The relationship between poisoning and accidental first aid

Poisoning is one of the top three types of accidents with the highest fatality rate worldwide. Poisoning first aid is the core component of the accident first aid system that has the highest timeliness requirements and the strongest specificity of treatment logic. The two are a strong binding relationship of "including core support". At the same time, the practical iteration of poisoning first aid is also continuing to complete the standard framework of the entire accident first aid.

Last summer, I followed a police officer at a grassroots first aid station. A parent put diluted herbicide in a mineral water bottle and put it on the dining table. My 8-year-old child was so thirsty when she came home from school that she took two big gulps of the herbicide. When it was delivered to the station, her lips were already black and there was still yellow-green liquid on the corners of her mouth. During the entire treatment process, we did not follow the routine procedures for ordinary accidents and measure a full set of vital signs. Instead, we immediately intubated the stomach for gastric lavage and injected a special antidote. In less than 20 minutes, the baby was brought back from the line of life and death. In other accident scenarios, this operation may not be compliant, but in poisoning first aid, rushing for time means rushing for life.

Regarding the relationship between the two, the first aid circle has actually always had two different practical tendencies. One group is people who have been working for 20 to 30 years. They believe that whether it is a car accident, a fall or poisoning, the first step in any emergency first aid is to ensure breathing and stabilize physical signs, and other treatments should be put in the back row. ； The other group is a young doctor who specializes in toxicology. They feel that poisoning is too special and the first step must be to block the continued absorption of the poison. Otherwise, it will be useless if the physical signs cannot be stabilized. I once met an aunt who mistakenly took toilet cleaning liquid. Her throat was so swollen when she arrived at the station that she could not speak. The new nurse's first reaction was to insert a gastric tube for gastric lavage. The director held her down - toilet cleaning liquid is highly acidic, and the gastric tube may perforate the corroded esophagus. At that time, she was given 200ml of warm egg white to neutralize it, and then used airway protection. In the end, the aunt recovered well, and she did not even have the sequelae of esophageal stenosis. Which of these two views do you think is right? In fact, there is no absolute right or wrong, it depends on the specific situation.

Many people still have the impression of poisoning as "eating something they shouldn't have eaten." In fact, I reviewed the 372 poisoning cases reported by our station last year. Nearly half were inhaled and were environmental accidents, such as carbon monoxide poisoning caused by burning charcoal with the windows closed in winter, people accidentally inhaling hydrogen sulfide at the construction site, and paint thinner leaked in the industrial park a while ago, and 17 patients were sent to the hospital at once. This kind of mass accident handling logic is extended from the poisoning first aid - you can't check each one slowly according to the ordinary accident process. You have to classify the physical signs first. Critical patients with red labels are treated first, those with yellow labels stabilize their signs, and those with green labels are observed. This grading process has now been used in the handling of all mass accidents such as car accidents and fires. It can be regarded as an unexpected contribution of poisoning first aid to the entire accident first aid system.

To be honest, many accidents that ordinary people think have nothing to do with poisoning actually have to be dealt with according to the logic of poisoning. For example, if you are bitten by a viper in the park in the summer, everyone thinks it is an accidental injury caused by an animal. In fact, it is poisoning by biotoxins. Just disinfecting and bandaging the wound is useless. You have to tie it near the heart immediately to prevent the spread of the toxin, and apply antivenom within 4 hours. ； There are also cases of vomiting, diarrhea, and muscle aches after eating unclean crayfish. Everyone thinks that it is a bad stomach, but in fact it is poisoning caused by rhabdomyolytic toxins carried by crayfish. When replenishing electrolytes, you must monitor your kidney function, otherwise problems may easily occur.

Of course, some people argue that taking poison is not an accident. It is true that actively ingesting poisons falls under the category of mental health or public health. But when you arrive at the emergency scene, you have no time or obligation to judge whether the person accidentally ingested the poison or took the poison on his own initiative. You should follow the poisoning first aid process and save lives first and then investigate the cause. This is also the core principle of "life first" in accidental first aid.

Last week, our website conducted quarterly training, and 12 of the 20 new cases were related to poisoning: one used nitrite as salt and poisoned the whole family, one suffered hallucinations and broke his head after eating the Internet celebrity "Jian Hand Qing", and there were also children who accidentally ate their parents' antihypertensive drugs as candy. Nowadays, everyone’s life scenes are becoming more and more complex, and there are more and more hidden poisoning risks. To put it bluntly, if you have a thorough understanding of poisoning first aid, you will not panic when encountering most of the unexpected accidents in life.