurs, then for a long time a person may experience: dizziness and headaches. Also, his memory, intellectual abilities are deteriorating, emotional fluctuations are noted, since during poisoning the gray and white matter of the brain is affected.

The consequences of severe poisoning, as a rule, are irreversible. Very often, such lesions end in death. In this case, the following severe manifestations are noted:

• subarachnoid hemorrhages;
• disorders of a skin-trophic nature (edema and tissue);
• cerebral edema ;
• violation of cerebral hemodynamics;
• deterioration of vision and hearing up to complete loss;
• polyneuritis ;
• pneumonia in severe form, which complicates coma;

First aid for carbon monoxide poisoning

Primarily, urgent care in case of carbon monoxide poisoning, it involves the immediate cessation of human contact with the gas that poisons the body, as well as the restoration of all important body functions. It is extremely important that the person who provides first aid does not become poisoned in the course of these actions. Therefore, if possible, it is necessary to put on a gas mask, and only after that go to the room where the poisoning occurred.

Before the start of PMP, it is necessary to take out or remove the one who suffered from the room in which the concentration of carbon monoxide is increased. You need to clearly understand what CO is what kind of gas, and how quickly it can harm the body. And since each breath of poisoned air will only increase negative symptoms, it is necessary to deliver the victim to fresh air as soon as possible.

No matter how quickly and professionally the first health care, even if the person feels relatively well, it is necessary to call ambulance. There is no need to be deceived by the fact that the victim is joking and laughing, because such a reaction can be provoked by the action of carbon monoxide on the vital centers of the nervous system. Only a professional doctor can clearly assess the patient's condition and understand what to do in case of carbon monoxide poisoning.

If the degree of poisoning is mild, the victim should be given strong tea, warm it up and ensure complete rest.

If confusion is noted, or it is absent at all, you should lay the person on his side on a flat surface, make sure that he receives an influx of fresh air by unbuttoning his belt, collar, underwear. Give a sniff of ammonia, holding the cotton at a distance of 1 cm.

In the absence of a heartbeat and breathing, artificial respiration should be carried out, a sternum massage should be done in the projection of the heart.

In an emergency, you can't act rashly. If there are still people in a burning building, you cannot save them on your own, as this can lead to an increase in the number of victims. It is important to immediately call the Ministry of Emergency Situations.

Even after a few breaths of CO poisoned air, death can occur. Therefore, it is a mistake to assume that protection from harmful influence carbon monoxide can be a wet rag or gauze mask. Only a gas mask can prevent the lethal effects of CO.

Treatment for carbon monoxide poisoning

Do not practice after poisoning treatment at home. A person in such a situation needs the help of specialists.

Provided that the victim is in a critical condition, doctors carry out a set of resuscitation measures. Immediately injected intramuscularly 1 ml of antidote 6%. The victim must be taken to the hospital.

It is important that in such conditions the patient is provided with complete rest. He is provided with breathing with pure oxygen (partial pressure 1.5-2 atm.) Or carbogen (composition - 95% oxygen and 5% carbon dioxide). This procedure is carried out for 3-6 hours.

Further, it is important to ensure the restoration of the functions of the central nervous system and other organs. The treatment regimen prescribed by the specialist depends on how severe the patient's condition is and whether the pathological reactions that occurred after the poisoning are reversible.

In order to prevent natural gas and CO poisoning, it is important to follow very carefully those rules that will help prevent dangerous situations.

• If there is a risk of carbon monoxide poisoning during certain work, they should only be carried out in rooms that are well ventilated.
• Carefully check the dampers of fireplaces, stoves, do not close them completely until the firewood is burned.
• In a room where CO poisoning can potentially occur, it is necessary to install autonomous gas detectors.
• If possible contact with carbon monoxide is planned, one capsule should be taken. Acizola half an hour before such contact. The protective effect will last up to two and a half hours after taking the capsule.

Acizol is a domestically produced medicine that is an effective and fast-acting antidote against acute CO poisoning. It creates an obstacle in the body for the formation carboxyhemoglobin , and also speeds up the process of removing carbon monoxide.

The sooner Acizol is administered intramuscularly in case of poisoning, the greater the chances of a person to survive. Also, this medicine increases the effectiveness of those measures that will subsequently be taken for resuscitation and treatment.

conclusions

Thus, carbon monoxide poisoning is very dangerous state. The higher the gas concentration, the more likely the death. Therefore, it is very important to be extremely careful to comply with all the rules of prevention, and at the first suspicion of such poisoning, immediately call for emergency care.

Carbon monoxide, or carbon monoxide (CO), is found wherever conditions exist for the incomplete combustion of carbon-containing substances.

CO is a colorless gas that has no taste, its smell is very weak, almost imperceptible. Burns with a bluish flame. A mixture of 2 volumes of CO and 1 volume of O 2 explodes on ignition. CO does not react with water, acids and alkalis.

CO poisoning often occurs in everyday life with improper use of heating stoves, gas water heaters, when, due to poorly functioning traction, oxygen deficiency is formed and conditions are created for incomplete combustion of fuel. AT last years due to the increase in the number of cars for personal use every year during the cold season, poisoning of drivers in closed garages, where there are cars with engines running, is ascertained.
Acute CO poisoning can also occur in production, especially in the chemical industry, during coal coking, in hard coal mines, foundries, when a large number of carbon monoxide. So, for example, coal gas contains 4-11% CO, coke gas - 70%, shale gas - 17%, generator gas from coal and coke - 27%, blast furnace gas - up to 30%. Car exhaust gases contain an average of 6.3%, and sometimes up to 13.5% CO2. In the cabs of cars, the concentration of CO can reach 0.05 mg per 1 liter of air or more, on the streets of cities, depending on the load of their transport - from 0.004 to 0.21 mg / l, and near cars - 1.5-7.1 mg / l. The danger of CO poisoning in garages is high if precautions (ventilation) are not followed. Yes, a 20 horsepower motor. With. can release up to 28 liters of CO2 per minute, creating a lethal concentration of gas in the air after 5 minutes.

Clinic

The first symptoms of poisoning can develop after 2 - 6 hours of exposure to an atmosphere containing 0.22-0.23 mg CO2 per 1 liter of air; severe poisoning with loss of consciousness and death can develop after 20-30 minutes at a CO concentration of 3.4-5.7 mg/l and after 1-3 minutes at a poison concentration of 14 mg/l.
CO easily enters the blood through the lungs and interacts with hemoglobin. The process of CO entry into the blood is significantly affected by the oxygen concentration in the inhaled air, an increase in which clearly inhibits the intensity of CO absorption. Each gram of hemoglobin is capable of binding 1.33-1.34 ml of oxygen or CO, but the affinity of hemoglobin for CO is many times greater than for oxygen. Acting with the ferrous iron of oxyhemoglobin (a compound of hemoglobin with oxygen that delivers the latter from the lungs to the tissues), CO converts it into carboxyhemoglobin (HbCO). A sharp decrease in the amount of oxyhemoglobin leads to a deterioration in the supply of oxygen to tissues and the development of oxygen deficiency (hypoxia). In the presence of HbCO, the elimination of oxygen from oxyhemoglobin is significantly slowed down, which aggravates hypoxia.
Under the toxic action of CO, the nervous system suffers the most as it is the most sensitive to hypoxia. In severe poisoning, diffuse brain damage, edema, and demyelination of white matter are noted. In some cases, damage to the nervous system can be reversible, but much more often they persist for a long time as long-term consequences of former intoxication. Most often, amnestic disorders, pseudo-hysteroid states, epilepsy, cerebellar and extrapyramidal disorders, and asthenia develop. Clinical observations in CO poisoning indicate the presence of serious respiratory disorders. With intoxication of moderate severity, focal pneumonia can be detected in a number of victims, severe poisoning is usually complicated by lobar pneumonia.
Already in the first hours after acute poisoning, damage to the heart muscle occurs, characterized by diffuse malnutrition of the myocardium (up to necrosis), changes in the vessels of the heart (degeneration of the endothelium, swelling of the vascular wall). Initially, the changes are reversible, with severe intoxication, organic changes in the myocardium can occur, such as toxic dystrophy, infarction, which is recorded on the ECG.
The leading clinical symptom in acute CO poisoning is impaired consciousness. Depending on the depth of the disorder of consciousness, there are 3 degrees of CO poisoning. With a mild degree of poisoning, it occurs without loss of consciousness, only a short-term fainting is possible. As a rule, patients have tinnitus, pulsation of the temporal arteries, headaches in the frontal, temporal regions, thirst, burning of the face, general anxiety, fear. Characterized by an increase in blood pressure up to 150/90 mm Hg. Art., moderate tachycardia. The content of HbCO in the blood is 15-20%.
In case of poisoning of moderate severity, the loss of consciousness is more or less prolonged and its recovery occurs independently immediately after the victim is taken out into fresh air or oxygen is inhaled. The content of HbCO in these cases is 20-40%. Psychomotor agitation, behavioral inadequacy, facial flushing, fever up to 38-40°C are clinically noted, arterial pressure increased to 150/90 mm Hg. Art., moderate tachycardia.
With a severe and extremely severe degree of poisoning, the content of HbCO in the blood is 60-80%. In this case, a long-term (for several hours and even days) loss of consciousness is observed. As a rule, coma occurs against the background of respiratory disorders more often according to the obstructive-aspiration type (with retraction of the tongue, accumulation of secretions in the oral cavity, trachea, trismus of masticatory muscles). Less commonly observed is the central form of respiratory distress - rare, shallow breathing is replaced by a stop due to paralysis of the respiratory center. At the same time, arterial hypotension up to collapse, pallor, cyanosis of the skin, signs of cerebral edema (stiff neck, anisocoria, etc.) are noted. The exit from a coma lasts a long time (up to several days). Typical are memory impairment (patients forget their name, words, do not recognize relatives, cannot read), dementia, epileptiform seizures, asthenia. As a rule, severe poisoning is complicated by pneumonia, trophic disorders (pressure sores).

Treatment

CO poisoning requires prompt removal of the poison from the body and specific therapy. The victim is taken out to fresh air, and upon arrival medical workers humidified oxygen inhalations are carried out (in an ambulance using KI-Z-M, AN-8 devices). In the first hours, pure oxygen is used for inhalation, then they switch to inhalation of a mixture of air and 40-50% oxygen. In specialized hospitals, oxygen inhalation is used at a pressure of 1-2 atm in a pressure chamber (hyperbaric oxygenation).
In case of respiratory disorders, before inhalation of oxygen, it is necessary to restore the patency of the respiratory tract (toilet of the oral cavity, the introduction of an air duct), to carry out artificial respiration up to tracheal intubation and artificial ventilation of the lungs.
In case of hemodynamic disorders (hypotension, collapse), most often resulting from lesions of the central nervous system, in addition to intravenous (bolus) analeptics (2 ml of cordiamine, 2 ml of 5% ephedrine solution), rheopolyglucin (400 ml) should be administered intravenously in combination with prednisolone (60-90 mg) or hydrocortisone (125-250 mg).
In case of CO poisoning, much attention should be paid to the prevention and treatment of cerebral edema, since the severity of the patient's condition, especially with prolonged impairment of consciousness, is determined by cerebral edema that has developed as a result of hypoxia. At the prehospital stage, patients are injected intravenously with 20-30 ml of a 40% glucose solution with 5 ml of a 5% solution of ascorbic acid, 10 ml of a 2.4% solution of aminophylline, 40 mg of lasix (furosemide), intramuscularly - 10 ml of a 25% solution of magnesium sulfate. It is very important to eliminate acidosis, for which, in addition to measures to restore and maintain adequate breathing, it is necessary to inject 4% sodium bicarbonate solution intravenously (at least 600 ml). In a hospital with severe symptoms of cerebral edema (stiff neck, convulsions, hyperthermia), a neuropathologist performs repeated lumbar punctures, craniocerebral hypothermia is necessary, in the absence of a special apparatus - ice on the head. In order to improve metabolic processes in the central nervous system patients, especially with severe poisoning, are prescribed vitamins, especially ascorbic acid (5-10 ml of a 5% solution intravenously 2-3 times a day), vitamins B 1, (3-5 ml of a 6% solution intravenously), B 6 ( 3-5 ml of 5% solution 2-3 times a day intravenously). For the prevention and treatment of pneumonia, antibiotics, sulfonamides should be administered. Severe patients with CO poisoning need careful care; toilet of the skin of the body, especially the back and sacrum, a change in body position (turns to the side), severe percussion of the chest (striking with the side surface of the palm), vibration massage, ultraviolet irradiation of the chest with erythemal doses (by segments) are necessary.

In some cases, CO poisoning can be combined with other serious conditions that significantly complicate the course of intoxication and often have a decisive influence on the outcome of the disease. Most often this respiratory tract burn, arising from the inhalation of hot air, smoke during a fire. As a rule, in these cases, the severity of the patient's condition is due not so much to CO poisoning (which can be mild or moderate), but to a burn of the respiratory tract. The latter is dangerous because in the acute period acute respiratory failure may develop due to prolonged, intractable laryngobronchospasm, and severe pneumonia develops in the next day. The patient is concerned about dry cough, sore throat, suffocation. Objectively noted shortness of breath (as in an attack bronchial asthma), dry rales in the lungs, cyanosis of the lips, face, anxiety. When toxic edema lungs, pneumonia, the condition of patients worsens even more, shortness of breath increases, breathing is frequent, up to 40-50 per minute, in the lungs there is an abundance of dry and moist rales of various sizes. Mortality in this group of patients is high.

Treatment mostly symptomatic: intravenous administration of bronchodilators (10 ml of a 2.4% solution of aminophylline with 10 ml of physiological saline, 1 ml of a 5% solution of ephedrine, 60-90 mg of prednisolone 3-4 times or 250 mg of hydrocortisone 1 time per day, 1 ml of 5% solution of ascorbic acid 3 times a day).
Great importance has local therapy in the form of oil inhalations (olive, apricot oil), inhalations of antibiotics (penicillin 500 thousand units in 10 ml of saline), vitamins (1-2 ml of 5% ascorbic acid solution with 10 ml of saline); with severe laryngobronchospasm - 10 ml of a 2.4% solution of aminophylline, 1 ml of a 5% solution of ephedrine, 125 mg of hydrocortisone in 10 ml of saline. With a strong cough, use codeine with soda (1 tablet 3 times a day), drinking warm milk with soda or Borjomi.

The second serious complication of CO intoxication is position injury (compression syndrome), which develops in cases where the victim lies unconscious (or sits) in one position for a long time, touching parts of the body (most often with the limbs) of a hard surface (the corner of the bed, the floor) or pressing the limb with the weight of his own body. In areas subjected to compression, unfavorable conditions for blood and lymph circulation are created. At the same time, the nutrition of muscle and nervous tissue, skin is sharply disrupted, which leads to their death. The victim develops foci of reddening of the skin, sometimes with the formation of blisters filled with liquid (like burns), soft tissue compaction, which further intensifies due to developing edema. The affected areas become sharply painful, enlarged, dense (up to stone density). As a result of the breakdown of muscle tissue, myoglobin (a protein that is part of muscle tissue) enters the bloodstream, if the injury zone is extensive, a large amount of myoglobin affects the kidneys: myoglobinuric nephrosis develops. Thus, the patient develops the so-called myorenal syndrome, characterized by a combination of trauma by position with renal failure. Clinically, to the muscle lesions described above, a violation of kidney function is added: at first, a small amount of dark brown urine is excreted in the patient, and then anuria occurs, followed by azotemia, hyperhydration, etc. The treatment of patients with miorenal syndrome is long and is carried out in specialized hospitals, as it requires the use of various special methods(hemodialysis, lymphatic drainage, etc.). In the presence of severe pain, painkillers can be administered - 1 ml of a 2% solution of promedol and 2 ml of a 50% solution of analgin subcutaneously or intravenously.

Prevention

In the vast majority of cases, poisoning occurs through the fault of the victims themselves: improper operation heating stoves, geysers, smoking in bed (especially when drunk), leading to a fire; keeping matches in places accessible to children; a long stay in a closed garage where the car is located with the engine running, a long rest (sleep) in the car with the heater and engine turned on, even if the car is on outdoors. It is especially important to conduct conversations and lectures with the population on the prevention of CO poisoning in the autumn-winter season.