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Poisoning a child with carbon monoxide (carbon monoxide) \
Last reviewed: 23.04.2024
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Carbon monoxide (CO) has a much more pronounced affinity for hemoglobin than oxygen, and creates with a hemoglobin a strong compound - carboxyhemoglobin, which prevents the normal transfer of oxygen to the tissues. The toxic effect of CO is not limited to the development of tissue hypoxia and a shift in the dissociation curve of oxyhemoglobin. Carbon monoxide binds cytochromes, resulting in respiratory depression at the mitochondrial level and lactic acidosis. Demyelination of white matter of the brain, edema, necrosis, petechial hemorrhages develops. Depression of the myocardium with development of arterial hypotension is characteristic.
The clinical picture of acute carbon monoxide poisoning is characterized by increasing central nervous system hypoxia (attenuation, impaired perception of light, headaches, dizziness, tinnitus). On examination, the skin is pale or dark-cherry (blue-purple), skin necrosis can develop with the formation of blisters. There is nausea, vomiting, muscle weakness. Breathing is superficial, intermittent, cramps, loss of consciousness, development of shock are possible. The cause of death in case of carbon monoxide poisoning is edema of the lungs and brain.
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Emergency medical care for carbon monoxide poisoning
It is necessary to immediately remove the victim from the infected area.
Patients in the mind to periodically stimulate the respiratory center are allowed to inhale the vapor of a 10% solution of ammonia (ammonia). A revision of the upper respiratory tract is necessary, with respiratory depression - auxiliary respiration, oxygenation with pure oxygen (100%). With the development of pulmonary edema - intubation of the trachea, IVL under a positive pressure of 4-6 cm of water, dehydration (furosemide 1-2 mg / kg). The victim is warmed, if possible, cold is applied to the head area.
Determine the level of carboxyhemoglobin and the gas composition of the blood, conduct ECG, chest rengtgenography. When edema of the brain, osmotic diuretics - mannitol 1-1.5 g / kg - and hyperbaric oxygenation under pressure up to three atmospheres are necessary.
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