Carbon monoxide poisoning in children and adolescents. Smoke and carbon monoxide poisoning in children Carbon monoxide poisoning in a child

Carbon monoxide poisoning happens quite often in everyday life and at work. (CO) - gas is lighter than air, odorless, formed during combustion with insufficient oxygen supply. The concentration of 0.07 - 0.08% CO in the air is considered life-threatening, the concentration of 0.4% CO is lethal.
Carbon monoxide poisoning can occur during a fire, during stove heating (untimely closing of stove pipes), when gas leaks, when you are in a room where a car is running.

Toxic effect and symptoms of poisoning.

Carbon monoxide forms carboxyhemoglobin with blood hemoglobin, which is unable to give oxygen to tissues. Hemoglobin binds to carbon monoxide 200-300 times more easily than oxygen.
Carboxyhemoglobin can be in a small amount in the blood (normally 1-3%). Its greater accumulation is the cause of oxygen deficiency or anoxemia.

At a concentration of about 10% of carboxyhemoglobin, the first clinical symptoms of oxygen deficiency appear, at 15-20%, signs of poisoning are pronounced, and at 65% of carboxyhemoglobin in the blood, death occurs.
Myoglobin also binds to carbon monoxide (about 10% of all hemoglobin), and carboxymyoglobin is formed.

Carbon monoxide is not destroyed in the body. In conditions of high oxygen concentration in the inhaled air and blood plasma, carboxyhemoglobin dissociates, carbon monoxide is removed through the lungs with exhaled air, and free hemoglobin combines with oxygen to form oxyhemoglobin.

The half-life of CO is:

• When breathing air - 4.5 hours;
• When breathing oxygen (100%) - 1.5 hours;
• When breathing in a pressure chamber - 2 minutes.

Caused by the accumulation of carboxyhemoglobin in the blood, anoxemia adversely affects, first of all, the central nervous system, in particular the vasomotor and respiratory centers.
The walls of the blood vessels are directly damaged, blood clots and hemorrhages are formed along the nerve fibers, in the central nervous system, in the heart muscle. There are trophic changes and necrosis on the skin, edema and softening in the brain and spinal cord, necrotic foci in the heart muscle. Breathing is at first superficial and rapid, then irregular, then stops.

The severity of poisoning depends on the concentration of carbon monoxide in the air, on the length of stay of the victim in his atmosphere, on pulmonary ventilation, on age and individual sensitivity to carbon monoxide. The younger the child, the more severe the poisoning.

With a low concentration of carbon monoxide in the air, its level in the blood rises slowly to 20-40% of the total hemoglobin.

The picture of poisoning develops gradually: headache, dizziness, tinnitus, nausea, vomiting appear. The child is agitated, he has a feeling of fear, hallucinations, then depression sets in. Although the child has enough physical strength to move to a safe place, he is not able to do it. Shortness of breath will increase, the concentration of carbon monoxide in the blood increases.

With the formation of 40-50% of carboxyhemoglobin, flushing of the skin appears, especially of the face. The carmine-red color of the skin from a significant amount of carboxyhemoglobin in the capillaries is gradually replaced by cyanosis due to paresis of the vasomotor center.

Body temperature remains low. An accelerated, weak pulse slows down, becomes irregular, extrasystoles, bigeminy, etc. are observed. Heart sounds at first with a clapping sound, then muffled. On the ECG, changes appear in the T wave and ST segment. Necrotic foci in the myocardium can give a picture characteristic of a heart attack.

Breathing quickened, shallow, subsequently becomes irregular. Muscle weakness increases, the poisoned lose consciousness, remaining in an atmosphere with a high CO content. Sometimes tonic contractions of the muscles appear. Pupils narrow and widen. Coma, involuntary urination and defecation sets in.

In the blood, leukocytosis increases to 20-30 thousand, of a neutrophilic nature with a shift of the formula to the left. Hyperglycemia with an abnormal glycemic curve results from changes in the central nervous system.

After a few hours, sometimes after several days, death occurs due to circulatory failure and pulmonary edema, or due to paralysis of the respiratory center.

At a high concentration (up to 1%) of carbon monoxide in the air, carboxyhemoglobin in the blood rapidly increases to 65-80%. The child loses consciousness, appears, death occurs due to paralysis of the respiratory center.

If the victims survive, the further outcome of the poisoning is different.

With the accumulation of about 30% of carboxyhemoglobin, poisoned children, taken out into the fresh air, quickly come to their senses, but do not remember what happened.

With the formation of about 40-50% or more carboxyhemoglobin, improvement occurs slowly. Necrosis and trophic changes appear on the skin, which are often mistaken for burns. There are pulmonary edema, myomalacia. Over the course of weeks, or even months, headaches, weakness of the muscles of the extremities, pulse disorders are periodically observed, and changes in the electrocardiogram also persist.

Damage to the central nervous system in the area of ​​subcortical centers can leave long-term consequences: parkinsonism, glycosuria, internal secretion disorders, damage to the optic, auditory nerves, hemiplegia, etc. Late death occurs from pneumonia or heart failure.

There are 3 degrees of severity of CO poisoning:

• Light (concentration HbCO 20-30%);
• Average (concentration of HbCO 30-40%),
• Severe (terminal) (concentration in the blood of HbCO more than 50%).

Carbon monoxide poisoning can be diagnosed by determining the concentration of carboxyhemoglobin in the blood. Metabolic acidosis is an adjunct symptom. insufficient for the diagnosis of CO poisoning, since it does not distinguish normal hemoglobin from carboxyhemoglobin (shows a false, overestimated result).

Treatment

• The victims are immediately taken out of the room where the poisoning occurred;
• Free the mouth and respiratory tract from vomit;
• While maintaining consciousness, it is necessary to ensure the inhalation of vapors of ammonia. Warm up the patient;
• Conduct oxygen therapy. In the first minutes, 100% oxygen is given through the mask, then the oxygen concentration is reduced to 40-60%. Feed rate 6-10 liters per minute. Oxygen therapy is carried out until carboxyhemoglobin drops to 10%;
• With severe bronchospasm - inhalation of β2-agonists or intravenous administration of aminophylline, prednisolone;
• In case of impaired consciousness, convulsive syndrome - tracheal intubation and mechanical ventilation with 100% oxygen under constant positive pressure;
• To maintain blood pressure, inject 10% caffeine solution (0.1 ml per year of life) subcutaneously or Cordiamine (0.1 ml per year of life) intramuscularly;
• To improve the processes of tissue respiration, a 0.25% solution of cytochrome C (cytomac) is prescribed from 4 ml (for young children) to 8 ml (for older children) intravenously drip in isotonic sodium chloride solution;
• Drugs are introduced that increase the alkaline balance of blood plasma, under the control of KOS;
• In severe cases, hyperbaric oxygenation is carried out in a pressure chamber with a pressure of 2-4 atm., Where the patient breathes for 1-4 hours with air saturated with oxygen. The effect is very good. After one session, carboxyhemoglobin can decrease from 50% to 5%;
• Syndrome therapy (antibiotics, bronchodilators, vitamins B, C);
• Treatment of cerebral edema and pulmonary edema is carried out according to treatment protocols.

In addition to oxygen, the antidote (CO) is also "Atsizol", which is administered both for the prevention and treatment of carbon monoxide poisoning. Adults are administered 1 ml intramuscularly, as soon as possible after poisoning (children are injected when absolutely necessary). For prophylaxis, -1 ml intramuscularly 20-30 minutes before the intended effect (CO).

Carbon monoxide, or carbon monoxide (chemical formula CO), is an extremely toxic, colorless gas. It is an indispensable product of incomplete combustion of carbon-containing substances: it is determined in automobile exhaust gases, cigarette smoke, in smoke during fires, etc. There is no smell of carbon monoxide, therefore, it is impossible to detect its presence and estimate the concentration in the inhaled air without devices.

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Once in the blood, carbon monoxide displaces oxygen from the connection with the respiratory protein hemoglobin and inhibits the functioning of active centers responsible for the formation of new hemoglobin, thereby causing acute oxygen starvation of tissues. In addition, carbon monoxide disrupts the course of oxidative processes in the body.

Carbon monoxide, which has a high affinity for the respiratory protein, binds to it much more actively than oxygen. For example, if the concentration of CO in the inhaled air is only 0.1% of the total volume (the ratio of carbon monoxide and oxygen is 1: 200, respectively), hemoglobin will bind equal amounts of both gases, i.e., half of the respiratory protein circulating in the systemic circulation will be occupied by carbon monoxide gas.

The decomposition of the carboxyhemoglobin molecule (hemoglobin-carbon monoxide) occurs approximately 10,000 times slower than the molecule of oxyhemoglobin (hemoglobin-oxygen), which determines the danger and severity of poisoning.

The exhaust gases of a car contain a maximum of 13.5% carbon monoxide, an average of 6-6.5%. So, a low-power motor of 20 liters. with. produces up to 28 liters of CO per minute, creating a lethal concentration of gas in the air in a closed room (garage, repair box) within 5 minutes.

Typical symptoms of poisoning appear after 2-6 hours of inhalation of air containing 0.22-0.23 mg of carbon monoxide per 1 liter; severe poisoning with loss of consciousness and death can develop in 20-30 minutes at a carbon monoxide concentration of 3.4–5.7 mg / l and in 1-3 minutes at a poison concentration of 14 mg / l.

Carbon monoxide poisoning most often occurs in the following cases:

• improper operation or malfunction of furnace equipment, gas heating appliances;
• stay in an unventilated closed room with the car engine running;
• fire;
• smoldering electrical wiring, household appliances, interior parts and furniture;
• violation of safety measures when working in a chemical production where carbon monoxide is used.

The likelihood of poisoning is directly proportional to the concentration of carbon monoxide in the inhaled air and the time it is exposed to the body.

Poisoning symptoms

The nervous system is most sensitive to changes in the level of oxygen in the blood. The degree of damage can vary from mild reversible to generalized, resulting in temporary or permanent disability, and in especially severe cases, the death of the victim.

In addition to the nervous system, the respiratory (tracheitis, tracheobronchitis, pneumonia) and cardiovascular (dystrophy and necrotization of the myocardium, degenerative changes in the walls of blood vessels) systems are most often involved in the pathological process.

Depending on the concentration of CO in the air and, accordingly, carboxyhemoglobin in the blood, several degrees of carbon monoxide poisoning are emitted.

Symptoms of mild poisoning (the content of carboxyhemoglobin in the blood does not exceed 30%):

• consciousness is preserved;
• constricting, oppressive headache, reminiscent of being pulled together in a hoop;
• dizziness, noise, ringing in the ears;
• lachrymation, profuse discharge from the nose;
• nausea, vomiting;
• possible mild transient visual impairment;
• difficulty breathing;
• sore throat, dry cough.

Poisoning of moderate severity (develops when the concentration of carboxyhemoglobin in the blood is from 30 to 40%):

• short-term loss or other impairment of consciousness (stunning, soporosis or coma);
• difficulty breathing, intense shortness of breath;
• persistent pupil dilation, anisocoria (pupils of different sizes);
• hallucinations, delusions;
• tonic or clonic seizures;
• tachycardia, pressing pains behind the breastbone;
• hyperemia of the skin and visible mucous membranes;
• discoordination;
• visual impairment (decreased acuity, flashing flies);
• decreased hearing acuity.

In case of severe poisoning (concentration of carboxyhemoglobin 40-50%):

• coma of varying depth and duration (up to several days);
• tonic or clonic seizures, paralysis, paresis;
• involuntary urination and / or defecation;
• weak threadlike pulse;
• shallow, intermittent breathing;
• cyanosis of the skin and visible mucous membranes.

In addition to the classic manifestations of carbon monoxide poisoning, atypical symptoms may develop in one of the following forms:

• fainting - characterized by a sharp decrease in blood pressure (up to 70/50 mm Hg and below) and loss of consciousness;
• euphoric - sharp psychomotor agitation, decreased criticism, disorientation in time and space, hallucinations and delirium are possible;
• fulminant - develops when the concentration of CO in the inhaled air is 1.2% or more, the content of carboxyhemoglobin in the systemic circulation in this case exceeds 75%. The death of the victim occurs rapidly, after 2-3 minutes.

12/08/2016 Domestic gas poisoning is not immediately apparent. It is preceded by the presence of the child for some time without the supervision of an adult. Often, parents do not even suspect that the cause of the child's discomfort is poisoning.

Therefore, it is very important to know the possible symptoms in order to be able to recognize poisoning among other ailments and provide help in time.
The thought of poisoning, first of all, can be prompted by a change in the child's behavior: he was just active, vigorous, playing cheerfully and suddenly lay down, became lethargic, apathetic, fell deeply asleep and does not wake up when trying to wake him up.

Parents should be wary if:

• the child fell asleep at an unusual time for him;
• sleeps for a long time during daytime sleep for no apparent reason;
• lethargic or overly agitated, restless;
• walks staggeringly, if he has already walked confidently before;
• speaks indistinctly if earlier speech was clear;
• coordination of movements was suddenly disturbed;
• the child is unusually pale, sweating, or, conversely, the skin is dry, reddened;
• the child has a low body temperature;
• the child has profuse salivation or dry mouth;
• narrowed or excessively dilated pupils, the width of the pupils does not correspond to the lighting (it is known that in bright light the pupils narrow, in the dark they dilate);

More formidable symptoms indicating possible poisoning:

• confusion, hallucinations;
• convulsions, loss of consciousness;
• heart rhythm disturbance, weak, frequent or infrequent pulse;
• increase or decrease in blood pressure;
• altered, noisy, rapid or infrequent breathing.

In case of poisoning or the slightest suspicion of it:

• immediately call an ambulance, take (take) him out into the fresh air, in no case self-medicate;
• try to find out the possible cause of the poisoning, if you do not know it reliably: ask the child if he can already explain, examine his body, face, clothes for specific odors, spots, redness and burns of the skin and mucous membranes;
• inspect the place where he was recently, potentially dangerous places in your house (first-aid kit, place where household chemicals are stored). Remember if you used any drugs during the day, if you left them in an accessible place. Did they give the child any medications, did they put drops in the nose, were they visiting yesterday or today, did they come to you;
• if a child is unconscious, he may experience suffocation from the retraction of the tongue or from the ingestion of vomit into the respiratory tract. In this case, it is better to lay the child on its side, control the pulse and breathing before the ambulance arrives. If necessary, clean the mouth of vomit with your finger, wrapped in a handkerchief, and make sure that possible vomiting does not interfere with breathing;
• collect the things necessary for hospitalization of the child;

What not to do:

• you cannot independently induce vomiting in unconscious children and in cases where you do not know at all how the child could have been poisoned, and do not see signs indicating a possible cause.
• you can not self-medicate for poisoning. In case of poisoning, it is always better to call rather than not call a doctor.
• you cannot give antidotes without consulting a doctor, even the seemingly most "harmless" ones. For example, milk can be given in case of poisoning with acids and alkalis, but if you dilute the gasoline that has entered the body with milk, the poison will be absorbed faster.
• we must not forget about ourselves. If a child is poisoned by chemical or volatile substances, carbon monoxide, before helping him, protect yourself: if necessary, wear gloves, open windows, etc. These measures are a manifestation of caring for the child, because if you also suffer, who will help him?

Two girls, 5 and 9 years old, were hospitalized with signs of carbon monoxide poisoning, and their mother felt unwell too, having opened the windows in time and called an ambulance. On the fact of the incident, the regional Investigative Committee opened a criminal case on the provision of services that did not meet safety requirements (Article 238 of the Criminal Code of the Russian Federation).

The incident happened on Thursday, October 25th. In the evening, the woman and her two daughters took turns taking a bath. The family lives on the second floor of a two-story building; the victim's apartment is equipped with a gas boiler. At about 20:00, the children complained of headaches.

Feeling unwell, the mother correctly assumed that the gas could be the cause. The woman immediately opened the windows and then dialed the ambulance and the Ministry of Emergency Situations. Rescuers were the first to arrive. The ambulance doctors took the children to the hospital, and the children were diagnosed with mild carbon monoxide poisoning. The girls were left in the hospital for medical supervision.

Investigators and gas specialists working on the spot suggest that faulty ventilation in the house could be the cause of the emergency. After checking in the Investigative Committee, they will assess the actions or inaction of officials responsible for the safety of the population.

A high-profile case of carbon monoxide poisoning occurred in November 2015 in Vyazniki. Then the 16-year-old girl lost consciousness in the shower. The father found his daughter lying on the floor unconscious, the doctors were unable to save the girl. Investigators later reported that the father installed gas equipment on his own and violated safety procedures.

In case of carbon monoxide poisoning, a person most often does not feel a foreign smell. With mild poisoning, some of the following symptoms are observed: headache, pounding in the temples, dry cough, watery eyes, nausea, reddening of the mucous membranes, tachycardia. With more severe poisoning, drowsiness, convulsions, hallucinations appear, motor paralysis is possible.

UPD 16.00

Gas workers have prepared a special memo on how not to get poisoned by carbon monoxide.

Carbon monoxide poisoning is one of the most common causes of deaths from natural gas in the home.

What you need to know about the combustion process in order not to get burned out?

Carbon monoxide, toxic to humans, is formed when any fuel is incompletely burned.

Combustion is a chemical reaction in which the hydrocarbons present in the fuel interact with the oxygen contained in the air.

When fuel is completely burned, be it wood, coal, fuel oil or natural gas, practically harmless carbon dioxide (CO 2) and water vapor enter the environment along with the heat and smoke generated.

If, due to an insufficient amount of air, the combustion of fuel does not occur completely, then flammable substances are released - hydrogen, soot, as well as carbon monoxide, which is fatal to humans - it is carbon monoxide (CO).

Silent killer

Carbon monoxide is often referred to as the "silent killer". It is colorless, tasteless, and odorless. At the same time, it spreads very quickly, mixing with air without losing its toxic properties. Entering the body during breathing, carbon monoxide penetrates from the lungs into the circulatory system, where it combines with hemoglobin. As a result, the blood loses its ability to carry and deliver oxygen to tissues, and the body very quickly begins to experience oxygen deficiency.

The toxicity of carbon monoxide is very high and is determined by its concentration in the air. The CO content in the air of 0.01-0.02% can cause mild poisoning. Finding a person for an hour in a room where the concentration of carbon monoxide reaches 0.1% leads to acute poisoning of moderate severity; severe poisoning occurs with a carbon monoxide concentration of 0.3% for half an hour. Death occurs when a person inhales air with 0.4% carbon monoxide for 30 minutes or at a CO concentration of 0.5% for just one minute.

Attention!

With intensive combustion of fuel in a room with impaired air exchange (with hermetically closed windows and doors, no draft), the lethal concentration of carbon monoxide is sometimes reached in a matter of minutes!

Emergency care for carbon monoxide poisoning

Symptoms of carbon monoxide poisoning, depending on the degree of damage and the general condition of the body, are: dizziness, headache, nausea, vomiting, tinnitus, shortness of breath, cough, watery eyes.

Emergency care at the first sign of poisoning is to immediately stop the further penetration of toxic carbon monoxide into the victim's body. It should be urgently removed from the contaminated room, and clean air should be provided. Call an ambulance by phone 03. Before the doctor arrives, you can bring a cotton swab moistened with ammonia to your nose, rub your chest, put heating pads on your legs, mustard plasters on your chest and back, give the victim hot tea or coffee to drink. In case of severe poisoning and moderate lesions, urgent hospitalization is required.

Saving air

It is possible to avoid carbon monoxide poisoning in a room where gas appliances are used by ensuring sufficient air flow from the street to the gas burner and good draft in the chimney. Modern safe gas boilers and water heaters with a closed combustion chamber work according to this principle: air intake for combustion in them is carried out directly from the street through a separate air duct; combustion products are also discharged through an individual chimney and do not come into contact with room air.

A particular danger from the point of view of the risks of carbon monoxide poisoning is posed by flow-through gas water heaters (columns) with an open combustion chamber without exhausting combustion products, which were previously massively installed (including in apartment buildings) and are still used in settlements that do not have a centralized hot water supply.

In order to ensure safety when using such speakers, they are provided with forced air injection into the room. However, many residents, carrying out repairs in their apartments, in violation of the operating rules, eventually eliminate such fans, and also significantly impair air circulation by installing sealed plastic windows and doors.

Unauthorized changes in the air exchange system in rooms often lead to carbon monoxide poisoning, even with properly working gas equipment!

What you need to remember in order not to get poisoned by carbon monoxide:

To avoid carbon monoxide poisoning while gas equipment is operating, be sure to open the vents, slightly open the windows to ensure the flow of air into the room.

The tight closing of windows and doors during the use of gas appliances contributes to the burning out of oxygen in the room and leads to incomplete combustion of fuel - the release of poisonous carbon monoxide.

Gas instantaneous water heater is used for short-term heating of water. Its operation in a constant mode increases the risk of poisoning by products of incomplete combustion of fuel.

Do not use a gas stove or oven to heat rooms - if there is insufficient air circulation, this can also lead to burnout of oxygen in the room and, as a result, to the formation of carbon monoxide.

Check the draft before using a gas water heater or a heating boiler.

Do not forget to conclude a contract for the inspection of smoke and ventilation ducts! Contact your management company for this.

Today we will look at the most common signs of various types of poisoning in children, and also talk about how to provide first aid in case of poisoning a child with poor quality food, carbon monoxide, mercury or other hazardous substances.
Poisoning in a child- quite a frequent occurrence, it can seriously affect the health of the baby. Not everyone knows how to properly provide first aid in this situation, so complications arise, and even death is possible. Parents need to know symptoms of poisoning in children, so that if necessary, see a doctor as early as possible to minimize the consequences. Consider the signs of the most common types of poisoning.

Gastrointestinal disorders in children are often referred to as signs of viral diseases: jaundice, various intestinal and rotavirus infections. It is important to know the characteristic food poisoning symptoms... A sick child has vomiting and diarrhea, there are complaints of nausea and abdominal pain (not constant, but arising from time to time), cramps in the abdomen are felt. You can provide first aid at home, prevent complications. If in a day or two symptoms disappeared and the state of health has improved, which means that the body was able to cope with the disease itself, without special treatment. When the problem worsens, and after a few days dehydration is noticeable (it is indicated by dizziness, dark urine and small volumes, rare urge to urinate, constant dryness in the mouth), you should immediately consult your doctor.

A serious risk to human health is mercury poisoning... A couple of hours after inhalation of mercury vapor, a severe form of pneumonia occurs. The child coughs, feels trouble breathing, the body temperature rises and cyanosis is observed. After severe intoxication, pulmonary edema is noted. What are the symptoms of mercury poisoning? The gastrointestinal tract cannot function normally, and the stool becomes frequent and liquid. The central nervous system is affected (a sluggish and sleepy child is overly active for short periods of time).

Dangerous for the child carbon monoxide poisoning: if you do not provide assistance in the first minutes, it can be fatal. Common causes of carbon monoxide poisoning: finding a baby in a private house with a faulty heating system, in a car with the engine on (completely closed), in a fire.
It is urgent to take out the recipient carbon monoxide poisoning the child into fresh air, then act depending on whether he is conscious or not. In the first case, fan the victim with a newspaper and turn on the fan (so that he can breathe clean air), in the second, perform a closed massage of the heart muscle. When taking out the child, do not forget to cover your face with a rag so as not to inhale the poisoned air and not get carbon monoxide poisoning yourself, try to do everything quickly.

You learned what poisoning is in a child, what symptoms cause mercury or carbon monoxide poisoning... Below we will tell you about how first aid is provided for poisoning with carbon monoxide, organophosphorus compounds, acetic acid, alkalis, poor quality food, mushrooms and poisonous plants, as well as about what symptoms a child has in one form or another of poisoning.

Now you know what there are types of poisoning in a child and what are the symptoms are typical for this or that type of poisoning. You will be able to provide first aid before the arrival of medical personnel if the child has been poisoned.

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