Smoke poisoning: carbon monoxide, tobacco, welding

Smoke poisoning happens quite often, and can have quite serious consequences. It can be both mild intoxication, and severe poisoning, which entail serious violations at all levels of the body, ranging from the cellular, and ending systemic, organismal. As with any other poisoning, a person needs emergency care.

[1]

Epidemiology

According to statistics, about 61% of all poisonings account for gas and smoke poisoning. Thus, carbon monoxide poisoning accounts for about 12% of all gas poisoning and smoke, and tobacco smoke poisoning accounts for about 8% of poisonings. Approximately 21% of people are poisoned with welding gas. Of these, about 67% get chronic poisoning, because people experience welding daily on the strength of their professional duties, and welding smoke systematically enters the body. Gradually, accumulating, he becomes the cause of serious poisoning. Quite often there are poisonings from plastic smoke (about 5%). Of interest is the fact that plastic combustion products are always toxic, and if a person inhaled smoke from burning plastic, poisoning is inevitable and develops in about 99.9% of cases.

In addition, approximately 32% of poisoning occurs in the domestic environment. Approximately 57% of poisonings are related to the professional activities of workers. The remaining 11% comes from accidental and deliberate poisoning that has occurred under various circumstances.

Among all the poisonings, approximately 71% are due to acute poisonings, 29% - to 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 toxin entering the blood. If a person does not help, about 85% of the poisoning is fatal. In case of carbon monoxide poisoning, with no assistance, death occurs in 100% of cases.

[2], [3], [4], [5]

Causes of the smoke poisoning

The main reason is the ingestion of toxins that are in the smoke and are formed as a result of burning. It may be products of complete or incomplete combustion. The transformation of one substance into another with the formation of vapor, smoke - well-known to us chemical processes, known since school. Many of these substances are dangerous to humans, and getting into the body, cause serious consequences.

The circumstances in which the poison enters the body may be different. But most often it is carelessness (in living conditions), non-compliance with the rules for the use of heating appliances, equipment, stoves. Separately, there are cases when people when working with smoke do not use personal protective equipment (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 (employees of boiler houses, employees of gas and oil and gas enterprises, stoves, firefighters, employees of the Ministry of Emergency Situations). In most cases, chronic poisoning is considered as an occupational disease in some professions. In this case, the cause of the poisoning becomes non-compliance with instructions, standards and protocols of actions, violation of safety, internal regulations. It is important to use only serviceable equipment, when working with sources of smoke to include exhaust hoods, to ventilate the room, to observe all precautions. Use personal protective equipment. Periodically, you need to drink courses of sorbents, apply preventive means.

Unfortunately, the frequent causes of smoke poisoning are cases of suicide, premeditated murder. Often the cause is accidents, fires, equipment malfunction, gas leakage, industrial and private accidents.

[6], [7]

Risk factors

At risk are people who, due to various circumstances, are directly in the outbreak of smoke, or near it. This includes people who are somehow in contact with toxic substances that are in the smoke. It can be people who are systematically exposed to smoke, for example, their work is in a certain way connected with smoke - firefighters, welders, barbecues.

Or it may include people who were randomly exposed to smoke: when making a fire (at rest, during a picnic), while working at the site (for example, harvesting, fumigation of trees, etc.). A special risk group consists of people who survived a fire, or those who live in a zone of frequent fires, catastrophes, accidents, near forests, where fires often occur, near industrial enterprises, in a military, combat, terrorist acts zone.

Also at risk are older people with neurovegetative, psychosomatic, degenerative disorders, sclerosis, paralysis, people with impaired neuropsychiatric reactions, inappropriate behavior, mental illness, autism. Often they may not even realize that they are in a smoke zone. What happens is a fire and you need to leave. Or they can open the gas, not realizing that they can be poisoned. This also includes children and children under 3-5 years old, especially if they are left unattended by parents, adults, people with disabilities, and disabled people.

[8], [9]

Pathogenesis

The basis of pathogenesis is the impact of toxic substances on the body. First, they penetrate one of the possible ways: through the skin, respiratory tract, the digestive tract, then enter the bloodstream and have an intoxicating effect there. The mechanisms are quite complex and are reflected in all levels of the body: cellular, tissue, organ, organism. Features of pathogenesis are determined primarily by the way the poison has penetrated the body, and also depends largely on the individual characteristics of the body: the state of detoxification immunity, the system of nonspecific resistance, neuroregulatory mechanisms, hormonal levels, the presence or absence of immune pathology, associated diseases, sensitization. An important role is given to age, as well as the dosage and nature of the substance that has penetrated the body.

As a rule, regardless of how the poison has penetrated the body, eventually it enters the bloodstream and is carried throughout the body. It is at this level that the main pathological processes take place. That is why it is so important to prevent the ingress of poison into the blood, and promptly provide emergency assistance to a person.

After the poison has entered the body, poisoning is accompanied by violations of the basic metabolic processes. First of all, the kidneys and the liver are affected, since they account for the main work on the treatment, neutralization and utilization of the poison from the body.

Inflammatory, intoxication, autoimmune, and sometimes allergic and atopic processes develop. When kidney function is impaired, dehydration almost always develops (large amounts of water are removed from the body). As a result of dehydration, the water-salt balance is inevitably disturbed. All this can lead to a serious condition, organ failure, coma, organ failure and systems.

[10]

Symptoms of the smoke poisoning

They are generally standard, and are characteristic of severe intoxication processes. As the poison enters the body, it has a damaging effect on the path through which it penetrates. This damage can be both reversible and irreversible. For example, if the poison penetrates 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 the gastrointestinal tract, the mucous membranes of the mouth, esophagus, stomach are damaged. Perhaps the development of a chemical burn, ulcers, erosions, bleeding. Sometimes a thermal burn develops, for example, during fires, if a person inhales hot smoke, steam. When penetrating the skin, the pores become clogged and inflamed. In contact with mucous membranes. They burn, become inflamed, redden, pain appears. Development of burns, dermatitis, ulceration of the skin is not excluded.

Then, regardless of the way in which the poison initially entered the body, standard intoxication develops. The poison enters the bloodstream, binds to the blood cells and is carried throughout the body. At the same time, 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 an orienting reflex, spontaneous physical activity, aggression, increased excitability, or vice versa, retardation develops. Dyspnea appears, breathing is sometimes disturbed, and the pulse changes. The frequency of respiratory movements, heart rate (both upward and downward) may develop arrhythmia, asthma attack, angina pectoris, spasm, convulsions, loss of consciousness, hallucinations, delusions, paralysis. There is a chill, fever, increase, or critical drop in temperature, pressure.

Carbon monoxide poisoning

The peculiarity of carbon monoxide smoke and its poisoning with products derived from it is that it binds to the hemoglobin of the blood, destroys it. If normally red blood cells have to carry oxygen, which is attached to the hemoglobin molecule, then when poisoning instead of oxygen, the carbon dioxide molecule joins to hemoglobin and is thus transported throughout the body, penetrating absolutely all cells and tissues of the body, including including the brain, the heart. Having achieved the goal, it has a destructive effect on these structures, as a result of which their function is completely disrupted, or their function is turned off, that is, failure develops, up to a complete loss of function, the development of multiorgan failure. As a result, death occurs rather quickly.

It is characteristic that if hemoglobin has attached a carbon monoxide molecule, then it can no longer attach an oxygen molecule. In this way. The body remains without oxygen. Cells and tissues do not just not receive oxygen (and it is vital for them), but instead receive carbon monoxide, which destroys them. In addition, it is normal on the way back, after the erythrocyte has given away the oxygen molecule, it attaches carbon dioxide, and takes it outside, thus cleaning the cells and tissues from the processed products. When poisoning is violated, and these processes. On the way back, carbon monoxide molecules also join, or nothing is attached. As a result, in the body there is an additional accumulation of carbon dioxide, recycled waste products of the cell, which would have to be removed from the body in the normal state. Accumulating, they also have a toxic effect on the body. Accordingly, the body receives double poisoning at the same time - with carbon monoxide gas, and those not derived from the functioning of the cell.

[11]

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 inhibitory effect on smooth muscles and heart muscle. It also has a negative effect on the basic parameters of cellular and tissue metabolism, violates the basic molecular and biochemical parameters, which leads to a violation of the basic functions of the body.

Headache, dizziness, constriction of the pupil, nausea, vomiting, hallucinations, delirium can indicate poisoning. In humans, the heartbeat, pulse, breathing, body temperature, and blood pressure decrease significantly. With a tendency to allergic reactions, edema, choking attack, anaphylactic shock develops.

Welding smoke poisoning

Welding smoke is most often poisoned by people who work with welding. Basically it is a chronic poisoning, which can be conditionally attributed even to occupational diseases. However, welding smoke poisoning also occurs in people who first encounter welding, as a result of the entry of large amounts of welding smoke into the body, or as a result of an increased sensitivity of the body to this smoke.

Often, when poisoning by welding smoke, there are signs of an acute abdomen (requires immediate surgical intervention). It manifests itself as a sharp, unbearable pain in the abdomen, diarrhea, profuse vomiting, sometimes with blood. Failure to provide urgent operational assistance in the first 2-3 hours is fatal.

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 may entail an inflammatory process, or an allergic reaction, swelling of the mucous membrane, irritation, hyperemia.

Progressed nasal congestion, difficulty breathing at night, a runny nose appears. In chronic poisoning, edema and inflammation progress, tracheitis, tracheobronchitis, bronchitis, pneumonia, pleurisy, pulmonary obstruction, alveolitis, as well as rhinosinusitis, sinusitis, frontitis, otitis media, etc. Develop.

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

Plastic smoke poisoning

Poisoning from plastic smoke is difficult, because as a result of plastic burning, many toxic substances are formed, most of which are firmly and irreversibly associated with the cellular structures of the blood, leading to their complete destruction. The characteristic features of such poisoning are weakness, sweating increases, heartbeat quickens. A distinctive feature of this type of poisoning is that the human body is covered with cold sweat, since the detoxification system and the thermoregulation apparatus are activated, which are aimed at eliminating the symptoms of poisoning and restoring disturbed processes in the body. Then the pupils dilate, coordination of movements is disturbed. Asphyxiation may develop, especially if a person has a tendency to allergic reactions. Gradually, the symptoms increase, increase. Without emergency care, a person inevitably dies.

In this case, correct diagnosis is especially important. Only knowing the cause of the pathology, you can quickly find an effective remedy, enter the antidote. This will prevent further intoxication.

[12]

Pain in the head after inhaling smoke

In most cases, if a person inhales smoke, he has a headache. The main reason for this is that not enough oxygen is supplied to the brain, 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 brain structures. Disrupted cerebral circulation, the state of the basic structures of the brain. Accordingly, the spasm, a pain develops. The functioning of not only the central, but also the peripheral parts of the nervous system, and subsequently the whole organism, is gradually disrupted.

The first signs are a sharp deterioration of health, profuse sweating, weakness, nausea, headache, dizziness. One of 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.

[13]

Stages

As a rule, there are three stages of poisoning.

At the first stage, the poison only enters the body, and damages those 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 entered the blood. When penetrating through the gastrointestinal tract, the development of a chemical burn of the esophagus and stomach occurs.

At penetration through the respiratory tract there is a burn of mucous membranes, the development of edema, 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, spreading throughout the body, penetration into the internal organs. So, when poisoning through the respiratory tract, the accumulation of smoke and toxic substances occurs in the alveoli. There they are absorbed, the absorption of the substance is absorbed, and then enters the blood. Gradually, it spreads to the internal organs, where the main toxic effect is carried out.

When poison is ingested through the gastrointestinal tract, the main absorption occurs through the walls of the large intestine, then through the walls of the small intestine. The substance then enters the bloodstream, spreads through the body, attacks target cells, and then exerts a toxic effect there.

The third stage - the ingress of poison in the target tissue, in the organs. The substance enters the liver, where a number of transformations occur. Normally, it undergoes neutralization and then is removed from the body. But with a large amount of poison, the liver does not 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 already other organs and tissues. In most cases, this means death, which comes 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 comes from multiple organ failure.

It is the process of processing substances by the liver and determines the further course of poisoning. If the liver was able to neutralize and remove the toxin, the body will recover. Therefore, it is important to carry out detoxification therapy in a timely manner, to assist the person. This will help the liver to cope with its functions, and will not allow it to destroy.

Conditionally emit another and the third stage, more precisely - the outcome of poisoning. It is either recovery, followed by a long recovery period, or death.

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Forms

Depending on the criteria underlying the classification of types of poisoning, several types can be distinguished. The most convenient and functional approach is the division of poisoning into 2 types - acute and chronic. Treatment depends on this directly, as well as the condition of the body.

In case of acute poisoning, an organism once a large amount of smoke. Develop acute processes that require immediate impact, urgent neutralization. In chronic poisoning, the poison systematically in small quantities accumulates in the body. Therefore, it is important to prevent further accumulation, remove already accumulated poison and eliminate the effects of its effects on the body.

Complications and consequences

When smoke poisoning can develop various and multifaceted effects and complications. They can affect any organs. These can be chemical burns, rhinitis, gastritis, blockage of the respiratory tract, edema, and anaphylactic shock. In chronic poisoning often develop diseases of the upper and lower respiratory tract, digestive disorders, blood circulation, diseases of the kidneys, liver, heart. The consequences of poisoning are extremely unfavorable for pregnant women: a transplacental route of poison penetration into the body is possible, and the risk of developing fetal pathology increases. It is extremely dangerous poisoning for children, especially infants and newborns, because their reaction develops very quickly, at a rapid pace, is difficult: an allergic reaction, anaphylaxis, peritonitis, pain and anaphylactic shock. The most severe cases, as well as the failure or improper provision of emergency care, end in severe pathology of the kidneys, liver, the development of cirrhosis, renal and hepatic insufficiency, multiple organ failure and death.

[15], [16]

Diagnostics of the smoke poisoning

The basis for the diagnosis of any poisoning, including smoke poisoning, is, first of all, the definition of the clinical picture of the pathology that is characteristic of one or another type of poisoning. To do this, it is important to collect the entire history, with a detailed description of the symptoms, early signs of 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 chosen, and the greater the chances of a successful outcome. Therefore, when the first signs of poisoning appear, you need to call an ambulance. You should also describe in detail all the symptoms, say with what substances was contact.

In the course of diagnosis, three groups of methods are mainly used:

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

Apply certain methods, depending on how the poison has 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 on the basis of the clinical picture.

[17], [18]

Analyzes

The main, most accurate and informative methods that allow you to quickly and effectively diagnose, and proceed to treatment, is a 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 the appropriate treatment, to introduce an antidote.

Three times the significance of the study - biochemical analysis of blood. On it you can accurately and quickly tell what pathologies develop in the body, damage to which organs, and to what extent the poison caused, how reversible or irreversible are the consequences, how long the poisoning occurred. Whether the kidneys, liver and many other important information are affected. This allows you not to spend time on other studies, and immediately begin treatment.

If necessary, to obtain more detailed information, apply other research methods.

[19]

Instrumental diagnostics

Today there is a huge variety of methods of instrumental diagnostics, and all of them are available at diagnosis at the time of poisoning. In many ways, the choice of method depends on the way the toxin that caused the poisoning entered the body. In case of smoke poisoning, it is most often the respiratory tract, less often skin.

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

When poison is introduced into the blood and internal organs, systemic lesions develop that require diagnosis. Apply: electrocardiogram, angiography, ultrasound of internal organs, abdominal cavity, small pelvis, heart, magnetic resonance and computed tomography. Gastroscopy, radiography, colonoscopy, rheography.

[20], [21], [22], [23], [24]

Differential diagnosis

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

[25], [26], [27]

Treatment of the smoke poisoning

Any poisoning requires urgent treatment, even if it is a common poisoning from a fire, or from a fire. It must be remembered that for any type of poisoning you need to act immediately, it affects the life of the victim.

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

Before the arrival of the doctor you need to ensure the victim rest. You can give a drink of warm tea. To neutralize the smoke, sorbents, other substances of a similar effect, aimed at the absorption and removal of poison from the body, are introduced into the body. You can offer warm milk, because it is a good sorbent.

After the threat of life has passed, supportive therapy is carried out, aimed at stabilizing, normalizing the state of the body.

Then follows rehabilitation therapy, which aims to eliminate the consequences.

[28]

Prevention

Prevention is reduced to compliance with the rules of work with gas appliances, equipment. It should be turned off at night, when leaving the stove, shut off the taps, appliances. Should not smoke or smoke in moderation. When working with welding use personal protective equipment. In case of fire, smoke. And even with the usual breeding of a campfire - walk away, do not inhale the smoke. Do not burn rubber, plastic. It is better to use other environmentally friendly types of disposal of these products. If smoke enters the body, first aid should be given as soon as possible.

[29]

Forecast

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