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Used for carbon monoxide poisoning. The effect of carbon monoxide on human health. Reference. Severe poisoning

Signs of carbon monoxide poisoning - headache, nausea, suffocation, impaired movement with a gas density of 0.02-0.03% and exposure to a person for 4-6 hours. At a density of 0.1-0.2% and exposure for 1-2 hours - coma occurs, breathing stops, death is possible. Intoxication by combustion products during a fire is 80% of the factors contributing to human mortality; more than 60% is due to carbon monoxide.

Carbon monoxide is a toxic substance that has a rapid toxic effect on the body. Dangerous for human life. At a density of 1.2% in space, the death of the victim without assistance medical care occurs within 3 minutes.

The dangerous effects of carbon monoxide occur in a short time:

1. It is impossible to determine by color, smell, or feel its presence in the room.
2. Seeps through barriers and soil.
3. Passes through porous materials, an ordinary gas mask cannot prevent its toxicity.
4. Organ systems and tissues are affected due to the gas blocking the flow of oxygen to them.
5. The substance combines with hemoglobin; when combined, carboxyhemoglobin is formed, which disrupts the functioning of organs. Red blood cells cannot deliver O2 to tissues, hypoxia occurs.
6. The central nervous system is affected as a result of lack of oxygen. Nausea, confusion in the head, and pain appear.

There is a disruption in the functioning of the heart muscle and striated muscles. The combination of a gaseous substance with muscle protein is manifested by weak pulse, palpitations, and difficulty breathing.

Causes and symptoms

The causes of poisoning are:

1. Household poisoning. Broken heating units: stoves, fireplaces. Leakage of propane containing 4-11% CO, long burning kerosene.
2. Fire. When burning Vehicle, buildings, fuel cars.
3. Traffic fumes. When the car is operated indoors, they contain a maximum of 13.5% carbon monoxide, an average of 6-6.5%. The concentration can become lethal within 5 minutes.
4. Gas, wiring in production premises. Gas product used for synthesis, acetone, phenol, methyl alcohol, methane. If ignited, their vapors are dangerous.
5. Gas on site gas appliances. Stoves, heat generators with insufficient air ventilation, clogging in ventilation pipes provoke an influx of carbon monoxide into production rooms.

Intoxication occurs when using hookahs and breathing units.

There are 3 degrees of intoxication due to the presence of CO density in space. You can distinguish and recognize to what extent the person inhaling the fumes has been poisoned using the symptoms according to severity:

Easy stage	Middle stage	Severe stage
Presence of carboxyhemoglobin in the blood
no higher than 30%	30-40%	40-50%
consciousness is pure; acute headache; noise in the head; dizziness; lacrimation;; mucus from the sinuses; the patient is feeling nauseous; vomit; temporary vision damage; difficulty breathing; dry throat; hoarse cough.	short-term interruptions of consciousness; dyspnea; breathe heavily; dilated pupils; hallucinogenic visions, delusions; convulsive conditions; rapid heartbeat, chest pain; redness of the skin, mucous membranes; visual acuity decreases, spots appear; hearing decreases.	possible coma for several days; convulsive conditions; urinary and fecal incontinence; decreased heart rate; breathing is interrupted; cyanosis of the dermis.

Atypical symptoms of poisoning in three forms:

1. Fainting form. Rapid drop in pressure 70/50 mmHg. or lower. Temporary loss of consciousness.
2. Euphoric form. Poor orientation in the room, severe agitation, delirium, fainting, breathing failure.
3. Lightning form. The density of carbon monoxide reaches 1.2% per 1m³. The level of carboxyhemoglobin in the patient's blood reaches 75%. Signs: convulsions, paralysis of the respiratory tract, lack of consciousness, death within 2-3 minutes.

Signs of smoke inhalation appear within 2-6 hours after inhaling air containing 0.22-0.23 mg CO per liter. Death occurs within 20-30 minutes if the CO concentration is 3.4-5.7 mg/l - within 1-3 minutes at a density of 14 mg/l. Code in ICD-10 X47.

A Necessary Antidote

It is important to administer the antidote “Acyzol” to the patient in the first minutes of providing first aid.

"Acyzol" is a fast-acting medicine that counteracts carbon monoxide poisoning. It blocks the formation of carboxyhemoglobin and quickly helps cleanse the victim’s body of carbon monoxide.

Condition - the sooner administration is undertaken after poisoning, the greater the chances of avoiding negative consequences for the patient.

Medicine offers an application algorithm:

1. Treatment involves intramuscular injection - 1 ml immediately after evacuation. The procedure is repeated after 60 minutes.
2. Prevention involves 1 ml intramuscularly 20-30 minutes before entering the danger zone.

The drug reduces several times Negative influence poison on the body.

First aid at home

First aid for carbon monoxide poisoning involves the following sequence:

1. Evacuate a person with the help of the Ministry of Emergency Situations.
2. Call an ambulance immediately.
3. The patient must be given access to fresh air. Unfasten the collar and chest, lay it on one side to avoid the tongue falling in. Open the windows indoors.
4. In a conscious state, give the victim tea to activate the vasomotor and respiratory centers.
5. To restore consciousness, apply ammonia. Soak the cotton wool in the solution and let it breathe. If there is no reaction, rub your arms, legs, chest, face to stimulate blood flow.
6. Presence of indicators of clinical death: no breathing, no pulse, carotid arteries do not pulsate, pupils do not move in the presence of light. In such situations, provide pulmonary and cardiac resuscitation. At home, the prehospital mechanism is as follows: 2 breaths, 30 chest compressions.
7. If the patient is conscious, lay him on his side and cover with something warm.

When evacuating a room, be sure to hold your breath and exit as quickly as possible with the victim.

First aid at home includes important points:

1. Take the patient outside, then the carboxyhemoglobin content in the blood will decrease by 50%.
2. The folk method is to place mustard plasters on the chest or back. Apply chest rub, which will increase blood circulation.
3. Do not overheat the victim.

Upon arrival, emergency workers provide the patient with oxygen through a special pillow and administer an antidote. The doctor conducts diagnostics and makes an accurate diagnosis. Symptoms in some cases may not indicate consequences. Only a doctor can recognize possible complications and determine correctly, based on tests, the type of patient, the severity of the intoxication.

The decision to hospitalize is made by the doctor. The following categories of patients are required to be admitted to the hospital:

• patients with a blood carboxyhemoglobin concentration of more than 25%;
• during pregnancy (more than 10%);
• with cardiovascular pathology (more than 15%);
• those who lost consciousness, became delirious;
• with a body temperature less than 36.6 °C.

A small child should be examined and hospitalized, including patients with mild intoxication.

Early treatment reduces mortality and disability.

Carbon monoxide poisoning requires the following treatment:

1. The victim is given breathing oxygen with a partial pressure of 1.5-2 atm or carbogen (95% oxygen and 5% carbon dioxide). The procedure lasts for 3-6 hours.
2. Quartz treatment is prescribed. Using a lamp, the breakdown of carboxyhemoglobin is accelerated.
3. Injection of 1 ml of cordiamine and 1 ml of 10% caffeine under the skin. Used for heart failure.
4. In case of complications of the respiratory tract, Isoniazid tablets are prescribed for prevention purposes. The drug is used in the treatment of pneumonia in children and adults. The dose is 5-15 mg per 1 kg of body weight, 1-3 times a day after meals.

Symptomatic infusion therapy includes the following steps:

1. Soda 4% solution 400 ml, hemodez 400 ml are administered intravenously.
2. Apply vitamins: solution of ascorbic acid 5%, 20 ml and glucose 40%, 60 ml intravenously.
3. The relief of seizures is carried out with the medication “Diazepam”.
4. Coma involves the administration of 0.01 mg/kg naloxone + 40-80 ml of 40% glucose + 100 mg of thiamine.

Drug therapy is aimed at normalizing the central nervous system, other systems and organs, depending on the severity of the poisoning.

Consequences and life prognosis

After the onset of carbon dioxide poisoning, deterioration may occur:

• circulatory disorders, cerebral edema;
• hemorrhages;
• deterioration of hearing and vision;
• possible myocardial infarction;
• blisters and swelling appear on the skin, necrosis and nephrosis are possible;
• coma is accompanied by chronic pneumonia.

If the carboxyhemoglobin level reaches 75%, death occurs within 3 minutes.

To prevent serious violations, it is necessary to take preventive measures:

1. Use gaseous appliances only in working condition.
2. Carry out periodic preventive inspections of equipment by a specialist.
3. Choose air access through ventilation.
4. Check the stove damper.
5. Do not work in enclosed spaces with the car engine running.
6. When working with carbon monoxide, follow safety precautions.

By following simple rules, you can avoid intoxication.

Gas poisoning is highly dangerous. In case of intoxication, it is necessary to ensure the elimination of smoke and quickly take the victim outside. Then immediately call an ambulance. Give the patient hot tea, turn him on his side, and provide warmth. The faster these measures occur, the higher the likelihood of saving the patient’s life.

Content

Signs that carbon monoxide (carbon monoxide (II), carbon monoxide, carbon monoxide) has formed in the air in a dangerous concentration are difficult to determine - invisible, may not smell, accumulates in the room gradually, imperceptibly. It is extremely dangerous for human life: it is highly toxic; excessive levels in the lungs lead to severe poisoning and death. A high mortality rate from gas poisoning is recorded annually. The risk of poisoning can be reduced by following simple rules and the use of special carbon dioxide sensors.

What is carbon monoxide

Natural gas is formed during the combustion of any biomass; in industry, it is a product of the combustion of any carbon-based compounds. In both cases prerequisite The release of gas is a lack of oxygen. Large volumes of it enter the atmosphere as a result of forest fires, in the form of exhaust gases generated during the combustion of fuel in car engines. For industrial purposes it is used in the production of organic alcohol, sugar, processing of animal meat and fish. A small amount of monoxide is also produced by human cells.

Properties

From a chemical point of view, monoxide is an inorganic compound with a single oxygen atom in the molecule, chemical formula- SO. This Chemical substance, which does not have a characteristic color, taste or smell, it is lighter than air, but heavier than hydrogen, at room temperatures not active. A person who smells only feels the presence of organic impurities in the air. It belongs to the category of toxic products; death at a concentration in the air of 0.1% occurs within one hour. Characteristics extremely permissible concentration equal to 20 mg/cub.m.

Effect of carbon monoxide on the human body

Carbon monoxide is deadly to humans. Its toxic effect is explained by the formation of carboxyhemoglobin in blood cells, a product of the addition of carbon monoxide (II) to blood hemoglobin. High level carboxyhemoglobin content causes oxygen starvation, insufficient oxygen supply to the brain and other tissues of the body. With mild intoxication, its content in the blood is low; natural destruction is possible within 4-6 hours. At high concentrations, only medications are effective.

Carbon monoxide poisoning

Carbon monoxide is one of the most hazardous substances. In case of poisoning, intoxication of the body occurs, accompanied by a deterioration in the general condition of the person. It is very important to recognize the signs of carbon monoxide poisoning early. The result of treatment depends on the level of the substance in the body and how quickly help arrives. In this case, minutes count - the victim can either be completely cured, or remain sick forever (it all depends on the speed of response of the rescuers).

Symptoms

Depending on the degree of poisoning, headaches, dizziness, tinnitus, rapid heartbeat, nausea, shortness of breath, flickering in the eyes, and general weakness may occur. Drowsiness is often observed, which is especially dangerous when a person is in a gas-filled room. When a large amount of toxic substances enters the respiratory system, convulsions, loss of consciousness, and in especially severe cases, coma are observed.

First aid for carbon monoxide poisoning

The victim should be provided with first aid on the spot in case of carbon monoxide poisoning. It must be immediately moved to Fresh air and call a doctor. You should also remember about your safety: when entering a room with a source of this substance, you should only take a deep breath, and do not breathe inside. Until the doctor arrives, it is necessary to facilitate the access of oxygen to the lungs: unbutton buttons, remove or loosen clothes. If the victim loses consciousness and stops breathing, artificial ventilation is necessary.

Antidote for poisoning

A special antidote (antidote) for carbon monoxide poisoning is a medication that actively prevents the formation of carboxyhemoglobin. The action of the antidote leads to a decrease in the body's need for oxygen, supporting organs sensitive to lack of oxygen: the brain, liver, etc. It is administered intramuscularly in a dosage of 1 ml immediately after removing the patient from an area with a high concentration of toxic substances. The antidote can be re-administered no earlier than an hour after the first administration. Its use for prevention is allowed.

Treatment

In case of mild exposure to carbon monoxide, treatment is carried out on an outpatient basis; in severe cases, the patient is hospitalized. Already in the ambulance he is given an oxygen bag or mask. In severe cases, in order to give the body a large dose of oxygen, the patient is placed in a pressure chamber. An antidote is administered intramuscularly. Blood gas levels are constantly monitored. Further rehabilitation is medicinal, the actions of doctors are aimed at restoring the functioning of the brain, cardiovascular system, and lungs.

Consequences

Exposure to carbon monoxide on the body can cause serious illnesses: changes in brain performance, behavior, and consciousness of a person, and unexplained headaches appear. Memory, the part of the brain that is responsible for the transition of short-term memory to long-term memory, is especially susceptible to the influence of harmful substances. The patient may feel the effects of carbon monoxide poisoning only after several weeks. Most victims recover fully after a period of rehabilitation, but some suffer the consequences for the rest of their lives.

How to detect carbon monoxide indoors

Carbon monoxide poisoning is easy at home, and it doesn't just happen during a fire. The concentration of carbon dioxide is formed due to careless handling of the stove damper, during the operation of a faulty gas water heater or ventilation. The source of carbon monoxide may be a gas stove. If there is smoke in the room, this is already a reason to sound the alarm. There are special sensors for constant monitoring of gas levels. They monitor the level of gas concentration and report if the norm is exceeded. The presence of such a device reduces the risk of poisoning.

Video

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Carbon monoxide, along with the inhaled air, enters the lungs, from where it penetrates the blood. In the blood, carbon monoxide interacts with hemoglobin, a protein that delivers oxygen to all tissues of the body. Each hemoglobin molecule contains an iron atom, which attaches an oxygen molecule to itself, resulting in oxyhemoglobin. The bond between an iron atom and an oxygen molecule is reversible. There are four heme-perfusion rings around the iron atom. The presence of hemoglobin allows the blood to carry 70 times more oxygen than a simple saline solution would.

Carbon monoxide replaces an oxygen molecule, resulting in the formation of carboxyhemoglobin instead of oxyhemoglobin,

Carbon monoxide even at 0.5% concentration can be fatal.

Which is no longer capable of performing the task of transporting oxygen.

The danger of carbon monoxide is that it reacts faster with hemoglobin than oxygen, and carboxyhemoglobin is a stronger compound than oxyhemoglobin. The concentration of carboxyhemoglobin gradually decreases in the body, but as its dissociation occurs at a slow pace, even exposure to a small concentration is dangerous carbon dioxide in the air for a long time. Manifestations of acute oxygen deficiency can begin already at a CO concentration in the air of 0.07%.

When carboxyhemoglobin levels in the blood exceed 20%, there are visible signs of carbon monoxide poisoning. With a carboxyhemoglobin content of 30%, dizziness, blurred vision, and weakness in the legs may be felt; at a concentration of 40-50%, clouding of consciousness is observed, and a concentration of 60-70% is fatal for a person. The higher the concentration of CO in the inhaled air, the more dangerous the content of carboxyhemoglobin in the blood accumulates. To give an idea of ​​what we are talking about, we can say that a carboxyhemoglobin concentration of 40% can be achieved after 3 hours in a room with a carbon dioxide content of 0.1%. If a person is not in a state of rest, but is engaged in active activity, this time is reduced.

Constant exposure to small amounts of carbon monoxide does not have significant consequences, but the presence of carboxyhemoglobin in the blood leads to a deterioration in health. A person may complain of a constant headache, loss of appetite, insomnia, irritability, lethargy, pain in the heart, attention and memory problems. Residents of large cities often report similar symptoms.

Insufficient oxygen supply to body tissues that continues over a long period of time can have serious consequences for the cardiovascular system and brain. Even when severe symptoms of oxygen deficiency are cured, disruption of the cerebral cortex can be observed, and in 70% of cases after carbon monoxide poisoning, mental disorders and personality changes appear.

In general, you shouldn't expect anything good from this gas. Hence the conclusion: precaution and forethought above all. Therefore, do not neglect the rules for installing and operating stoves, fireplaces, and other devices that ensure the combustion of any fuel. Kitchens equipped gas stoves, boiler rooms, boiler rooms must be constantly ventilated

However, there is one hundred percent certainty that the concentration of carbon monoxide in the room does not exceed acceptable standards, you can get
only by installing a special sensor. This is a device that, depending on the type, is powered either from a 220 volt network or from ordinary AA batteries, which is able to respond to the carbon dioxide content in the indoor air. Operating 24 hours a day, the gas sensor requires no maintenance or maintenance. When it is time to replace the batteries or a power failure occurs, the device itself notifies you with an audible signal. If the permissible level of carbon monoxide concentration in the room is exceeded, the sensor turns on a loud siren, and in some models it also gives a light signal.

Depending on the model and manufacturer, such devices cost from 90 to 300 thousand rubles.

Carbon monoxide (CO) poisoning is a dangerous condition that can lead to death. It is frivolous to think that with carbon monoxide modern man rarely occurs in your life. After all stove heating is a thing of the past, not everyone experiences fires. And experts find signs of carbon monoxide poisoning among motorists, hookah lovers, fireplace owners, and workers of large factories.

What is the danger

Carbon monoxide quickly and quietly causes poisoning. Sometimes people do not have time to take measures to save lives. Everything must be done in advance, but to do this you need to know what a great danger this gas poses:

1. the concentration of carbon monoxide can be small - only 1.2%, death occurs within 3 minutes;
2. the gas is colorless, odorless - no one feels that they are breathing a dangerous composition;
3. this gas passes through all obstacles - solid walls, wet wipes, layers of soil, all partitions;
4. porous media do not absorb carbon monoxide, i.e. filter materials, e.g. protective equipment will not be saved from him.

The effects of gas are invisible but destructive. We must remember the properties of this invisible killer. Be careful where carbon monoxide occurs.

Places of poisoning

In our modern world There are many places where the effect of carbon monoxide will be on the human body permanently or temporarily. You can get poisoned:

1. in closed parking lots;
2. near highways;
3. when stuck in traffic jams for a long time;
4. in long tunnels;
5. in case of violation of the rules of use in cottages with fireplaces, in bathhouses with stoves;
6. when working on hazardous industries;
7. in garages with poor ventilation;
8. on fire;
9. when smoking a hookah.

Carbon monoxide poisoning takes a few hours to a few days to show symptoms. Everything will depend on the concentration of the harmful gas, the time of inhalation, and the state of human health. For example, in a garage with poor ventilation, a person suddenly suddenly wants to sleep, although he slept well at night. But this a clear sign poisoning with this gas.

Impact on humans

The effect of carbon monoxide on the body is amazing. It joins hemoglobin 200 times faster than oxygen. This produces carboxyhemoglobin, which will interfere with the distribution of oxygen throughout organs and tissues. Lack of oxygen will negatively affect the functioning of the entire body.

Symptoms of carbon monoxide poisoning depend on the volume of the substance in the air, the time of inhalation, and the health of the person. Sometimes they can be confused with signs of another illness or taken for a cheerful mood. Signs of poisoning:

• excruciating headache, often in the temporal part;
• constant nausea;
• loss of concentration;
• drowsiness;
• soreness in the eyes;
• lacrimation;
• increased heart rate;
• dry throat, cough;
• chest pain;
• increased blood pressure;
• severe dizziness;
• fog;
• hearing loss;
• hallucinations are possible.

If a person has been in a gas-polluted room for a long time, then acute carbon monoxide poisoning is possible. Then the existing symptoms will be joined by fainting, in some cases even coma, paralysis. The victim begins to have convulsions and uncontrolled release of feces and urine. In severe cases, there is a disruption of the upper respiratory tract.

If such signs occur, it is necessary to immediately take the poisoned person to a medical facility.

Late consequences of poisoning

When CO poisoning occurs, you should definitely visit a doctor, even if the symptoms have passed. Complications will appear later; after about two days, the first consequences after poisoning begin. Victims sometimes do not associate them with carbon monoxide, which makes it difficult to make a diagnosis. Signs of complications:

1. deterioration of sensation in the legs;
2. dysfunction of the bladder;
3. diarrhea;
4. cerebral edema;
5. exacerbation of mental illness (if any);
6. pulmonary edema;
7. disruption of the heart, possible cardiac arrest.

Later manifestations of complications are noticeable a month after poisoning. This occurs in people with weak hearts and diseases of the central nervous system. They begin to experience significant memory loss and apathy. In severe cases, paralysis, decreased intelligence. If the cardiovascular system is weak, myocardial infarction may develop. Rapidly developing pneumonia also occurs.

People with chronic diseases find it difficult to tolerate intoxication of the body with harmful gases. That is why the complications of poisoning are so severe for them.

Immediate actions upon detection of victims

Quick, competent first aid is required for carbon monoxide poisoning.

1. Provide the patient with fresh air. We need to take it away from crowds of people.
2. Notify the hospital. If a person talks and laughs, this may be influenced by the gas.
3. When a person is conscious and answers questions adequately, give him tea with sugar.
4. If the poisoned person is unconscious, give him cotton wool and ammonia to smell. Lay on your side (to prevent your tongue from sticking into your airways), unbutton any clothes that are blocking your breathing. Rub your chest and back.
5. If there is no breathing, perform artificial respiration.

It is easy to understand that a person has suffered from carbon monoxide poisoning if a fire is visible nearby, or if he is lying in a car with the engine running. But if a person is unconscious, and there are no signs nearby that indicate poisoning, it is better to revive him and take him to the doctors. It is difficult to determine the damage by symptoms; your actions can make it even worse.

Help at the fire!

You need to be especially careful during a fire. In such an emergency, there is a large concentration of the deadly gas; you can become poisoned by taking just 2 to 3 breaths. Wet rags, scarves, medical masks, and other improvised means will not help. We only need modern gas masks.

When there are burning rooms with people in the fire, you cannot try to save them yourself, this will lead to an increase in the number of victims, you must call the Ministry of Emergency Situations by calling 112.

Carrying out treatment

Carbon monoxide poisoning is difficult for the body to tolerate, so first aid helps preserve human health and life. In the first three hours, you need to let the injured person breathe pure oxygen, for example, through oxygen cushion. It’s good if doctors are nearby, since it is necessary to quickly administer the antidote. All these measures are aimed at reducing the effect of carbon monoxide on the victim’s body.
Further treatment is carried out in the hospital. The patient is provided with regular therapeutic oxygen breathing. All health measures are aimed at restoring the functions of damaged internal organs and the brain. The success of these measures depends on the severity of the condition.

Preventive measures

It is easier to prevent contact with carbon monoxide and poisoning than to correct the consequences later. You just need to follow the precautions:

1. work where combustion is present will be performed in ventilated rooms;
2. correctly adjust the dampers of fireplaces and stoves;
3. in houses with gas water heaters and stoves, carry out preventive inspections and cleaning of the water heaters;
4. check the condition of ventilation in residential premises;
5. in a closed garage, turn off the car engine;
6. install autonomous analyzers in rooms with a potential threat of CO leakage;
7. follow the rules fire safety;

Preventive measures will help reduce the effects of fatal gas poisoning. It is necessary to learn to follow basic fire safety rules childhood. It is necessary not only to teach, but to practice. The rules should be automatically followed when necessary, even if the person himself is confused difficult situation.

Conclusion

Any poisoning is dangerous for humans. The consequences of carbon monoxide poisoning are very difficult to bear. Significant damage occurs to important organs of the human body. In many cases, these changes cannot be corrected.

Some people react particularly strongly to carbon monoxide. Walking along polluted streets is especially dangerous for pregnant women and small children. Persons with pulmonary diseases do not tolerate smoky rooms well. This applies to people with bronchitis and pneumonia.
It is harmful for older people to breathe air containing high levels of harmful gases. Also, patients whose bodies are weakened by long-term chronic diseases have a difficult time in rooms with carbon monoxide. Carbon monoxide poisoning occurs faster in men than in women.

In conditions modern city The air is full of car exhaust. People breathe carbon monoxide constantly, which may be why their health becomes so weak. This gas has too much of a toxic effect on the human body. Slowly but surely destroying internal organs from the inside, disrupting the functioning of all systems.

Carbon monoxide, or carbon monoxide (CO), occurs wherever conditions exist for incomplete combustion of carbon-containing substances.

CO is a colorless, tasteless gas; its odor is very weak, almost imperceptible. Burns with a bluish flame. A mixture of 2 volumes of CO and 1 volume of O2 explodes when ignited. CO does not react with water, acids and alkalis.

CO poisoning often occurs in everyday life due to improper use of heating stoves and gas water heaters, when, due to poorly functioning draft, an oxygen deficiency is formed and conditions are created for incomplete combustion of fuel. IN last years Due to the increase in the number of cars for personal use, every year during the cold season, drivers are poisoned in closed garages where cars are located with their engines running.
Acute CO poisoning can also occur in production, especially in the chemical industry, during coal coking, in coal mining, and foundries, when large amounts of carbon monoxide are formed during the production process. So, for example, coal illuminating gas contains 4-11% CO, coke gas - 70%, shale gas - 17%, generator gas from coal and coke - 27%, blast furnace gas - up to 30%. Car exhaust gases contain an average of 6.3%, and sometimes up to 13.5% CO. In car cabins, the concentration of CO can reach 0.05 mg per 1 liter of air or more, on city streets, depending on the traffic load, from 0.004 to 0.21 mg/l, and near cars - 1.5-7.1 mg /l. The danger of CO poisoning in garages is great if precautions (ventilation) are not followed. So, the engine is 20 hp. With. can release up to 28 liters of CO per minute, creating a lethal concentration of gas in the air after 5 minutes.

Clinic

The first symptoms of poisoning can develop after 2 - 6 hours of exposure to an atmosphere containing 0.22-0.23 mg of CO per 1 liter of air; severe poisoning with loss of consciousness and death can develop after 20-30 minutes at a CO concentration of 3.4-5.7 mg/l and after 1-3 minutes at a poison concentration of 14 mg/l.
CO easily penetrates the blood through the lungs and interacts with hemoglobin. The process of CO entry into the blood is significantly influenced by the oxygen concentration in the inhaled air, an increase in which clearly inhibits the intensity of CO absorption. Each gram of hemoglobin is capable of binding 1.33-1.34 ml of oxygen or CO, but the affinity of hemoglobin for CO is many times greater than for oxygen. By interacting with ferrous iron of oxyhemoglobin (a compound of hemoglobin with oxygen that delivers the latter from the lungs to the tissues), CO converts it into carboxyhemoglobin (HbCO). Sharp decrease the amount of oxyhemoglobin leads to a deterioration in the oxygen supply to tissues and the development of oxygen deficiency (hypoxia). In the presence of HbCO, the removal of oxygen from oxyhemoglobin is significantly slowed down, which aggravates hypoxia.
With the toxic effects of CO, the nervous system suffers the most as it is the most sensitive to hypoxia. In severe poisoning, diffuse brain damage, edema, and demyelination of the white matter are noted. In some cases, damage to the nervous system can be reversible, but much more often they persist for a long time as long-term consequences of former intoxication. The most common developments are amnestic disorders, pseudohysteroid conditions, epilepsy, cerebellar and extrapyramidal disorders, and asthenia. Clinical observations of CO poisoning indicate the presence of serious respiratory disorders. In case of intoxication of moderate severity, focal pneumonia can be found in a number of victims; severe poisoning is usually complicated by lobar pneumonia.
Already in the first hours after acute poisoning, damage to the heart muscle occurs, characterized by diffuse disturbances in myocardial nutrition (up to necrosis), changes in the vessels of the heart (degeneration of the endothelium, swelling of the vascular wall). Initially, the changes are reversible; with severe intoxication, organic changes in the myocardium may occur, such as toxic dystrophy, infarction, which is recorded on the ECG.
The leading clinical symptom in acute poisoning SO is a disorder of consciousness. Depending on the depth of the disorder of consciousness, there are 3 degrees of CO poisoning. In mild cases, poisoning occurs without loss of consciousness; only a short-term fainting state is possible. As a rule, patients experience tinnitus, pulsation of the temporal arteries, headaches in the frontal and temporal regions, a feeling of thirst, burning of the face, general anxiety, and fear. Characterized by an increase in blood pressure up to 150/90 mm Hg. Art., moderate tachycardia. The HbCO content in the blood is 15-20%.
In case of poisoning of moderate severity, the loss of consciousness is more or less prolonged and recovery occurs independently immediately after the victim is removed to fresh air or inhaled oxygen. The HbCO content in these cases is 20-40%. Psychomotor agitation, inappropriate behavior, facial flushing, increased body temperature to 38-40°C are clinically noted. arterial pressure increased to 150/90 mm Hg. Art., moderate tachycardia.
In severe and extremely severe poisoning, the HbCO content in the blood is 60-80%. In this case, a long-term (over several hours or even days) loss of consciousness is observed. As a rule, coma occurs against the background of breathing disorders, most often of the obstructive-aspiration type (with retraction of the tongue, accumulation of secretions in the oral cavity, trachea, trismus of the masticatory muscles). Less commonly observed is the central form of respiratory distress - rare, shallow breathing is replaced by a stop due to paralysis of the respiratory center. In this case, arterial hypotension up to collapse, pallor, cyanosis of the skin, signs of cerebral edema (stiff neck, anisocoria, etc.) are noted. Coming out of a coma takes a long time (up to several days). Characteristic are memory impairment (patients forget their name, words, do not recognize relatives, cannot read), dementia, epileptiform seizures, asthenia. As a rule, severe poisoning is complicated by pneumonia and trophic disorders (bedsores).

Treatment

In case of CO poisoning, prompt removal of the poison from the body and specific therapy are necessary. The victim is taken out into the fresh air, and upon the arrival of medical workers, inhalations of humidified oxygen are carried out (in an emergency setting using KI-Z-M, AN-8 devices). In the first hours, pure oxygen is used for inhalation, then they switch to inhalation of a mixture of air and 40-50% oxygen. In specialized hospitals, oxygen inhalation is used under a pressure of 1-2 atm in a pressure chamber (hyperbaric oxygenation).
In case of breathing disorders, before oxygen inhalation, it is necessary to restore the patency of the respiratory tract (oral toilet, insertion of an air duct), perform artificial respiration up to tracheal intubation and artificial ventilation lungs.
In case of hemodynamic disturbances (hypotension, collapse), most often resulting from damage to the central nervous system, in addition to the intravenous administration (boost) of analeptics (2 ml of cordiamine, 2 ml of 5% ephedrine solution), rheopolyglucin (400 ml) should be administered intravenously drip in combination with prednisolone (60-90 mg) or hydrocortisone (125-250 mg).
In case of CO poisoning, great attention must be paid to the prevention and treatment of cerebral edema, since the severity of the patient’s condition, especially with prolonged disturbance of consciousness, is determined by cerebral edema that develops as a result of hypoxia. At the prehospital stage, patients are administered intravenously 20-30 ml of a 40% glucose solution with 5 ml of a 5% ascorbic acid solution, 10 ml of a 2.4% solution of aminophylline, 40 mg of Lasix (furosemide), intramuscularly - 10 ml of a 25% solution of magnesium sulfate. It is very important to eliminate acidosis, for which, in addition to measures to restore and maintain adequate breathing, it is necessary to administer a 4% sodium bicarbonate solution intravenously (at least 600 ml). In a hospital setting, with severe symptoms of cerebral edema (stiff neck, convulsions, hyperthermia), a specialist neurologist performs repeated lumbar punctures; craniocerebral hypothermia is required; in the absence of a special apparatus, ice on the head. In order to improve metabolic processes in the central nervous system patients, especially those with severe poisoning, are prescribed vitamins, especially ascorbic acid (5-10 ml of a 5% solution intravenously 2-3 times a day), vitamins B 1, (3-5 ml of a 6% solution intravenously), B 6 ( 3-5 ml of 5% solution 2-3 times a day intravenously). To prevent and treat pneumonia, antibiotics and sulfonamides should be administered. Severely ill patients with CO poisoning require careful care; it is necessary to wash the skin of the body, especially the back and sacrum, change the position of the body (turning on the side), heavy percussion of the chest (effleurage with the side surface of the palm), vibration massage, ultraviolet irradiation of the chest with erythemal doses (by segments).

In some cases, CO poisoning can be combined with other serious conditions that significantly complicate the course of intoxication and often have a decisive influence on the outcome of the disease. Most often this respiratory tract burn, which occurs when inhaling hot air or smoke during a fire. As a rule, in these cases, the severity of the patient’s condition is due not so much to CO poisoning (which can be mild or moderate), but rather to a burn to the respiratory tract. The latter is dangerous because in the acute period acute respiratory failure may develop due to prolonged, intractable laryngobronchospasm, and in the next day severe pneumonia develops. The patient is bothered by a dry cough, sore throat, and suffocation. Objectively, shortness of breath (as during an attack of bronchial asthma), dry wheezing in the lungs, cyanosis of the lips, face, and anxiety are noted. When toxic pulmonary edema or pneumonia occurs, the patient's condition worsens even more, shortness of breath increases, breathing is frequent, up to 40-50 per minute, and there is an abundance of dry and moist wheezing of various sizes in the lungs. Mortality in this group of patients is high.

Treatment mainly symptomatic: intravenous administration of bronchodilators (10 ml of 2.4% aminophylline solution with 10 ml of physiological solution, 1 ml of 5% ephedrine solution, 60-90 mg of prednisolone 3-4 times or 250 mg of hydrocortisone 1 time per day, 1 ml of 5% ascorbic acid solution 3 times a day).
Great importance has local therapy in the form of oil inhalations (olive, apricot oil), antibiotic inhalations (penicillin 500 thousand units in 10 ml of saline), vitamins (1-2 ml of 5% ascorbic acid solution with 10 ml of saline); for severe laryngobronchospasm - 10 ml of 2.4% aminophylline solution, 1 ml of 5% ephedrine solution, 125 mg of hydrocortisone in 10 ml of physiological solution. For a severe cough, use codeine with soda (1 tablet 3 times a day), drink warm milk with soda or Borjomi.

The second severe complication of CO intoxication is positional injury (compartment syndrome), which develops in cases where the victim lies unconscious (or sits) in one position for a long time, touching parts of the body (most often with limbs) to a hard surface (corner of the bed, floor) or pressing the limb with the weight of his own torso. In areas subject to compression, unfavorable conditions for blood and lymph circulation are created. In this case, the nutrition of muscle and nervous tissue and skin is sharply disrupted, which leads to their death. The victim develops areas of reddening of the skin, sometimes with the formation of blisters filled with liquid (like burns), hardening of soft tissues, which are further intensified due to developing edema. The affected areas become sharply painful, increased in volume, dense (up to stone density). As a result of the collapse muscle tissue myoglobin (a protein that is part of muscle tissue) enters the blood; if the injury area is extensive, a large amount of myoglobin affects the kidneys: myoglobinuric nephrosis develops. Thus, the patient develops the so-called myorenal syndrome, characterized by a combination of positional trauma and renal failure. Clinically, in addition to the muscle lesions described above, renal dysfunction is added: first, the patient produces a small amount of dark brown urine, and then anuria sets in, followed by azotemia, overhydration, etc. Treatment of patients with myorenal syndrome is long and is carried out in specialized hospitals, so as it requires the use of various special methods (hemodialysis, lymphatic drainage, etc.). If there is severe pain, you can administer painkillers - 1 ml of a 2% solution of promedol and 2 ml of a 50% solution of analgin subcutaneously or intravenously.

Prevention

In the vast majority of cases, poisoning occurs due to the fault of the victims themselves: improper operation heating stoves, geysers, smoking in bed (especially when drunk), leading to a fire; storing matches in places accessible to children; a long stay in a closed garage, where there is a car with a running engine, a long rest (sleep) in a car with the heater and engine on, even if the car is parked outdoors. It is especially important to conduct conversations and lectures with the population on the prevention of CO poisoning in the autumn-winter season.