The difference between poisoning and accidental first aid is that

The first priority for ordinary accidental injury first aid is to quickly control fatal injuries and maintain vital signs. The cause of the injury can be investigated after life is stable.； In poisoning first aid, "locating the source of poisoning" must be placed at the same or even higher level than maintaining physical signs. Wrong intervention may accelerate the deterioration of the injury.

Last summer, when I was on duty at 120, I encountered a particularly impressive police call: two emergency calls were made to the same unit building in the old city. Uncle Zhang on the first floor was hit by a retrograde delivery truck while riding an electric scooter. He suffered an open fracture of his calf and suspected intracranial hemorrhage. Grandma Li on the third floor was pickling cold vegetables at home and mistakenly sprinkled the nitrite in an old seasoning bottle as table salt. The couple vomited and had diarrhea at the same time and fainted in the kitchen for half an hour after eating. After we arrived at the scene, we dealt with it in two ways: first, we put a neck brace on Mr. Zhang, applied pressure to stop the bleeding, and measured his blood oxygen and blood pressure. We didn’t ask him much about what kind of car he was hit by, and we only made up for the cause of the accident after he was taken to the ambulance. ； But for Grandma Li and his wife, their first reaction was to dig through the kitchen trash can to find leftover cold dishes and condiment bottles. At the same time, they called their family members to ask if they had any chronic diseases and whether they might have taken medications by mistake. Even the intravenous access was waiting to get the remaining nitrite bottles and confirm that it was nitrite poisoning before injecting the corresponding specific antidote.

Don’t think that this is our deliberate prioritization. It’s the experience that comes from actually stepping into pitfalls. The old nurse who taught me before told me about a case in the early years. There was a young man who had an argument with someone and drank toilet cleaning liquid. The neighbor did not know that he was poisoned. When he saw him lying on the ground and vomiting violently, he picked his throat to induce vomiting. It turned out that the toilet cleaning liquid was highly acidic and passed through the esophagus twice, directly burning the esophagus and causing adhesions. Later, he spent hundreds of thousands of yuan on dilation surgery before he could barely eat. If vomiting is caused by an ordinary accidental fall, inducing vomiting can prevent suffocation, and there will be no major problems no matter what.

There is controversy over this priority in the industry. There is a group of emergency doctors who advocate "stabilize the physical signs first and then find the cause." Especially for patients who have suffered cardiac arrest, whether it is poisoning or an accident, it is definitely right to perform cardiopulmonary resuscitation first. You can't ignore the heartbeat that is about to stop and empty the medicine bottle next to it, right? But the opinion of the other school is also very reasonable: the window for special intervention in many poisonings is only a few minutes, such as organophosphorus pesticide poisoning. If atropine is given 10 minutes late, the patient may not be saved. If the patient is misjudged to be a normal fainting and given glucose infusion, the toxicity will be aggravated. The pre-hospital first aid operating standards updated in the past two years have actually balanced the two opinions: as long as there are no immediate fatal signs (such as cardiac arrest, aortic bleeding, asphyxia), those suspected of poisoning must find the source of the poison as soon as possible, and then take intervention measures.

To put it bluntly, the difference between the two is like giving emergency help to a computer: if the computer is dropped and cannot be turned on, you can first pull out the hard drive to save the data, and then repair other hardware, regardless of whether it was dropped from the table or smashed by someone.； But if your computer crashes after clicking on a virus file, you must first figure out whether it is a ransomware virus or a mining virus, and then find the corresponding killing tool. Then you can format it randomly or force restart. Maybe all the data is lost and it cannot be repaired.

Ordinary people don't actually need to remember too complicated operating procedures, just remember a little judgment trick: if there are empty medicine bottles, pesticide bottles, leftover strange food around the person who had the accident, or if several people have the same symptoms of vomiting, convulsions, or fainting at the same time, then There is a high probability of poisoning. When calling 120, be sure to state clearly "what you may have eaten/touched". If there are obvious signs of a car accident, fall, or being smashed, first explain where the bleeding is and whether you are conscious, and leave the rest to the emergency personnel.

In the past few years before I started working in the hospital, the regret I have seen the most is not that the operation was wrong, but that the situation was not explained clearly when calling 120. It was not until I was taken to the hospital that I found out it was poisoning, and I missed the best time for intervention. It is really a pity. If you know more about this little difference, maybe it will be of great help one day.