Acute poisoning often occurs in accidents during production and maintenance, and is often seriously ill and develops rapidly. The key to the success of acute poisoning treatment is early treatment, and the main cause of failure is inhalation of large doses of poison and ineffective rescue on site. Therefore, once acute poisoning occurs, the on-site staff should take responsibility for the rescue. This is a very important part. The principle of on-site first-aid is to maintain the patient's vital signs, stop the re-absorption of the poison, and give necessary early treatment; if there are many people with acute poisoning, it is necessary to distinguish the patient's priorities, arrange the rescue force, and transfer it to the hospital on the spot. To ensure that the rescue is not busy, so that the poisoned person does not miss the diagnosis, not misdiagnosed, and strive to compete in time and minutes.
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First, on-site rescue preparation
For gas-defense stations, health stations, and special high-risk jobs in toxic and hazardous operating units, the following equipment and emergency medicines should be reserved as needed:
(1) Gas masks used by ambulance personnel.
(2) Oxygen cylinders and oxygen bags.
(3) eye wash pot, tourniquet, small splint, opener, tongue clamp, bandage, simple surgery bag.
(4) 2% boric acid water, 5% sodium bicarbonate solution for flushing eyes and skin.
(5) First aid medication.
Second, on-site self-help and mutual rescue points
All employees must be familiar with the operating environment of the factory and the poisonous and hazardous posts in this workshop, and grasp the dangers and hazards of this position. Master the symptoms of common poisoning and self-help and mutual rescue knowledge, and prepare for self-help and mutual rescue at any time.
In workplaces where toxic gas leaks may or may have occurred, when symptoms such as dizziness, headache, and nausea suddenly appear, the possibility of poisoning must be considered, and effective measures should be taken according to actual conditions.
(1) If you have a gas mask on your body, you should hold your breath and wear a gas mask quickly and skillfully to leave the poisoned environment.
(2) Hold your breath and quickly get out of the poisoned environment or move to the upper wind side.
(3) Send a distress signal.
(4) If it is a irritating gas such as chlorine or ammonia, pour the handkerchief into the water and cover the nose and run outward.
(5) If you grab something at the fastest speed or get on the windward side at the height without a fence, try to avoid falling and trauma.
(6) To prevent toxic and harmful liquid from splashing into the eyes. If the eyes are stained, rinse immediately with running clean water; if one eye is stained, protect the other eye from the other time to avoid contamination.
(7) If the chemical stains the skin, rinse immediately with plenty of running water, and the hair is no exception. If it stains clothes, shoes and socks, it should be removed immediately and rinse the skin.
(two) mutual rescue
In many cases, it is impossible to save yourself. In particular, the poisoning condition is heavier. When the patient is unconscious or when the eyes are stimulated by chemical substances, they need help.
(1) When an acute poisoning patient appears, the unit should immediately start the emergency rescue plan for acute poisoning.
(2) The on-site ambulance personnel wear appropriate gas masks and quickly cut off the source while trying to rescue the patient.
(3) Move the patient to a place where the air is fresh to the wind as soon as possible. During the handling process, be calm and calm, do not drag and pull hard to avoid more damage caused by the handling process.
(4) After the patient is moved to the fresh air, check whether the mind is clear, whether the pulse, heartbeat exists, whether the breathing stops, and whether there is bleeding or fracture. If the patient is found to have stopped breathing, perform artificial respiration on the spot; if there is a heartbeat stop, perform a chest chest compression at the site immediately. Untie the collar and belt to keep the airway open. In the cold season, you should pay attention to heat preservation, keep the patient quiet, and closely observe the patient's condition.
(5) Remove contaminated clothing, clean contaminated skin and eyes in time, and be careful not to ignore the perineum and armpits.
(6) Immediately notify the hospital to prepare for the rescue. Whenever the notice is made, it should be as clear as possible what poison poisoning, the number of poisoning, the route of invasion and the general condition.
Third, cardiopulmonary resuscitation
Cardiopulmonary resuscitation includes mouth-to-mouth insufflation and extracorporeal heart compression. The purpose is to provide a minimum blood supply to vital organs such as the brain and heart, and to restore spontaneous breathing and circulatory kinetic energy as soon as possible, and to create basic conditions for further rescue.
1. Determine whether the patient is conscious
Quick and quick shouting and shaking the patient: "Hey! What's the matter with you?", if there is no response, it means that you have lost consciousness.
2. Call for help
Once the patient's consciousness is lost, call "Come on!" and ask someone to help rescue the patient.
3. Positioning position
The patient should be placed in the supine position. When turning the patient, the head, shoulders and trunk should be rotated at the same time to avoid fracture or other trauma.
4. Open the airway
First of all, the secretions, blood, etc. in the mouth should be quickly cleaned up. If there are dentures, the dentures should be removed. There are 3 ways to open the airway.
(1) Lifting the neck and raising the neck: The rescuer is kneeling on the side of the patient's head, one hand is placed on the back of the patient's neck to lift the neck, the other hand is placed on the forehead, and the forehead is pressed to make the head recline. The degree requires that the mandibular angle is perpendicular to the earlobe and the ground.
(2) Lifting the head and lifting the head: one hand is placed on the forehead to tilt the head back, and the index finger and middle finger of the other hand are placed under the mandible near the lower jaw, and the lower jaw is lifted.
(3) Pushing the jaw method: The rescuer grasps and lifts the mandibular angles on both sides of the patient, pushes the lower jaw forward, and the fallen tongue root leaves the posterior pharyngeal wall. This method is suitable for those with suspected neck injuries.
5. Judging breathing
After opening the airway, check whether the patient has spontaneous breathing by looking at (observing the ups and downs of the chest and abdomen breathing movements), listening (whether there is airflow coming in and out of the patient's nose), feeling (using the cheeks to see if there is airflow in and out). If there is no breathing, immediately perform artificial insufflation.
6. Manual blowing
Use the thumb and forefinger of the hand on the forehead to pinch the patient's nostrils to prevent the gas from escaping. Then, take a deep breath, try to open the mouth, wrap the patient's mouth and hold it tightly, and blow the air 2 times (the amount of air per blow) 800 to 1000 ml), if there is still no spontaneous breathing, the air is blown at a frequency of 12 times per minute. At the same time, squintly observe whether the chest wall is raised. In addition, mouth-to-nose insufflation is also possible.
7. Determine if there is a pulse
The most effective way to diagnose a heartbeat is to touch the carotid artery. You can also touch the artery.
8. Chest boxing heart
At the moment of sudden cardiac arrest, the emergency is abnormally increased. For example, 1 to 2 times in the front of the boxing heart, the heart can be re-jumped.
9. Thoracic heart compression
The patient is lying on a hard board or on a flat surface. The pressing part is located at the lower third of the sternum. The rescuer uses the index finger and the middle finger to move up to the lower sternal notch along one side of the rib. The middle finger is placed at the notch, and the index finger and the middle finger are placed flat on the lower end of the sternum. The other hand overlaps, and the fingers are lifted up without touching the chest wall. With the weight of the ambulance personnel, it is transmitted to the arms and palms, and the arms are straight and cannot be bent. The force should be moderate, rhythmic, with impact compression, so that the sternum is depressed by 4 to 5 cm, and the compression frequency is 80-100 times per minute for adults. The pressing time and the loosening time must be equal, and the pressing interval no longer presses the chest, which is convenient for the heart to fill.
10. Single rescue
15 cardiac presses were alternated with 2 blows. That is, the ratio of pressing to blowing is 15:2.
11. Double rescue
Five heart presses were alternated with one blow. That is, the ratio of pressing to blowing is 5:1.
12. Some poisons, such as acute hydrogen sulfide, acute hydrogen cyanide and other poisoning caused by breathing, heartbeat stop, should not be mouth-to-mouth breathing, you can use the following methods for artificial respiration.
(1) Prone back pressure method: put the patient on a hard board or flat ground, take the prone position, the rescuer's two legs bent to knees on both sides of the thigh, and put the lower back of the shoulder blade. The ambulance personnel leaned forward and slowly compressed downwards. The direction of the force was downward, slightly pushed forward, and the air in the lungs was pushed out to form an exhalation. Then relax and expand the chest to create inhalation. The speed is 12 to 16 times per minute.
(2) supine chest compression method: put the patient on a hard board or flat ground, take the supine position, the head is fully reclined, and the tongue can be pulled out and fixed if possible. The two big legs of the ambulanceman squat down on both sides of their hips, and the hands are placed flat on the lower part of the breasts of the rescued person. After being bent down and pressed forward, the shoulders of the rescuer can be saved in a straight line. The inner air is forced out, causing exhalation; then the force is stopped, the chest is enlarged, and the inhalation is formed. The speed is 12 to 16 times per minute.
Fourth, the precautions for acute poisoning patients to the hospital
On-site rescue and preliminary treatment are very important. Timely and effective on-site rescue can maintain the patient's basic vital signs and lay the foundation for further rescue of the hospital. Pay attention to the following questions when sending patients to the hospital:
(1) Critically ill patients with acute poisoning must be quickly escorted to the hospital after being rescued at the scene.
(2) To choose a hospital with a close distance and rescue conditions and rescue experience.
(3) If the patient's breathing or heartbeat is stopped, cardiopulmonary resuscitation should be performed immediately at the site. If there is no resuscitation, the escort must continue during the escort.
(4) Acute poisoning combined with trauma such as fractures and hemorrhage must be fixed and hemostasis before being sent to the hospital.
(5) In escort, patients with shock should take a low position. Patients with coma or vomit should be biased to one side when lying down to avoid inhalation of vomit into the lungs. For critically ill patients, changes in consciousness, pupils, blood pressure, respiration and pulse should be closely observed and treated as necessary.
(6) After the acute poisoning patient is sent to the hospital, he should continue to guard the patient next to the patient and talk to the doctor about the patient's poisoning time, the name of the poison, the change of the condition, the rescue time and measures, including the name and dosage of the drug. And methods, etc., to facilitate further hospital rescue.