Poisoning with organophosphorus compounds: variants of the course, diagnostic and treatment tactics of the emergency medical care brigade
DOI:
https://doi.org/10.11603/mcch.2410-681X.2017.v0.i1.7683Keywords:
Organophosphorus compounds, poisoning, emergency medical care, antidote therapy, clinical protocols of emergency medical care.Abstract
Introduction. The article discusses the variety of organophosphorus compounds, ways of their intake, characteristic clinical manifestations and the modern algorithm of pre-hospital therapy in the practice of the emergency medical care brigade (EMC). The relevance of this problem lies in the fact that the total mass poisoning are poisoning with organophosphorus compounds (OPhC), because they are widely used in agriculture, industry and medicine. These compounds have a wide range of activity against pests of agricultural crops.
The aim of the study – to improve quality of diagnostics and administering of quality first medical aid by the EMC workers to the patients poisoned with phosphoorganic comounds.
Materials and Methods. The main pathogenetic mechanism of action organophosphorus compounds is inhibition of cholinesterase activity – the enzyme which hydrolyzes acetylcholine and plays an important role in the process of synaptic transmission of the nerve impulse in cholinergic formations. Inhibition of cholinesterase activity leads to the cessation or reduce the breakdown of acetylcholine, which leads to the accumulation of the latter and excessive excitement they cholinergic system. Poisoning by organophosphorus compounds leads to the formation of cholinesterase, which loses the ability to hydrolyze acetylcholine, and very slowly recovers its activity.
Results and Discussion. Studies showed that the clinical picture of the effect of different organophosphorus compounds on the human body is the manifestation from the сentral or peripheral cholinergic systems. The rate of development of clinical manifestations depends on the mechanisms of admission of the poison into the body.
If the poison gets through the respiratory tract, to the fore, appear symptoms of respiratory disorders, oral – digestive tract, through the skin – muscular fibrillation. Further, regardless of the mechanisms of penetration of organophosphorus compounds in the body, in the clinical picture of acute poisoning are manifested symptoms of affection of Central nervous system (the autonomic centers of the hypothalamic structures), eyes (miosis, decreased visual acuity, accommodation spasm), cardiovascular system (vegetative-vascular dystonia, myocardial), alimentary canal (hypersalivation, colic, dyskinesia of the intestine, biliary tract, toxic hepatitis), respiratory (bronchospasm, bronchure), skeletal muscles (convulsions).
Conclusions. Given the polymorphism of clinical manifestations of the poisoning and its complications is vital the familiarization of the brigade of emergency medical care these conditions and provide skilled pre-hospital medical care. Through this comprehensive pre-hospital emergency medical care is the use of amilnitrite, in the presence of apnea or with significant respiratory failure – artificial lung ventilation and inhalation of oxygen. With the weakening of cardiac activity should use the solution of cordiamin subcutaneously, but when the vascular collapse – oxygen inhalation and subcutaneous injection of norepinephrine. Antidote therapy requires the introduction of 20 ml of chromosone intravenous, further – 30 % sodium hyposulfite intravenously.
References
Bohomolnyi, B.R., Kononenko, V.V., & Chuv P.M. (2011). Medytsyna ekstremalnykh sytuatsii [Medicine of emergency situations]. Odesa: Odes. derzh. med. un-t [in Ukrainian].
Dubytskyi, A.Yu., Semenov, I.O., & Chepkyi, L.P. (2009). Medytsyna katastrof [Medicine of catastrophes]. Kyiv: KURS [in Ukrainain].
Hrydasov, V.I., Kovalov, V.M. & Katrych, M.V. (2012). Medytsyna katastrof [Medicine of catastrophes]. Kharkiv: Zoloti storinky [in Ukrainain].
Cherniakov, H.O., Kochin, I.V., & Sydorenko, P.I. (2011). Medytsyna katastrof [Medicine of catastrophes]. Kyiv: Zdorovia [in Ukrainian].
Skaletskyi, Yu.M., & Mysula, I.R. (Eds.). (2013). Viiskova toksykolohiia, radiolohiia ta medychnyi zakhyst: Pidruchnyk [Military toxicology, radiology and medical protection]. Ternopil: Ukrmedknyha [in Ukrainian].
Musalatov, Kh.A. (2002). Meditsina katastrof (osnovy okazaniya meditsinskoy pomoshchi postradavshim na dogospitalnom etape) [Medicine of catastrophes (bases of medical aid providing for injured at pre-hospital stage]. Moscow: GOU VUNMTs MZ RF [in Russian].
Sergeev, V.S. (2010). Zashchita naseleniya i territorii v chrezvychainykh situatciyakh [Protection of population and territory in emergency situations]. Moscow: Akademicheskiy proekt [in Russian].
Nikonova, V.V., & Feskova, A.E. (Eds.). (2008). Meditsyna neotlozhnykh sostoyaniy. Izbrannye klinicheskie lektsii [Medicine of emergencies. Selected clinical lectures]. Donetsk: Zaslavskiy [in Russian].
Malenkyi, V.P. (Ed.). (2000). Nevidkladni stany v medytsyni [Emergency states in medicine]. Vinnytsia: Vinoldrukarnia [in Ukrainian].
Neiko, Ye.M. (2003). Diahnostyka ta likuvannia nevidkladnykh staniv i zahostren terapevtychnykh zakhvoriuvan [Diagnostics and treatment of emergency states and acute conditions of therapeutic diseases]. Vinnytsia: Nova Knyha [in Ukrainian].
Mishchuk, I.I. (Ed.). (2006). Intensyvna terapiia nevidkladnykh staniv [Intensive therapy of emergency states]. Vinnytsia: Lohos [in Ukrainian].
Shvets, N.I., Pidaev, A.V., Bents, T.M., Fedorov, O.A., & Mironets, V.I. (Eds.). (2006). Neotlozhnye sostoianiya v klinike vnutrenney meditsiny [Emergency states in the clinic of internal medicine]. Kyiv [in Russian].
Tarasiuk, V.S. (Ed.) (2010). Medytsyna nadzvychainykh sytuatsii. Orhanizatsiia nadannia pershoi medychnoi dopomohy [Medicine of emergency situations. Arrangement of first medical aid providing]. Kyiv: VSV Medytsyna [in Ukrainain].
