Fume poisoning: carbon monoxide, tobacco, welding fumes

Smoke poisoning occurs quite often and can have quite serious consequences. It can be either mild intoxication or severe poisoning, which entails serious disturbances at all levels of the body, from the cellular to the systemic, organismic. As with any other poisoning, a person needs emergency help.

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Epidemiology

According to statistics, gas and smoke poisoning accounts for approximately 61% of all poisonings. Thus, carbon monoxide poisoning accounts for approximately 12% of all gas and smoke poisonings, and tobacco smoke poisoning accounts for approximately 8% of poisonings. About 21% of people are poisoned by welding gas. Of these, approximately 67% suffer from chronic poisoning, since people are exposed to welding every day due to their professional duties, and welding smoke systematically enters the body. Gradually, accumulating, it causes serious poisoning. Poisoning by smoke from plastic is quite common (approximately 5%). It is interesting that the combustion products of plastic are always toxic, and if a person inhales smoke from burning plastic, poisoning is inevitable and develops in approximately 99.9% of cases.

In addition, approximately 32% of poisonings occur in domestic conditions. Approximately 57% of poisonings are related to the professional activities of workers. The remaining 11% are accidental and intentional poisonings that occur under various circumstances.

Of all poisonings, approximately 71% are acute poisonings, 29% are chronic poisonings. Smoke toxins enter the body through the skin in 5% of cases, through the respiratory tract - in 92% of cases, through the digestive tract - in 3% of cases. In all 100% of cases, a clinical picture of typical poisoning develops, with the toxin entering the blood. If a person does not provide assistance, approximately 85% of poisonings end in death. In the case of carbon monoxide poisoning, if assistance is not provided, death occurs in 100% of cases.

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Causes smoke poisoning

The main reason is the entry of toxins that are in the smoke and are formed as a result of combustion. These can be products of complete or incomplete combustion. The transformation of some substances into others with the formation of steam, smoke - chemical processes that are well known to us, known since school. Many of these substances are dangerous for humans, and when they enter the body, they cause serious consequences.

The circumstances under which the poison enters the body may vary. But most often it is carelessness (in domestic conditions), failure to comply with the rules for using heating devices, equipment, stoves. Separately, there are cases when people do not use personal protective equipment when working with smoke (negligence, irresponsibility, careless attitude).

Chronic poisoning most often occurs due to the fact that smoke systematically, over a long period of time, enters the human body (boiler house employees, gas and oil and gas company workers, stove-setters, firefighters, emergency services employees). In most cases, chronic poisoning is considered an occupational disease in some professions. In this case, the cause of poisoning is non-compliance with instructions, standards and protocols of actions, violation of safety precautions, internal regulations. It is important to use only serviceable equipment, turn on hoods when working with smoke sources, ventilate the room, observe all safety precautions. Use personal protective equipment. Periodically, it is necessary to take courses of sorbents, use preventive measures.

Unfortunately, suicide and intentional homicide are also common causes of smoke poisoning. Accidents, fires, equipment failures, gas leaks, industrial and private accidents are also common causes.

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Risk factors

The risk group includes people who, due to various circumstances, are directly in the source of smoke or near it. This includes people who, in one way or another, come into contact with toxic substances that are in the smoke. These may be people who are systematically exposed to smoke, for example, their work is in some way connected with smoke - firefighters, welders, barbecue makers.

Or this may include people who were accidentally exposed to smoke: when making a fire (while on vacation, during a picnic), during work on the site (for example, cleaning, fumigation of trees, etc.). A special risk group is made up of people who have survived a fire, or those who live in areas of frequent fires, disasters, accidents, near forests where fires often occur, near industrial enterprises, in areas of military, combat operations, terrorist attacks.

Also at risk are elderly people with neurovegetative, psychosomatic, degenerative disorders, sclerosis, paralysis, people with impaired neuropsychic reactions, inadequate behavior, mental illnesses, autists. Often they may not even understand that they are in a smoke zone. That there is a fire and they need to leave. Or they can open the gas without realizing that they can be poisoned. This also includes children under 3-5 years of age, especially if they are left without the supervision of parents, adults, people with disabilities, or disabled people.

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Pathogenesis

Pathogenesis is based on the effect of toxic substances on the body. First, they penetrate in one of the possible ways: through the skin, respiratory tract, digestive tract, then enter the blood, and have an intoxicating effect there. The mechanisms are quite complex and are reflected at all levels of the body: cellular, tissue, organ, organismic. The features of pathogenesis are determined primarily by the way in which the poison entered the body, and also largely depend on the individual characteristics of the body: the state of detoxifying immunity, the system of non-specific resistance, neuroregulatory mechanisms, hormonal background, the presence or absence of immune pathology, concomitant diseases, the level of sensitization. An important role is also given to age, as well as the dosage and nature of the substance that entered the body.

As a rule, regardless of how the poison entered the body, it eventually enters the blood and spreads throughout the body. It is at this level that the main pathological processes occur. That is why it is so important to prevent the poison from entering the blood and to provide the person with emergency assistance in a timely manner.

Once the poison has entered the body, the poisoning is accompanied by disturbances in the main metabolic processes. The kidneys and liver are the first to suffer, since they have to do the main work of processing, neutralizing and utilizing the poison from the body.

Inflammatory, intoxication, autoimmune, sometimes allergic and atopic processes develop. When kidney function is impaired, dehydration almost always develops (a large amount of water is excreted from the body). As a consequence of dehydration, the water-salt balance is inevitably disrupted. All this can lead to a serious condition, organ failure, comatose state, organ and system failure.

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Symptoms smoke poisoning

They are generally standard and are characteristic of severe intoxication processes. While the poison penetrates the body, it has a damaging effect on the route through which it penetrates. This damage can be both reversible and irreversible. For example, if the poison penetrates through the respiratory tract, a chemical burn of the respiratory tract occurs, damage to the mucous membranes, difficulty inhaling/exhaling, and other similar phenomena. When penetrating through the gastrointestinal tract, the mucous membranes of the mouth, esophagus, stomach are damaged. Chemical burns, ulcers, erosions, and bleeding may develop. Sometimes a thermal burn also develops, for example, during fires, if a person inhales hot smoke or steam. When penetrating through the skin, pores become clogged and inflamed. When it gets on the mucous membranes. They burn, become inflamed, turn red, and pain appears. The development of burns, dermatitis, and skin ulcers is possible.

Then, regardless of how the poison initially entered the body, standard intoxication develops. The poison enters the blood, binds to blood cells and is carried throughout the body. In this case, the normal functioning of the body is disrupted at the molecular level. There is a violation of consciousness, coordination, balance, speech, thought processes, and even the orienting reflex, spontaneous motor activity, aggression, increased excitability, or, conversely, inhibition develop. Shortness of breath appears, sometimes breathing is impaired, the pulse changes. The frequency of respiratory movements, heart contractions (both increase and decrease), arrhythmia, asthma attack, angina, spasm, convulsions, loss of consciousness, hallucinations, delirium, paralysis may develop. Chills, fever, an increase or a critical drop in temperature, pressure appear.

Carbon monoxide poisoning

The peculiarity of carbon monoxide smoke and poisoning by its products, derivatives is that it binds to hemoglobin in the blood, destroys it. If normally red blood cells should carry oxygen, which attaches to the hemoglobin molecule, then in case of poisoning, instead of oxygen, a carbon dioxide molecule attaches to hemoglobin, and thus is transported throughout the body, penetrating, thus, absolutely all cells and tissues of the body, including the brain, heart. Having reached the target, it has a destructive effect on these structures, as a result of which their function is completely disrupted or switched off, that is, insufficiency develops, up to a complete loss of function, the development of multiple organ failure. As a result, death occurs, quite quickly.

It is characteristic that if hemoglobin has attached a carbon monoxide molecule, it can no longer attach an oxygen molecule. Thus. The body is left without oxygen. Cells and tissues not only do not receive oxygen (and they need it vitally), but instead receive carbon monoxide, which destroys them. In addition, normally, on the way back, after the red blood cell has given up an oxygen molecule, it attaches carbon dioxide and removes it, thus cleaning the cells and tissues from processed products. In case of poisoning, these processes are also disrupted. On the way back, carbon monoxide molecules are also attached, or nothing is attached. As a result, the body additionally accumulates carbon dioxide, processed products of cellular activity, which should normally be removed from the body. Accumulating, they also have a toxic effect on the body. Accordingly, the body simultaneously receives double poisoning - both carbon monoxide and non-excreted products of cellular functioning.

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Tobacco smoke poisoning

The essence of tobacco smoke poisoning is the toxic effect of nicotine on the body. In large quantities, it has a paralyzing and depressing effect on smooth muscles and the heart muscle. It also has a negative effect on the main parameters of cellular and tissue metabolism, disrupts the main molecular and biochemical indicators, which leads to disruption of the main functions of the body.

Headache, dizziness, pupil constriction, nausea, vomiting, hallucinations, delirium may indicate poisoning. A person's heart rate, pulse, and breathing increase significantly, and their body temperature and blood pressure decrease. If there is a tendency to allergic reactions, swelling, an attack of suffocation, and anaphylactic shock develop.

Welding fume poisoning

Welding smoke poisoning most often affects people who work with welding. This is mainly chronic poisoning, which can be conditionally classified as an occupational disease. However, welding smoke poisoning also occurs in people who have encountered welding for the first time, as a result of a large amount of welding smoke entering the body, or as a result of increased sensitivity of the body to this smoke.

Often, when poisoned by welding smoke, signs of acute abdomen appear (requires immediate surgical intervention). It manifests itself as sharp, unbearable pain in the abdomen, diarrhea, profuse vomiting, sometimes with blood impurities. If emergency surgical care is not provided in the first 2-3 hours, a fatal outcome occurs.

Less severe cases of welding smoke poisoning are accompanied by the development of rhinitis, since in most cases the poison enters the body through the respiratory tract. At the same time, conjunctivitis also develops, since the mucous membrane of the eye suffers significantly from welding smoke, and a chemical burn develops. This can lead to an inflammatory process or an allergic reaction, swelling of the mucous membrane, irritation, and hyperemia are noted.

Nasal congestion progresses, difficulty breathing at night, and a runny nose appears. In chronic poisoning, swelling and inflammation progress, tracheitis, tracheobronchitis, bronchitis, pneumonia, pleurisy, pulmonary obstruction, alveolitis, as well as rhinosinusitis, sinusitis, frontal sinusitis, otitis, tubootitis, etc. develop.

Also, part of the pathology falls on the skin. Redness, irritation, dry skin, chemical burn are observed.

Plastic smoke poisoning

Poisoning with smoke from plastic is severe, since burning plastic produces many toxic substances, most of which firmly and irreversibly bind to the cellular structures of the blood, leading to their complete destruction. Characteristic features of such poisoning are weakness, increased sweating, and increased heart rate. A distinctive feature of this type of poisoning is that a person's body is covered in cold sweat, since the detoxification system and thermoregulatory apparatus are triggered, which are aimed at eliminating the symptoms of poisoning and restoring the processes disrupted in the body. Then the pupils dilate, and coordination of movements is impaired. Suffocation may develop, especially if a person has a tendency to allergic reactions. Gradually, the symptoms increase, intensify. Without emergency care, a person inevitably dies.

In this case, correct diagnostics are especially important. Only by knowing the cause of the pathology can you quickly find an effective remedy and administer an antidote. This will prevent further intoxication.

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Headache after inhaling smoke

In most cases, if a person has inhaled smoke, he or she will have a headache. The main reason for this is that the brain does not receive enough oxygen, and there is also an excess of carbon dioxide and metabolic by-products. All these substances accumulate, penetrate the blood-brain barrier, destroy microglia, disrupt the functional state of glial cells and other vital structures of the brain. Cerebral circulation and the state of the main structures of the brain are disrupted. Accordingly, spasm and pain develop. Gradually, the functioning of not only the central but also the peripheral parts of the nervous system is disrupted, and subsequently the entire body as a whole.

The first signs are a sharp deterioration in health, profuse sweating, weakness, nausea, headache, dizziness. Among the first symptoms in the mouth is a slight metallic taste, which indicates the destruction of hemoglobin, and that the poison has already entered the blood.

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Stages

As a rule, three stages of poisoning are distinguished.

At the first stage, the poison only penetrates the body and damages the structures through which it enters the body. Local symptoms develop, depending on how the smoke affects the body. At this stage, the poison has not yet penetrated the blood. When penetrating through the gastrointestinal tract, a chemical burn of the esophagus and stomach develops.

When penetrating through the respiratory tract, there is a burn of the mucous membranes, the development of edema, and irritation of the upper and lower respiratory tract.

The second stage is characterized by the accumulation and further absorption of toxins, their penetration into the blood, spread throughout the body, and penetration into the internal organs. Thus, in case of poisoning through the respiratory tract, the accumulation of smoke and toxic substances occurs in the alveoli. Their absorption also occurs there, the substance is absorbed and then penetrates into the blood. Gradually, it spreads throughout the internal organs, where the main toxic effect occurs.

When poison enters through the gastrointestinal tract, the main absorption occurs through the walls of the large intestine, then through the walls of the small intestine. Then the substance enters the blood, spreads throughout the body, attacks target cells, and then has a toxic effect there.

The third stage is the poison getting into the target tissues, into the organs. The substance penetrates the liver, where a number of transformations occur. Normally, it is neutralized and then removed from the body. But with a large amount of poison, the liver cannot cope with the neutralization and processing of this poison. A large amount of toxin, on the contrary, kills liver cells (cirrhosis, acute liver failure develops). And then the poison freely migrates through the body, attacking other organs and tissues. In most cases, this means death, which will occur sooner or later. But it is already inevitable, because if the poison has destroyed the liver, there is no longer a structure that can neutralize it, accordingly, it begins to destroy other organs and systems. Death often occurs from multiple organ failure.

It is the process of processing the substance by the liver that determines the further course of poisoning. If the liver was able to neutralize and remove the toxin, the body will recover. Therefore, it is so important to conduct detoxification therapy in a timely manner and provide assistance to the person. This will help the liver cope with its functions and will not allow it to be destroyed.

Conventionally, a third stage is also distinguished, or more precisely, the outcome of poisoning. This is either recovery, followed by a long recovery period, or death.

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Forms

Depending on the criteria underlying the classification of poisoning types, several types can be distinguished. The most convenient and functional approach is to divide poisoning into 2 types - acute and chronic. The treatment and the state of the body directly depend on this.

In acute poisoning, the body is exposed to a large amount of smoke at one time. Acute processes develop that require immediate action and urgent neutralization. In chronic poisoning, the poison systematically accumulates in the body in small quantities. Therefore, it is important to prevent further accumulation, remove the already accumulated poison and eliminate the consequences of its impact on the body.

Complications and consequences

Smoke poisoning can cause various and multifaceted consequences and complications. They can affect any organs. These can be chemical burns, rhinitis, gastritis, airway obstruction, edema, anaphylactic shock. Chronic poisoning often causes upper and lower respiratory tract diseases, digestive and circulatory disorders, kidney, liver, and heart diseases. The consequences of poisoning are extremely unfavorable for pregnant women: the poison can enter the body transplacentally, increasing the risk of developing fetal pathology. Poisoning is extremely dangerous for children, especially infants and newborns, since their reaction develops very quickly, at a rapid pace, and is severe: an allergic reaction, anaphylaxis, peritonitis, pain, and anaphylactic shock are possible. The most severe cases, as well as failure to provide or improper provision of emergency care, end in severe kidney and liver pathology, the development of cirrhosis, renal and hepatic failure, multiple organ failure and death.

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Diagnostics smoke poisoning

The basis for diagnosing any poisoning, including smoke poisoning, is, first of all, determining the clinical picture of the pathology that is characteristic of a particular type of poisoning. To do this, it is important to collect the entire anamnesis, with a detailed description of the symptoms, early signs of the pathology, as well as the circumstances under which the poisoning occurred. The sooner the diagnosis is made, the faster the correct treatment will be prescribed, the antidote will be selected, and the greater the chances of a favorable outcome. Therefore, when the first signs of poisoning appear, you need to call an ambulance. You should also describe all the symptoms in detail, say what substances there was contact with.

During diagnostics, three groups of methods are mainly used:

• methods for diagnosing skin lesions,
• methods of diagnosing respiratory pathology,
• methods for diagnosing damage to the digestive system.

One method or another is used depending on how the poison entered the body.

There are also a number of universal diagnostic methods and tests that are used for any poisoning, including clinical and toxicological studies. In many ways, the diagnosis is made based on the clinical picture.

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Tests

The main, most accurate and informative methods that allow you to quickly and effectively make a diagnosis and proceed to treatment are toxicological analysis. It allows you to accurately determine the substance that caused the poisoning, and often its quantity (concentration). This makes it possible to prescribe appropriate treatment, administer an antidote.

The third most important test is a biochemical blood test. It can accurately and quickly tell what pathologies are developing in the body, what organs are damaged, and to what extent the poison caused them, how reversible or irreversible the consequences are, how long ago the poisoning occurred. Whether the kidneys, liver, and many other important information are affected. This allows you not to waste time on other tests, but to immediately begin treatment.

If it is necessary to obtain more detailed information, other research methods are also used.

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Instrumental diagnostics

Today, there is a huge variety of instrumental diagnostic methods, and all of them are available when making a diagnosis during poisoning. The choice of method largely depends on the way in which the toxin that caused the poisoning entered the body. In case of smoke poisoning, this is most often the respiratory tract, less often - the skin.

If the poison enters through the respiratory tract, the following research methods are used: spirogram, radiograph, fluorogram, functional tests, MRI, CT, biopsy, bronchoscopy, diagnostic laparoscopy. In case of skin pathologies, the main research method is direct examination of the skin and mucous membranes (visually, through a magnifying glass, microscope). If necessary, a scraping or biopsy is taken.

When the poison gets into the blood and internal organs, systemic lesions develop that require diagnostics. The following are used: electrocardiogram, angiography, ultrasound of internal organs, abdominal cavity, pelvis, heart, magnetic resonance and computed tomography, gastroscopy, radiography, colonoscopy, rheography.

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Differential diagnosis

In the course of differential diagnostics, it is important to differentiate the signs of one disease from the signs of another disease with similar manifestations. Different diagnostic methods, such as laboratory and instrumental ones, may be required in the course of differential diagnostics.

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Treatment smoke poisoning

Any poisoning requires urgent treatment, even if it is a common poisoning from a campfire or fire. It is important to remember that with any type of poisoning, you need to act immediately, the life of the victim depends on it.

The first thing to do in case of smoke poisoning is to take the victim out into the fresh air or away from the source of the smoke. Then you should immediately neutralize the poison and stop its further impact on the body. In the meantime, call an ambulance or ask those nearby to do so.

Until the doctor arrives, the victim must be kept at rest. You can give him warm tea to drink. To neutralize the smoke, sorbents and other substances of similar action are introduced into the body, aimed at absorbing and removing the poison from the body. You can offer warm milk, since it is a good sorbent.

After the threat to life has passed, supportive therapy is carried out, aimed at stabilizing and normalizing the body's condition.

This is followed by restorative therapy, which is aimed at eliminating the consequences.

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Prevention

Prevention comes down to following the rules for working with gas appliances and equipment. You should turn them off at night, when the stove goes out, turn off the taps and appliances. You should not smoke, or smoke in moderation. When working with welding, use personal protective equipment. In case of fire, smoke. And even when making a regular fire - move away, do not inhale the smoke. You should not burn rubber, plastic. It is better to use other, environmentally friendly methods of disposal of these products. If smoke gets into the body, first aid should be provided as quickly as possible.

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Forecast

If you provide first aid to the patient in a timely manner, neutralize the toxins that entered the body along with the poison, and then carry out the necessary treatment, the prognosis will be favorable. Smoke poisoning ends in death only if first aid is not provided in a timely manner. The prognosis for carbon monoxide poisoning is also unfavorable. Often, even timely first aid does not guarantee a favorable prognosis.