The difference between poisoning and accidental first aid

The essential difference between the two is that the traceability of the cause of the disease, the targeting of the intervention logic, and the extended requirements for subsequent treatment are completely different. To put it simply, the core of accident first aid is "stop loss", while the core of poisoning first aid is "rejection."

In July last year, I worked the night shift at the district emergency center. I received two 120 orders at the same time in the middle of the night. One was a farmer in the suburbs who had vomited and had diarrhea after eating the porcini mushrooms he picked and was unconscious. The other was a young man who fell on the roadbed without a helmet at night and his face was covered in blood. The two cars arrived at the scene, and we divided them into two groups to deal with them. The movements were completely different.

Look at the young man who fell. The first thing we did when we rushed up was to hold the back of his neck steady and secure it to avoid shaking the possibly damaged cervical vertebrae. Then we felt the carotid artery to see if there was any sudden arrest. We wiped the blood off his face and looked for the wound. If the amount of bleeding was large, we directly used sterile gauze to apply pressure and hold it down. We were very gentle throughout the entire process. To put it bluntly, the first logic of accidental first aid is "don't make trouble": whether it is a car accident, burns, electric shock or drowning, the first step is to separate the person from the source of the injury (pull the switch, drag the person out of the water, remove the scalding water cup), and all subsequent operations are to prevent the existing injury from worsening - it is just a fracture, and if you pull it randomly, you may puncture the blood vessel ； Originally it was just a concussion, and if you shake it a few times, it may cause intracranial bleeding. Being able to do this is already a big help.

Oh, by the way, we have been quarreling in the industry for many years about the issue of "whether an accidental injury can be moved." The old-school protocol says that as long as you suspect spinal injury, you must not move and wait for professionals to move. Now many young doctors also say that if a person is lying in the middle of a road with heavy traffic, or there is a collapsed heavy object or a fire hazard, life should be given priority. There is nothing wrong with dragging a coat to a safe place. Originally, first aid is based on the situation. There is no 100% standard answer.

Let’s talk about the aunt who ate poisonous mushrooms that day. We squatted down and asked her family first: “How much did she eat, how long did she eat, and whether she ever vomited on her own?” While asking, we used a tongue depressor to press the base of her tongue to induce vomiting, and at the same time poured saline into her mouth. What we wanted to do was to try to expel all the poison remaining in the body before the toxins were absorbed by the gastrointestinal tract. Unlike accidental "stop loss", the core logic of poisoning is to "cleanse the poison" - even if you can't see any major problems with the person for the time being, as long as the poison is still in the body, thunder may explode at any time.

There are even more controversies about poisoning and vomiting. The previous first aid manual said that it can be induced as long as the poison is taken within half an hour and the person is awake. Now more and more clinicians are mentioning that if you drink corrosive poisons such as toilet cleaning liquid and sulfuric acid, inducing vomiting will cause stomach acid and the poison to burn the esophagus and throat for a second time. You must not touch it.； But most of the first responders who travel to suburban counties have another experience: the countryside is far from urban hospitals. If you really drink something as highly toxic as paraquat, even if there is a slight risk of burns, you have to spit out part of the poison first, which is better than getting all the poison into the blood and not being able to save it. Both arguments are reasonable, and it is just a matter of weighing the pros and cons.

The subsequent treatment of the two is even further apart. For accidental injuries, as long as the wounds are treated, the fractures are fixed, and internal bleeding is ruled out, the next step is to slowly recover, and no special targeted operations are required. ； But poisoning is different. You have to figure out what kind of poison you are poisoning before you can use the antidote for the disease. For organophosphorus poisoning, you need a sufficient amount of atropine. For tetrodotoxin poisoning, you need artificial lung support. If you don’t know the source of the poison, you can’t even prescribe medicine. The year before last, I met a panicked family member who said they had drunk pesticides. When asked about the pesticides, they said they didn’t know. The empty bottles were thrown away. We had to do gastric lavage and wash three large buckets of normal saline. It took almost half an hour to diagnose organophosphorus poisoning based on the symptoms. Fortunately, we were rescued in the end. If it had been ten minutes later, I can’t imagine the consequences.

Not all situations can be distinguished so clearly. I took an order last month. The young man was so drunk that he fell down the steps and kowtowed. When the order was delivered, half of his face was covered in blood and he was already unconscious. You can't just induce vomiting to expel alcohol at this time, right? A CT scan must be taken first to confirm whether there is intracranial hemorrhage, and there is no way to induce vomiting when a person is comatose. For fear that the vomit will be choked into the trachea and suffocate, the only option is to intubate the airway and then deal with the poisoning. In such a complicated situation, you have to be flexible and don't stick to the textbook standards.

To be honest, ordinary people don’t need to remember so many complicated procedures. They just need to remember two core points: if you encounter an accidental injury, don’t pull it randomly. If there is bleeding, hold it with a clean cloth and call 120 immediately.； If you encounter someone who may be poisoned, keep the remaining poison, medicine bottles, and vomitus first. Don't feed them randomly. Wait until the emergency personnel arrive and show them directly. It is much better than just messing around.

I have been working in pre-hospital emergency care for almost 6 years, and I have seen too many cases where things were delayed due to confusion between two logics: people who ate poisonous mushrooms and thought they had a bad stomach, and were given antidiarrheal medicine first to suppress all the toxins in the body.； He broke his leg and thought he was possessed by an evil spirit. He pinched people and poured talisman water on them, which turned the fracture into a disability. In fact, to put it bluntly, you never need to get perfect marks in first aid. As long as you don't make fatal mistakes, it will already help a lot.