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Therapeutic tactics in emergency situations with exposure to chemical poisonous substances (AHOV)


Currently, tens of thousands of various chemicals are used in industry and agriculture. Some of them are toxic and harmful. Any emergency situations - leakage, pipeline breakdown, tank destruction, fire, explosion - can lead to the release of a large amount of chemical poisonous substances into the atmosphere and the earth. According to the degree of toxicity, these substances are divided into extremely toxic (derivatives of arsenic, mercury, cadmium, lead); highly toxic (sulfuric, nitric, acetic acids); moderately toxic and low toxic.
According to the effects on the body, AHOV are divided into groups:
1) substances with a predominantly choking effect (chlorine, phosphorus trichloride, phosgene, sulfur chloride);
2) substances with predominantly common toxic effects (carbon monoxide, hydrocyanic acid, dinitrophenol, ethylene chloride);
3) substances with a generally toxic and asphyxiating effect (acrylonitrile, nitrogen oxides, sulfur dioxide);
4) substances with a neurotropic effect (carbon disulfide, organophosphorus compounds);
5) substances with choking and neurotropic effects (ammonia);
6) metabolic substances (metabolic poisons: dioxide, dimethyl sulfate, methyl bromide, methyl chloride, ethylene oxide).
AHOV can enter the human body through the respiratory tract, gastrointestinal tract, skin and mucous membranes. Almost all AHOV enter the vaporous or aerosol state in the respiratory tract, in the blood, causing severe intoxication of the body.
General rules for assistance
Cessation of further intake of poison into the body and removal of non-absorbable poison.
The accelerated elimination of absorbed toxic substances from the body.
The use of specific antidotes (antidotes). Pathogenetic and symptomatic therapy (restoration and maintenance of vital functions).
The implementation of the fastest evacuation from the affected area.
In chemical accidents, along with the provision of emergency medical care, it is necessary to carry out sanitary and hygienic measures.
Measures to reduce or eliminate contact with a toxic substance, the use of personal and collective protective equipment by emergency personnel, rescue workers and medical workers, field teams, and the public; timely sanitization, evacuation can significantly reduce the severity of the lesion, and sometimes prevent it.
In modern life, most often you can expect an accident with the release of chlorine or ammonia. Therefore, priority measures are taken when exposed to chlorine or ammonia.
Chlorine exposure
When exposed to chlorine, it is necessary:
1) isolate the danger zone within a radius of 200 m and prevent outsiders;
2) stay on the windward side;
3) avoid low places;
4) prohibit entry to basements and tunnels;
5) enter the accident zone in full protective clothing;
6) to evacuate people from the pollution zone (about 10 km).
Urgent Care
Removing gas mask and contaminated clothing.
Washing eyes, nose, mouth with 2% solution of drinking soda.
Instillation of vaseline or olive (peach) oil in the eyes.
For pain in the eyes - 2-3 drops of a 0.5% solution of dicaine.
For the prevention of infection - the introduction of an eye ointment or instillation of a 20% sodium sulfacyl solution.
Peace, warming, drinking warm milk with Borjomi or soda.
Inhalation of a 1-2% solution of sodium hyposulfite ("antichlor"), a 2% solution of drinking soda for 10-15 minutes, or a 10% solution of menthol in chloroform.
If breathing is difficult, inhalation of solutan or salbutamol 2-3 times a day; warm water or soda inhalations.
With spasm of the glottis - heat on the neck, atropine 0.1% solution - 1 ml subcutaneously.
When coughing - stoptussin and others; banks, mustard plasters (alternate).
With bronchospasm - calcium chloride 10% solution - 5-10 ml intravenously 1-2 times a day; oxygen therapy, antibiotic therapy (ampicillin, oxacillin sodium salt, gentamicin, etc.) for the prevention of infectious complications.
With persistent bronchospasm - in the absence of the effect of the previous therapy - atropine 0.1% solution - 1.8 ml intravenously, prednisone 30-60 mg intravenously, alupent 0.5% solution 1 ml intramuscularly, tracheotomy.
With anxiety and convulsions - phenazepam - 0.0005 g; Seduxen or Relanium - 0.005 g per 1 tablet 2-3 times a day; GHB 20% solution - 5-20 ml intravenously, slowly, under the control of respiration.
With laryngeal edema - tracheotomy, rehabilitation of the tracheobronchial tree (endotracheal catheter, electric suction).

With toxic pulmonary edema - prednisone - from 300-400 to 2000-3000 mg intravenously; stimulation of diuresis with mannitol (1-2 g per 1 kg of patient weight) intravenously; Lasix - 40 mg or more; Mechanical ventilation with positive pressure at the end; heparin - 5 thousand units 4 times a day intramuscularly; oxygen therapy with defoamers.
With cardiovascular failure and lung damage: mesatone, 1% solution - 1 ml intramuscularly; dopamine - 5 ml with 200 ml of saline intravenously; norepinephrine hydrotartrate - 1-2 ml with 500 ml of 5% glucose solution intravenously (under the control of blood pressure); cordiamine - 2 ml intramuscularly, subcutaneously; caffeine-benzoate sodium 10% solution - intramuscularly subcutaneously; sulfocamphocaine 10% solution - 2 ml intramuscularly, subcutaneously; strophanthin 0.25% solution - 0.5 mm with 20 mg of 5% glucose solution or saline intravenously; panangin - 10 ml in an ampoule - 1-2 ampoules with 50-100 ml of a 5% glucose solution intravenously (slowly); Lasix - 40 mg or more; oxygen therapy; Mechanical ventilation with positive pressure at the end; heparin - 5 thousand units 4 times a day intramuscularly; trental - 1 ml once a day intravenously; nitrosorbide - 0.02 g, 1 tablet 3 times a day; Corinfar - 0.02 g, 1 tablet 2 times a day; vitamins Bl, B6, E, 1 ml intramuscularly.
Hospitalization in severe cases in a hospital.
Ammonia exposure
When exposed to ammonia, it is necessary:
1) isolate the danger zone and prevent outsiders from entering it;
2) stay on the windward side;
3) enter the accident zone in protective clothing;
4) allow the gas to evaporate during a massive leak;
5) to evacuate people from the pollution zone (about 5 km);
6) comply with fire safety measures.
Therapeutic tactics
Removing gas mask, contaminated clothing.
Flushing eyes, nose, mouth with water or alum.
After washing the eyes, instillation of vaseline, olive (peach) oil in the eyes.
For pain in the eyes - 2-3 drops of a 0.5% solution of dicaine.
To prevent infection, apply an ophthalmic ointment (0.5% synthomycin, 10% sulfacyl) or instill a 20% sodium sulfacyl solution.
Fresh air, inhalation of warm water vapor with the addition of vinegar or several crystals of citric acid; 10% solution of menthol in chloroform.
In case of skin damage - after dousing with pure water, application of lotion from a 5% solution of ascorbic acid or 1% solution of hydrochloric acid.
If breathing is difficult, inhalation of solutan or salbutamol 2-3 times a day; warm water or soda inhalations.
With spasm of the glottis - heat on the neck; atropine 0.1% solution - 1 ml subcutaneously.
When coughing - stoptussin and others; banks, mustard plasters (alternate).
With bronchospasm - aminophylline 2.4% solution - 10 ml intravenously (slowly); calcium chloride 10% solution of 5-10 ml 1-2 times intravenously; oxygen therapy; broad-spectrum antibiotics for the prevention of infectious complications.
Anxiety and convulsions - phenazepam 0.0005 g, seduxen or relanium - 0.005 g, 1 tablet 2-3 times a day; GHB 20% solution - 5-20 ml intravenously (by stream, slowly, under the control of respiration);
With laryngeal edema - tracheotomy, rehabilitation of the tracheobronchial tree; endotracheal catheter, electric suction.
With toxic pulmonary edema and cardiovascular failure: prednisone - from 300-400 to 2000-3000 mg intravenously; heparin - 5 thousand units 4 times a day intramuscularly; Mechanical ventilation with positive pressure at the end; oxygen therapy with antifoam; Lasix 40 mg or more; sulfocamphocaine 10% solution - 2 ml intramuscularly, subcutaneously; strophanthin 0.25% solution - 0.5 ml with 20 ml of 5% glucose solution or saline intravenously; panangin - 10 ml with 50-100 ml of a 5% glucose solution intravenously (slowly); nitrosorbide - 0.02 g 3 times a day; Corinfar - 0.02 g 2 times a day; mesatone 1% solution - 1 ml intramuscularly; dopamine - 5 ml with 200 ml of saline intravenously; norepinephrine hydrotartrate - 1-2 ml with 500 ml of 5% glucose solution intravenously under the control of blood pressure; cordiamine - 2 ml intramuscularly, subcutaneously; sodium caffeine benzoate 10% solution - 1 ml subcutaneously; ephedrine - 5 ml intramuscularly; trental - 1 ml once a day intravenously; vitamin B6 - 5% solution, vitamin B1 - 6% solution, vitamin C - 5% solution, vitamin PP - 1% solution of 1 ml intramuscularly;
Hospitalization in severe cases.
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Therapeutic tactics in emergency situations with exposure to chemical poisonous substances (AHOV)

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