Relationship between poisoning and accidental first aid

Poisoning is a high-incidence type accounting for 17% of the total number of accidental injuries in the world according to WHO statistics in 2022. Poisoning first aid is a subdivision with the highest timeliness requirement and the lowest fault tolerance rate in the accidental first aid system. There is not only a subordinate relationship of "injury type-coping scheme", but also a two-way influence logic of "poisoning induces secondary accidents and accidents aggravate poisoning injuries", which is by no means a simple "subset" relationship.

Last week, I went to the police with 120, which just explained this relationship: Aunt Zhang on the first floor of the old residential area used nitrite in an old salt bag as edible salt, and mixed two plates of cold cucumber for his wife, grandson and nephew who came to visit. In less than half an hour, four people turned purple all over their lips, and the 10-year-old grandson was sobbed and planted on the ground, with a two-centimeter cut on his forehead. On the way to the hospital, he was given oxygen to fight methylene blue and put pressure on the child.

Seriously, in the past, when we were doing emergency pre-job training, we all classified poisoning into the subcategory of "accidental first aid" by default, just follow the process, but in recent years, more and more clinical cases tell us that the degree of binding between the two is far deeper than everyone thinks. Many people only know that poisoning is an accident, but they don't realize that convulsions, syncope and confusion during the poisoning attack are themselves the high-risk causes of secondary accidents: people who eat poisonous mushrooms dig their throats to induce vomiting and break their ribs, people who are poisoned by carbon monoxide knock over the kettle when they faint and get burned, and people who drink pesticides hit the wall and hurt themselves when they are confused. This kind of situation is too common in emergency departments. The statistics of CDC in 2023 also show that the number of secondary accidental deaths caused by poisoning in China is 12% higher than that caused by poisoning directly. Don't think this figure is exaggerated. Of the 27 poisoning patients I received last year, 11 cases were accompanied by secondary injuries of different degrees, and everything happened.

I sorted out the priority list of poisoning scenes commonly used in police at ordinary times, all of which are practical experiences from clinical practice:

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Interestingly, there is still a lot of controversy about the "operational boundary of poisoning first aid" in the emergency circle, which just reflects the linkage logic of the two: one group is old doctors who adhere to the traditional pre-hospital first aid guidelines and think that the first disposal step of non-corrosive poisoning is vomiting, especially in many counties and rural areas of China, which are more than one hour's drive from the hospital. It is worthwhile to discharge the poison as soon as possible, even if there is a little secondary risk; The other group is young doctors who refer to the guidelines updated by the American Association of Emergency Physicians (AAEM) in 2023. They think that ordinary people have no operating experience, and vomiting can easily lead to secondary accidents such as aspiration and esophageal tear, which will aggravate the injury. It is better to stay on the side and wait for medical treatment.

Actually, I won't die when I go to the police myself. Last month, I picked up a young man who ate poisonous mushrooms in a mountain group building. It's still two and a half hours' drive from the urban hospital. The young man is usually very strong and has no basic illness. I instructed his companion to press the tongue root with a clean spoon to induce vomiting on the phone, and then urged him after spitting and drinking warm salt water. When he arrived at the hospital, his stomach was basically empty, and there was no problem with the subsequent liver and kidney indicators. But last week, an old lady who drank detergent by mistake had cirrhosis of the liver with esophageal varices, and her home was only 10 minutes' drive from the hospital. I told her family to stop messing around and lie on her side until we arrived, for fear that her vomiting would directly lead to blood vessel rupture and massive bleeding.

In fact, after all, there is no universal standard answer to first aid. The relationship between poisoning and accidental first aid, to put it bluntly, is that you always have to put "specific people" in the first place, instead of clinging to the process provisions-after all, what we want to save is never the symptom of "poisoning", but the living person who is poisoned, and by the way, we just stop the secondary accidents that may be fatal together.