[Medical emergency] how to emergency treatment of acute carbon monoxide poisoning?

The chief symptom of acute CO poisoning is coma patients often accompanied by severe multi-organ injuries and complicated complications that endanger life. The timely implementation of effective emergency care is the key to successful rescue of patients with CO poisoning, which can effectively reduce the mortality rate and improve the treatment effect, and can prevent and reduce the occurrence of complications.

CO is a highly toxic suffocating gas poison. Through the aspiration channel into the alveoli is absorbed into the blood and hemoglobin combined with carboxyhemoglobin, because the affinity of CO and hemoglobin is 300 times greater than the affinity of oxygen , and the degree of dissociation of carboxyhemoglobin is slower than oxygen whole hemoglobin, the difference between the two is 3600 Times. When the human body inhales CO , the CO in the plasma quickly excretes oxygen in the oxyhemoglobin, causing hypoxemia, causing tissue hypoxia, and when the CO concentration is too high, it can also bind to the iron of the red blood cell pigment oxidase. , Which directly inhibits the systemic cell uptake, the central nervous system is the most sensitive to hypoxia, often the first to suffer.

In CO poisoning, organs with less vascular anastomoses in the body and metabolic processes such as the brain and heart are most vulnerable to damage. Small blood vessels in the brain are rapidly paralyzed and expand. In the brain, adenosine triphosphate (ATP) is quickly depleted in the absence of oxygen, the sodium pump is not working properly, and sodium ions accumulate in the cells and induce intracerebral edema.

Hypoxia causes vascular endothelial cells to swell and cause cerebral vascular circulation disorders. In the absence of oxygen, the accumulation of acidic metabolites in the brain increases vascular permeability and produces interstitial edema of brain cells. Cerebral blood circulation disorders can cause thrombosis, ischemic necrosis, and extensive demyelination.

First, with first aid

1 , on-site first aid

Immediately remove the patient from the poisoning site and place it in fresh air. If it is a closed room, immediately open the window for ventilation and release the patient's collar and belt. Keep the suction path open and keep warm. Heart arresters should undergo cardiopulmonary resuscitation immediately.

2 , promptly correct hypoxia

This is the key to rescue CO poisoning patients. Rapid oxygenation is the most effective way to correct hypoxia. Mild poisoned persons were given nasal catheters or masks with low-flow oxygen inhalation. Those with moderate to severe poisoning were given high-flow oxygen. The oxygen flow rate was 8 to 10 L/min (the time did not exceed 24 hours to avoid oxygen poisoning).

3 , hyperbaric oxygen therapy

Hyperbaric oxygen therapy is the safe and effective first choice for rescuing CO poisoning, which can reduce the incidence of mortality and sequelae. Hyperbaric oxygen therapy can rapidly improve the body's hypoxic state; it can also reduce intracranial pressure and relieve cerebral edema; and it can prevent and treat sequelae caused by brain damage caused by CO poisoning.

4 , prevent brain edema

Early use of hydrocortisone or dexamethasone or 20% mannitol intravenous drip, while the input of fresh photon-quantity blood, helps to improve tissue hypoxia. Adenosine triphosphate, coenzyme A , cytochrome C , vitamin B , and vitamin C can be used to promote brain cell function recovery.

5 , symptomatic treatment

Susceptibility to stimulants when there is smoking failure, physical cooling using high fever, wearing an ice cap on the head, placing an ice pack on the body surface, so that the body temperature is maintained at about 32 °C , such as the use of hibernation drugs if the chills or cooling effect during cooling process is poor . Frequent convulsions are the first choice for Xi Jing.

6 , other treatments

Such as the new drug naloxone and Xingnaojing application, prevention and timely control of infection.

Second, nursing measures

1. Closely monitor vital signs

CO poisoning caused by the ultrastructure of the lung hypoxia, edema, caused by blood and blood exchange barriers, can cause suction failure, there is significant hypoxia, carbon dioxide retention and absorptive acidosis and other life-threatening. CO poisoning can cause central absorption failure, should pay attention to changes in patients with absorption frequency, rhythm, can be expressed earlier as a tidal absorption, mid-term performance of deep and uniform absorption, often accompanied by snoring and inhalation depression, after the frequency slows down , similar to the normal suction shape; late performance of the absorption rate and interval are irregular, suction frequency is often less than 12 times per minute , and intermittent suction, sighing, sobbing-like suction and jaw movement; serious, the suction can suddenly stop . Pay attention to changes in the pupils, be alert to the occurrence of cerebral edema and cerebral palsy.

2 , keep

Severe headaches, dizziness, and frequent vomiting may occur in patients with moderate or severe respiratory tract CO poisoning. When nursing coma patients with severe poisoning, attention should be paid to keeping the aspiration path open, unclamping the collar, and placing a pillow on the neck to make the head as far as possible. Retreat; If frequent vomiting and aspiration of a large number of secretions, should promptly absorb secretions, so that the patient's head side to avoid asphyxia. If the suction pipe obstructs the back of the tongue, pull the tongue out quickly to make it smooth.

3 , rapid establishment of intravenous access

Controlling the infusion rate to prevent heart failure and pulmonary edema effectively and quickly establish a smooth venous channel is the key to success.

When infusion of diuretic dehydrating agent, the drip rate should be properly adjusted within the therapeutic range, because after CO poisoning, the myocardium is damaged and is in a state of ischemia. If the drip rate is too fast at this time, a large amount of liquid is input in a short time and the cardiac load is more To aggravate, prone to heart failure. Care should be taken to observe whether the patient has paroxysmal nocturnal suction difficulties, increased heart rate, reduced urine output and other symptoms, these are the performance of early heart failure. At the same time pay attention to whether the patient has cough, purpura, difficulty breathing, coughing a large number of white or pink foam phlegm and other pulmonary edema.

4. Care of acute urinary retention

CO poisoning leads to normal physiological dysfunction of the central nervous system and urinary system, and urinary retention may occur. When urinary retention occurs, the patient is often accompanied by restlessness. The perforation of the bladder is dull, and catheterization is required at this time to relieve urinary retention as soon as possible. Urinary catheters should be strictly aseptically operated, and intubation should be gentle to prevent damage to the urethral mucosa. Because the mucosa of the urethra is in an ischemic state after CO poisoning, it is prone to hemorrhage after rubbing. If the bladder is highly inflated and the condition is severe, such as a heavy urine injection should not exceed 1000 ml, to avoid sudden decompression of the bladder, causing acute congestive bladder mucosa, hematuria. When you enter the hyperbaric oxygen chamber, be sure to open the catheter.

5 , observe whether there is increased intracranial pressure to prevent cerebral edema

Care should be taken to measure and record body temperature, pulse, respiration, and blood pressure at regular intervals. If blood pressure increases progressively, breathing is slower and deeper after a quick start, and rapid and slow pulse is indicative of an increase in intracranial pressure. The patient's head is elevated 15 to 30 cm to reduce intracranial pressure. The head is cold-treated with an ice bath to prevent brain edema. It also reduces the metabolism of brain tissue, reduces its oxygen consumption, improves the tolerance of brain cells to hypoxia, and slows or controls the development of brain damage.

6. Closely observe the condition and early discover other complications

Early detection of complications allows patients to receive early treatment and improve treatment. For example, diabetes patients monitor blood glucose to prevent the occurrence of ketoacidosis; patients with severe poisoning observe clotting time, be alert to the occurrence of DIC , and pay attention to changes in urine output, alerting to the occurrence of acute renal failure.

Third, nursing experience

1. Careful and meticulous work should be done by the nurses to closely monitor the changes in the condition indications and discover the complications in time so that they can be effectively dealt with in case of illness changes or complications.

2. The nurse must have solid theoretical knowledge and solid basic skills. The combination of the two should be more conducive to the monitoring of changes in the condition and the success rate of salvage.

Fourth, prevention

1. It should be widely publicized that there should be safety settings (such as chimneys, small ventilation windows, wind buckets, etc.) when using indoor coal fires to explain the possible symptoms and first aid common sense of gas poisoning, with particular emphasis on the harm and severity of gas to small infants. The installation of the coal stove chimney should be reasonable. Coal stoves without chimneys should be placed outdoors at night.

2. Do not use the elimination of water heaters, such as straight-line water heaters and flue-type water heaters, these two water heaters are banned by the state production and sales; do not use extended service water heaters; install the water heater is best to ask professionals to install, not on their own Install, remove, and refit gas appliances. The bathroom doors and windows should not be closed during the shower in winter, and the shower time should not be too long.

3. When driving, do not allow the engine to idle for a long time. When the vehicle is stopped, do not open the air conditioner for too long. Even while driving, open the windows frequently to allow convection inside and outside the vehicle. If you feel uncomfortable, that is, you have to stop for a rest; if you feel dizzy, heavy, and weak in your driving or riding an air-conditioned vehicle, you should open the window and breathe fresh air in time.

4. Install carbon monoxide alarms where carbon monoxide may be generated. The carbon monoxide detector is a device specifically designed to detect the concentration of carbon monoxide in the air. It can alarm in time when the concentration of carbon monoxide is exceeded, and it can also forcefully open windows or exhaust fans to keep people away from carbon monoxide.

The information in this article comes from the Internet and was reorganized and edited by China Rescue Equipment Network.