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81 patients of acute organophosphorus pesticide poisoning first aid and nursing

Author: LiXiaoQin From: www.yourpaper.net Posted: 2010-06-24 10:46:43 Read:
[Abstract] purpose to explore aid and nursing of acute organophosphorus pesticide poisoning patients. By emetic, catharsis, gastric lavage, intravenous injection of atropine, pralidoxime intravenous infusion, oxygen, supportive care and treatment. Results 75 cases were cured, two cases of families of critically ill patients to abandon the treatment left the hospital and 4 died, the cure rate was 93%. Conclusion acute organophosphorus pesticide poisoning timely and thorough removal of toxic, timely, adequate, sustained and effective application of the antidote, the strict observation of the condition and intensive care is the key to successful treatment.
nursing experience Keywords organophosphorus pesticides; poisoning; first aid;
Is located in the county hospital, our hospital treated dozens of cases of organophosphorus pesticide poisoning patients from rural areas, most of which are oral toxicity, as well as because of the improper use of pesticides absorbed through the skin poisoning and inhalation poisoning. Now in our hospital first aid and nursing of 81 cases of acute organophosphorus pesticide poisoning patients admitted from July 2007 - November 2009 are summarized below.
1 clinical data
81 cases of organophosphorus pesticide poisoning patients, children 6 cases. Emergency department observation of 23 cases, inpatient department treatment of 58 cases; oldest 80 years old, the youngest 2 years old; 30 males and 51 females; 68 cases of self-serving, eating four cases (children), through the skin absorption poisoning, inhalation poisoning; mild in 58 cases, all cured. Severe in 23 cases, are due to the oral poisoning, admission has varying degrees of coma, cerebral edema, pulmonary edema, cholinesterase activity below 30%, 2 patients left the hospital to give up treatment, 4 cases she died.
first aid and care
2.1 rapid removal of the poison, to prevent the re-absorption
2.1.1 oral poisoning (1) induce vomiting: Usually within 4 ~ 6h after the poisoning, applicable to the conscious, able to co-patients, pediatric, coma, convulsions, service-corrosive, severe heart disease were banned, oral warm water or 1:5000 potassium permanganate solution, each 100 to 200 ml, to then with finger or spatula oppression of the base of the tongue or irritation pharyngeal emetogenic repeatedly. Induce vomiting, gastric lavage, can greatly shorten the time of gastric lavage, reducing the absorption of poisons. (2) gastric lavage: oral organophosphorus pesticide poisoning patients, thorough gastric lavage is very important, gastric lavage the sooner, the more thorough the better the prognosis [1]. The common gastric lavage with 2% sodium bicarbonate solution, 1:5000 potassium permanganate solution, water. Trichlorfon poisoning disable the sodium bicarbonate its case base becomes more toxic dichlorvos. Potassium permanganate can make 1605, the more virulent after Rogor hydrogenated. In the case of unknown pesticide use water is the safest. Our hospital water gastric lavage. Patients with the head lower than the left lateral decubitus live lotion to prevent aspiration of the trachea. Each lavage amount of about 200 to about 250ml, too much can poison into the intestine. General lotion total of at least 2 to 5L, always maintain the balance of intake and output, repeated lavage until clear and odorless liquid. The gastric lavage avoid cold overheating, overheating enables the stomach vasodilation, to speed up the absorption of the poison, too cold chills aggravate the condition. (3) catharsis: cathartic purpose is to remove the poison into the intestine, gastric lavage from the tube into a 5% magnesium sulfate solution 60 to about 100 ml or 250 ml mannitol catharsis, but the stomach dysfunction or coma should not be magnesium sulfate, so as not to aggravate the inhibition of the central nervous system.
2.1.2 contact poisoning organophosphorus pesticides but also through the respiratory tract, skin and mucous membrane absorption poisoning, skin contact Immediately remove contaminated clothing, repeatedly rinse thoroughly with plenty of soap and water or water body, cleanse the hair, eyes the polluter available water or physiological brine repeatedly flush eyes, put on clean clothes, to ensure the cleanliness of the skin, to prevent the re-absorption of pesticides.
2.1.3 allow the patient to breathe fresh air, to keep the airway open, give oxygen inhalation inhalation poisoning.
2.2 to promote the establishment of intravenous access has absorbed the excretion of toxins and prevent absorption of the poison. (1) The best two intravenous access for an intravenous infusion of atropine to antagonize the body of excess acetylcholine, rapid lifting of the muscarinic symptoms of organophosphate poisoning, excitement, respiratory center, against organophosphate poisoning due to central inhibition. Another intravenous infusion of pralidoxime other rescue medication. The pralidoxime cholinesterase resurrection drugs, early application allows phosphoryl cholinesterase off the phosphate group, thereby restoring the activity of cholinesterase and direct combination of organic phosphorus in the blood into non-toxic substances from the in vitro, to release the nicotine-like symptoms such as fasciculations. (2) to give diuretics, oxygen, prevent serious complications such as cerebral edema, pulmonary edema, a conditional hospital the viable blood purification treatment such as dialysis and other measures.
2.3 organophosphate poisoning to keep the airway open so that patients often increase in nasal secretions, should be promptly clear the airways, oxygen, if necessary, endotracheal intubation or tracheotomy or artificial breathing machine to prevent respiratory failure. 3 Diet Care
Given high-protein, high-sugar, low-fat, semi-liquid diet, taboos oil for food, so as not to aggravate the poisoning, oral poisoning vomiting, gastric lavage should be 1 to 2 days of fasting.
observing closely
4.1 detection of vital signs closely observed temperature, pulse, respiration, blood pressure, pupil changes, urine output.
4.2 grasp indication for atropine mydriasis, dry mouth, facial flushing, dry skin, reduce the secretion of glands, lung auscultation decreased or disappeared, and heart rate. If the patient miosis, sweating, heart rate shall promptly notify the doctor, to prevent the dosage of atropine. If the patient has high fever, no sweat, rapid pulse, restlessness, delirium, hallucinations and other psychotic symptoms, significantly dilated pupil light reflex slow or disappear, you should inform your doctor immediately adjust the dosage and symptomatic treatment, to prevent atropine poisoning. In addition, atropine, there is a common side effect of causing urinary retention. Delirious patients, sometimes restless because urine inflation and should be closely observed, if necessary, by intermittent catheterization [2].
4.3 complications with acute organophosphorus pesticide poisoning complications of pulmonary edema, respiratory failure, delayed neurosis. Its performance are: increased respiratory secretions, lung widely moist rales; headache, screaming, shallow breathing, rhythm disorders, cold extremities; hysteria attack. Master and carefully observe the performance of the complications, the disease has been timely and effective treatment is essential.
4.4 coma patient care coma patients to good oral care, skin cleansing, regular turning of care, the suction tube to a one-time use, disinfected on a regular basis, to avoid cross-infection.
4.5 after gastric lavage retained gastric tube should pay attention to wash out whether the liquid garlic odor to determine the retention time of tube.
5 psychological care
Create a quiet and comfortable environment to the patient, caring, patient and considerate. This group from the service in 68 patients (83%), to understand the patient's psychological care, with the patient to discuss the cause of despair, do psychological counseling to help patients find their own values, to establish the confidence and courage of re-living . Expressed concern and sympathy for the situation of the patient so that the patient optimism treatment [3]. Patients and their families in rural areas to promote knowledge of pesticide poisoning protection, can not remember the clothes and smear hair soaked with pesticides used to eliminate lice nit, nor to tick off the pesticide on the kang. In this group were the pesticide soaked clothes and hair apply pesticides used to eliminate lice nit absorbed through the skin poisoning.
6 Summary
Organophosphorus pesticide poisoning usually dangerous disease, timely and thorough removal of toxic, timely, adequate, sustained and effective application of the antidote, the strict observation of the condition and intensive care is the key to successful treatment.
[References]
1 Guo Min INTO repeated gastric lavage in acute organophosphorus pesticide poisoning rescue the meaning of success. Inner Mongolia Medical Journal, 2005,37 (4) :381-382.

2 Cui chapter of the book. Internal medicine, 7th edition, Beijing: People's Health Publishing House ,2008,11:925-931.

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