The relationship between poisoning and accidental first aid

Poisoning itself is one of the four most common types of accidental emergencies (the other three are mechanical injury, burns and scalding, and suffocation by foreign objects). Poisoning first aid is a special branch in the entire accident first aid system with the narrowest time window, the lowest treatment error tolerance rate, and the highest requirements for traceability of the cause. The two are related by "include + high weight binding" - at least 40% of the success rate of accidental first aid treatment in a region is determined by the response and handling level of local poisoning first aid.

Last year, I was working the day shift at the street first aid station. I was particularly impressed by Uncle Zhang who was brought in by his family members at around 2pm: he was paralyzed and confused. His family members insisted that he had sunstroke from playing chess downstairs for too long at noon. I pinched the person at home for ten minutes and drank two bottles of Huoxiang Zhengqi water. Instead of waking up, his lips became increasingly purple. I opened his eyelids to look at his pupils, and then touched his fingertips. The symptoms of blue-purple cyanosis were very obvious, which was not the flushing and high fever of heat stroke at all. After questioning for a long time, he said that he had eaten cold cowpeas that had been in the refrigerator for three days in the morning.

You see, this is the misunderstanding that many people have about poisoning and accidental first aid: they always think that poisoning is an extreme situation of "drinking pesticides and swallowing poison." Little do they know that eating spoiled food, breathing leaked gas, or even a child accidentally biting the toilet cleaner at home are all poisonings and all accidents that require first aid. The logic of dealing with many ordinary accidents is to "preserve the physical signs first and then find the cause." For example, if you fall and break a bone, first stop the bleeding and fix it, and then take a radiograph to see where the break is. But in poisoning, the opposite is often true - if you can't find the cause of the poisoning, using the wrong antidote will accelerate the condition's deterioration.

Speaking of this, a debate that has been quarreling in the first aid circle for almost ten years can illustrate the problem: mainstream first aid guidelines in Europe and the United States advocate that all patients with unexplained disorders of consciousness should first maintain breathing and circulatory signs according to conventional accident procedures, and then start the detoxification process after the test result is clear that they are poisoned. The advantage is that the wrong drug will not be given due to misjudgment, but the disadvantage is that the golden rescue time for poisoning is likely to be missed.； However, many emergency doctors on the front lines in China prefer to "check for physical signs while tracing the source". As long as there are signs of suspected poisoning - such as multiple people in the same space getting sick at the same time, cyanosis of the lips, and vomitus with a special smell, they can give activated carbon adsorption and provide symptomatic support without waiting for the test results, which can buy back a lot of time. I personally encountered a case of poisonous mushrooms eaten at a family dinner. All four patients were suffering from vomiting and diarrhea when they were delivered. We did not wait for the poison test results from the CDC, but first administered activated charcoal and made preliminary preparations for blood purification. Later, the results came out to be amanitin poisoning. Because of the preparations made in advance, all four patients were rescued. If we had to wait for the test results for two hours, two of them might not be able to survive. Of course, some people say that this method is too risky. If it is misjudged that it is not poisoning, injecting activated carbon will cause aspiration. This is correct. It is essentially a balance between "seeking stability" and "grabbing time". There is no absolute right or wrong, only the difference between applicable scenarios.

There are also many accidents that are inherently tied to poisoning and cannot be discussed separately. Last month, I picked up a three-year-old child. The parents said that the child had swallowed a button battery, and the X-ray showed that it was stuck in the middle of the esophagus. At this time, you said that it was an accident caused by suffocation by a foreign object? Or poisoned? No matter what - as long as the strong alkali liquid in the button battery leaks out, it can burn through the esophagus in 2 hours, and the subsequent corrosion and poisoning is more dangerous than the foreign object stuck in the throat itself. When many parents encounter this situation, their first reaction is to slap the baby on the back to induce vomiting, which will accelerate battery leakage. The correct approach is not to feed the baby anything, but to run to a hospital with endoscopy immediately. The sooner the better.

Oh, by the way, don't believe those "universal detoxification prescriptions" posted on the Internet, such as mung bean soup, licorice water, and drinking soapy water to induce vomiting. They are really useless. Especially when drinking soapy water, if you accidentally swallow strong acid or alkali, vomiting will corrode the esophagus for a second time, which is purely harmful. If you really suspect that someone around you has been poisoned, call 120 as soon as possible and explain clearly what you ate, how much you ate, and how long it took. If there is any leftover poison or vomitus, just pretend to bring it to the doctor instead of messing around.

I am doing pre-hospital first aid this year for the eighth year. I have encountered at least two hundred cases of poisoning, including teenagers who drank paraquat as cola, some who ate poisonous mushrooms they picked and sent to them by their families, and some who were poisoned by carbon monoxide while keeping the windows closed and burning charcoal for heating in winter. Many times you will find that in the context of accident first aid, poisoning is always the most special one - it is not like a fall that has obvious wounds. Many times the early symptoms are exactly the same as those of colds, heatstroke, and fatigue. A little negligence can miss the best rescue time. To put it bluntly, accident first aid is the line of defense that underpins all emergencies, and poisoning first aid is the frontmost and most easily broken section of this line of defense. If you know more about the relevant knowledge, you will be more confident than others in pulling people back when something goes wrong.