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SYNDROME-BY-SYNDROME THERAPY

It is carried out in accordance with main pathologic syndromes arising in poisonings.

Respiratory disorders:

— aspiration-obturation form, as a result of tongue retraction, aspiration of vomits, salivation, bronchorrhea, laryngeal edema, is observed more often in the patients being in comatose state. A patency of respiratory tracts is restored in accordance with the rules of resuscitation. If asphyxia developed as a result of burn of respiratory tract (with acid and alkali) and edema of the larynx, an urgent cricothyreotomy or tracheostomy is needed;

— central form is a result of respiratory center depression in coma, disturbance of respiratory musculature innervation in poisoning with OPC and pachycarpine. Artificial pulmonary ventilation is indicated primarily with the simplest devices (Ambou's bag, RPA), mask or through an intubation tube simultaneously with antidote therapy;

— pulmonary form caused by a toxic edema of the lungs or tracheobronchitis, more often in poisoning with vapours of chlorine, ammonia, acids, phosgene and nitrogen oxides. It develops just after inhalation of toxic substance or in 3-4 hours. Treatment lies in the intravenous administration of hormones (prednisolone 60-90 mg, hydrocortisone 125-250 mg), broncholytics (by 1 ml 5% ephedrine or euphilline solution) and antihistaminic agents (1 ml 1% dimedrol solution or 1 ml 2% suprastin solution, 10 ml 10% calcium chloride or gluconate). An early administration of antibiotics, inhalation of humidified oxygen, vapors of ethyl alcohol for a foam breaking, ephedrine and dimedrol are indicated. For a dehydration 80-400 mg of furosemid solution (lasix) are introduced intravenously;

— a hemic hypoxia as a result of poisonings with carboxyhemoglobin- or methemoglobin-forming (nitrates, aniline) substances when oxygen transport by blood is disturbed or tissue hypoxia arises as a result of blockade of respiratory enzymes — cytochrome oxidases (in poisonings with cyanides). The antidote therapy is of great significance in combination with APV and oxygen inhalation.

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