The difference between poisoning and accidental first aid is that

The former gives priority to blocking the continuous effects of poisons and matching the corresponding detoxification plan, while the latter gives priority to preventing the rapid deterioration of injuries and maintaining basic vital signs. The on-site judgment priorities, disposal sequences, and contraindications of the two are completely different, and they must not be mixed.

Last week, we were doing first aid science popularization in the community. Two young men simulated two scenarios. One was riding an electric bicycle and falling with an open fracture. The other was poisoning by accidentally taking half a bottle of antihypertensive medicine. The first reaction of both of them was to pinch the person first, which made me laugh. This is a typical example of not understanding the difference in the logic of the two first aids.

Think about it, for ordinary accidental injuries, whether it is a fall, a burn, being hit by something, or a fish bone stuck in the throat, the cause is basically written clearly on the scene. You can find out everything at a glance. Even if you don't know why you fainted, you can treat it as a head injury first, stop bleeding and ventilate first, and you won't go wrong. But poisoning is different. Too many poisoning scenarios are "cryptogenic": an old man faints at home alone, and you don't know whether he took the wrong medicine or had a cerebral infarction. ； After a family dinner, they all suffer from vomiting and diarrhea. You don’t know whether there are pesticides in the food or because they collectively ate spoiled bacteria. The first thing our pre-hospital emergency responders do when they arrive at the scene is always to look for “poison clues”: Are there any empty medicine bottles in the trash can? Is there a strange smell in the air? Does the vomit have an unusual color and smell? There is actually a bit of controversy in the industry on this point. In the past, old first aid textbooks would require ordinary people to induce vomiting first when they discover poisoning. Now the latest guidelines from the AHA (American Heart Association) have narrowed the scope of application for ordinary people to induce vomiting to "non-corrosive poisons, ingestion within 15 minutes, and full consciousness." It is a very narrow scenario. There are still many people who teach general vomiting in grassroots first aid training in China. My personal suggestion is not to induce vomiting in practice. Call 120 first to explain the situation clearly and follow the operator’s instructions. After all, you don’t know what you are eating. If inducing vomiting burns through the esophagus, it will be more troublesome.

Let’s talk about the difference in the order of treatment. Last month, I picked up a man who had taken dichlorvos in the car. His family was worried, so they gave him artificial respiration. As a result, he also inhaled a lot of volatile pesticides. When they arrived at the hospital, they both squatted in the emergency room to have their stomachs evacuated, which made a big mistake. If you were to have an ordinary accident, such as someone who fainted due to a myocardial infarction, it would definitely be right for you to go and do cardiopulmonary resuscitation and artificial respiration, but poisoning is different. You must first isolate the "poison source" from the person: for inhalation poisoning, move to a ventilated area first, for contact poisoning, take off poison-stained clothes, and for ingestion poisoning, wipe the residue around the mouth first, otherwise you will get in first and cause trouble. The logic of handling ordinary accidents is to "preserve life first." No matter what the problem is, stop bleeding first, ventilate the airway first, perform cardiopulmonary resuscitation first, and wait for the rest to be sent to the hospital. ； The logic for dealing with poisoning is to "cut off the source of the poison first." Otherwise, while you are doing cardiopulmonary resuscitation, the poison is still seeping into the body, and it is completely useless.

There are also ridiculous differences in contraindications. For example, for ordinary burns and scalds, it is common sense to flush cold water for 15 minutes immediately, right? However, if you encounter chemical contact poisoning such as concentrated sulfuric acid or concentrated alkali, it will be bad if you directly shower with cold water. Concentrated sulfuric acid will generate a lot of heat when it meets water, and can directly cook the dermis. You must first wipe away the remaining chemical reagents with a dry cloth before flushing. For another example, in ordinary coma, we will ask the person to be turned into a "recovery position" to prevent choking on vomit. However, if you swallow corrosive poisons such as concentrated sulfuric acid and toilet cleaning spirit, if you turn it casually, it may burst the digestive tract that has been corroded as thin as a cicada, causing massive bleeding.

This is interesting. Someone asked me before, if I had diarrhea after eating spoiled seafood or was stung by a wasp and became swollen, is this considered poisoning or an accident? In fact, the boundary between the two is not black and white. In our industry, we are generally accustomed to classifying ingestion and contact with clear exogenous poisons (including chemical poisons, biological poisons, toxins from spoiled food, etc.) as poisoning, and the remaining injuries caused by physical, mechanical, and external forces are classified as accidents. But how can we have time to classify them for you when we actually arrive at the scene? You must deal with the most serious problem first: if you go into anaphylactic shock after being stung by a wasp, you must first give epinephrine for anaphylactic shock. There is no need to worry about whether it was poisoning or an accident.

To put it bluntly, the two things are essentially competing for different things: accidental first aid is competing for time with the progression of the injury. If you stop bleeding one minute late, the person may go into hemorrhagic shock.； Poisoning first aid is to compete with the spread of poison. If you cut off the source of the poison one minute later, the more poison will enter the blood, the difficulty of subsequent treatment will be doubled. Don’t panic if you are really unsure. When calling 120, explain all the details you can see at the scene: Are there any empty bottles? Is there any strange smell? Are a group of people getting sick at the same time? The operators are professionally trained and will teach you step by step what to do, which is much more reliable than searching blindly on your phone.