Poisoning with carbon monoxide is the pathological state arising at inhalation of the air saturated with carbon monoxide or smoke. In a clinical picture violations of activity of the central nervous system, respiratory and cardiovascular insufficiency prevail. A characteristic symptom of poisoning is bright hyperaemia of integuments. The diagnosis is established on the basis of given the anamnesis, clinical manifestations, determination of level of carboxyhemoglobin of blood. As emergency aid oxygenotherapy and dezintoksikatsionny actions is performed. Further symptomatic conservative treatment is carried out.
Poisoning with carbon monoxide
Poisoning with carbon monoxide, or carbon monoxide, develops at excess of its threshold limit value (0,08 mg/litre) in the inhaled air. Weight of intoxication directly depends on the content of this chemical compound in the surrounding atmosphere and time of an exposition. Inhalation by the sated carbon monoxide (3-5 mg/l) of air within half an hour provokes a serious poisoning. Receipt in respiratory organs of mix of the gases containing 14 mg/l of carbon monoxide within 1-3 minutes leads to death. Poisoning with carbon monoxide enters the four of the most often found poisonings, conceding to intoxication alcohol, drugs and medicines. Arises in life and on production.
Reasons of poisoning with carbon monoxide
Any process of incomplete combustion of organic substances is followed by release of carbon monoxide. Most often poisoning with burning products, including carbon monoxide, arises at the fire. Besides, due to the lack of organoleptic properties at this gas, its leak becomes imperceptible for the person. Pregnant women, children and people with diseases of cardiovascular system are most subject to harmful effects. Excess of maximum permissible content of carbon monoxide is promoted indoors by the following factors:
- Household. In life intoxication carbon monoxide happens because of the wrong use of the furnace, gas equipment, decay of an electrical wiring. As other frequent reason serves stay in the closed garage near the car with the working engine. Quite often symptoms of poisoning are observed at smokers of a hookah.
- Production. Toxin in excess quantity gets to air when carrying out explosive works in mines, service of blast and martin furnaces, synthesis of some chemicals. Poisoning usually occurs at non-compliance with sanitary and hygienic requirements and violation of the rules of operation of the equipment.
At inhalation carbon monoxide gets to respiratory system where there is its diffusion in blood. Gas has high affinity to hemoglobin, a myoglobin and ferriferous enzymes of a human body. It easily reacts with hemoglobin, forming incapable to transport oxygen in fabric carboxyhemoglobin. The hypoxia develops. Delay of dissociation of compound of oxygen with hemoglobin in the presence of carboxyhemoglobin aggravates oxygen starvation of all bodies and fabrics. The biochemical processes happening to participation of ferriferous enzymes are at the same time broken. Nedookislenny products of metabolism which have additional toxic effect on the central nervous system and other bodies collect.
At a pathoanatomical research bright red coloring of skin, mucous membranes, internals attracts attention. Symptoms of hypostasis of a brain, lungs are observed. Comes to light stagnant polnokrovy internals. In heart, lungs, a brain dot hemorrhages, sites of a degeneration and necrosis are found.
The disease can proceed sharply and chronically. Its current depends on concentration in air of carbon monoxide and time of its influence. At essential excess of admissible norms during the short period of time there comes sharp poisoning. Long regular inhalation of air with slightly increased content of carbon monoxide provokes development of chronic process. Depending on weight of clinical manifestations distinguish 3 degrees of poisoning:
- Easy degree. It is characterized by passing pathological symptomatology, disappearing after the termination of harmful effects. Separate manifestations can remain within a day. Concentration of a pathological form of hemoglobin does not exceed 30%.
- Average degree. Develops at 30-40% of carboxyhemoglobin in blood. Symptoms of poisoning are sharply expressed. After delivery of health care symptoms are stopped. The residual phenomena disturb the victim within several days.
- Heavy degree. Level of carboxyhemoglobin makes 40-50%. Severe defeats of bodies and systems, quite often leading by a lethal outcome are observed. Often complications develop. Symptoms of a disease remain several weeks.
Except a classical form of intoxication carbon monoxide the atypical options of poisoning masking under other pathological states sometimes meet. On clinical symptomatology experts in the field of toxicology and resuscitation distinguish lightning, euphoric, sinkopalny forms of a disease. Separate point allocates a powder disease at which toxic effect of carbon monoxide together with other explosive and powder gases is observed.
Symptoms of poisoning with carbon monoxide
Because of low tolerance of a brain to oxygen starvation at poisoning with carbon monoxide into the forefront the neurologic symptomatology acts. At easy degree of intoxication of the victim the pressing headache disturbs. It is localized mainly in temporal and frontal areas. Is followed by dizziness, nausea, vomiting, noise in ears. Quite often the headache is accompanied by sight violations. Patients complain of doubling in eyes, inadequate color perception. Gait becomes shaky, the speed of reactions decreases.
At further influence of toxin severity is aggravated, there are tonic and clonic spasms, the hyperthermia, consciousness is oppressed up to coma. Subsequently retrograde amnesia is observed. From cardiovascular system tachycardia, violations of a rhythm and conductivity of heart come to light. Quite often the patient is disturbed by intensive pains of the pressing and squeezing character behind a breast and in the left half of a thorax. At emergence of bronchitis or toxic pneumonia short wind, dry cough, substantial increase of temperature is observed.
The euphoric form of a disease is characterized by psychomotor excitement. High spirits of the victim and lack of criticism to the state are replaced by nonsense and hallucinations with the subsequent violation of consciousness. Sharp falling of arterial pressure, a collapse is peculiar to Sinkopalny option. At the lightning course of poisoning very quickly after a short episode of spasms, there occurs loss of consciousness and death. The powder disease is shown by signs of irritation of mucous membranes of eyes, nasopharynxes, a trachea and bronchial tubes along with symptoms of an adverse effect of carbon monoxide.
Specific symptoms of chronic poisoning with poisonous gas are absent. Variability of symptoms of the general intoxication of an organism is characteristic. Patients suffer from a frequent headache, dizziness, test weakness, fatigue and irritability. Weight loss, a hair loss, decrease in sight and hearing is observed. Function of endocrine glands, immune system is broken.
During timely removal of the defeat which was injured from the center symptoms of intoxication of easy degree pass independently, functions of the main systems of an organism are restored without consequences. Sharp poisoning of average and heavy degree quite often is complicated by neurologic frustration. The victim it is long headaches disturb. Development of mononeuritis of various localization, paresis, parkinsonism is possible. Complications from the blood circulatory system are shown by intracardial blockade, thromboses of vessels. Inhalation of the air saturated with toxic carbon monoxide during pregnancy leads to fruit malformations. Poisoning of heavy degree often causes death of the victim.
In diagnosis of poisoning with carbon monoxide anamnestichesky data and survey of the victim are of great importance. A characteristic symptom of serious intoxication is bright red coloring of integuments. Toxicologists and resuscitators do not allocate patognomonichny fizikalny symptoms of poisoning with dangerous carbon monoxide. At fizikalny inspection tachycardia, a hyperthermia, frequent, in hard cases faltering breath (Cheyn-Stokes), a lowering of arterial pressure come to light. It is final help to confirm the diagnosis:
- Laboratory analyses. At a research of peripheral blood are observed , the high level of hemoglobin. The quantity of leukocytes is also increased, the stab shift of a leykotsitarny formula is noted, at the same time the speed of subsidence of erythrocytes is reduced. Determination of level of carboxyhemoglobin and its ratio with normal hemoglobin of blood allows to judge severity of poisoning.
- Radiological research of a thorax. Symptoms of sharp emphysema of lungs and stagnation on a small circle of blood circulation come to light. Expansion of roots of lungs is observed. Decide small - and krupnoochagovy shadows on indistinct contours on both sides. Radiological changes usually are completely allowed within 7-10 days.
Treatment of poisoning with carbon monoxide
At suspicion of poisoning with carbon monoxide it is necessary to evacuate urgently the victim from a dangerous zone, to provide it inflow of fresh air, to stimulate breath, to warm. Oxygenotherapy is appointed, antidote is entered. If necessary resuscitation actions are carried out. The patient is subject to obligatory hospitalization. In a hospital dezintoksikatsionny and symptomatic therapy is performed. Intravenous infusions are appointed, kardiotropny, anticonvulsive drugs, corticosteroids, diuretics, vitamins are injected. At a hyper thermal syndrome the kraniotserebralny hypothermia is carried out. The serious poisoning is the indication for carrying out hyperbaric oxygenation.
Forecast and prevention
The forecast depends on severity of pathological process, timeliness and quality of medical care. Slight poisoning is stopped without consequences, medium-weight and heavy quite often leads to complications from the central nervous and cardiovascular systems. It is not possible to predict recovery of the patient staying in a coma. A bad predictive sign is aggravation of neurologic symptomatology within the first 48 hours against the background of intensive treatment.
In the preventive purposes it is necessary to follow rules of fire safety. In order to avoid household and production poisoning it is not necessary to use the faulty gas and oven equipment, electric devices. It is not recommended to be in a garage at the working automobile engine. Production rooms have to be ventilated well.