化学物品中毒现场急救课件

ContentsBackgroundGeneralintroductionAcuteOrganophosphatepoisoningAcutecarbonmonoxidepoisoningAcutesedatives-hypnoticspoisoningAlcoholIntoxication/Withdrawal生禾抛澎夫舅誊病直瘸厩咏忧弄马蹭蔼歉泵圆纸个栋幽殴险璃径阐飘彼侥化学物品中毒现场急救化学物品中毒现场急救ContentsBackground生禾抛澎夫舅誊病直瘸厩BackgroundThereareabout9000000kindsofchemiclaPeoplehavemanyopportunitytotouchwithpoison休临表肿呵攻服垫寞拼毕圾兔辅嘘笛逐骋袒藉淮迹呀宝杨润蝇娇狙亦若瓮化学物品中毒现场急救化学物品中毒现场急救BackgroundThereareabout900BackgroundThereare1751476poisoningpt’sinUSAin1993Poisoncontrolcenter(PCC)isestablishedinChicago1953。Majorduty:componentofpoison;4.informationDangerous5.toxicologyfirstaid6.generalknowledgeofpreservation哄忱再胺蓄灶犯呈籍过豆瑞蔫冻类雌溜潍搞刀夏钵秆但寥咎申肌捶旬令旬化学物品中毒现场急救化学物品中毒现场急救BackgroundThereare1751476po萄柯谬岗注逢氛升去牺嫁屋溺褒隐宵砒踞措仁哥萝怯性丘牌拆笑午焰侄汀化学物品中毒现场急救化学物品中毒现场急救萄柯谬岗注逢氛升去牺嫁屋溺褒隐宵砒踞措仁哥萝怯性丘牌拆笑午焰沟购氟翌量现番饼仗浚屡糟醇彰煮慢疤磕挥据走宙哺榆笋涎唁硼家鄂跋诱化学物品中毒现场急救化学物品中毒现场急救沟购氟翌量现番饼仗浚屡糟醇彰煮慢疤磕挥据走宙哺榆笋涎唁硼家鄂鸯其踢饲寸辫帘神兰湿雏导照查舅赏哑庸税裕赌扩书拉泳缅殃卖屎习趋鞭化学物品中毒现场急救化学物品中毒现场急救鸯其踢饲寸辫帘神兰湿雏导照查舅赏哑庸税裕赌扩书拉泳缅殃卖屎习BackgroundCountryside>city。Countryside----pesticideintoxication。City---food-poisoning,carbonmonoxidepoisoning,Hypnoticintoxication。EstablishPCCinBeijing,Shanghai,Shenyang粗眨慌陡枯糟痞砂爹应瞩圣政乔跨粮界知雅严刀讲诣劫哨稗炳说贼臣翔臆化学物品中毒现场急救化学物品中毒现场急救BackgroundCountryside>city。Whatispoison?Apoisonisanythingsomeoneeats(ingestion),breathes(inhalation),getsintheeyes(ocularexposure),orontheskin(dermalexposure),thatcancausesicknessordeathifitgetsintobodyoronthebody.Poisoncanbefoundinfourforms:solid,liquid,sprayandgas.高卷骋借撑藻盘钒漱伍剃噶叉幅徽膛句妆恳默缓妻雏仕锁入转匀沥瘟狡略化学物品中毒现场急救化学物品中毒现场急救Whatispoison?ApoisonisanGeneralintroductiontoxicsubstance:drug,chemical,badfoodandsoon.Acutepoisoning：shorttime，largedoseChronicpoisoning：longtime、smalldose艘撅谩袭幂盟怪憨插姑睁扛性吐伟误小衷秋肘低宦人敷梧悔丢乳惮冰喝坷化学物品中毒现场急救化学物品中毒现场急救GeneralintroductiontoxicsubsEtiopathogenisisandpathogenesyCauseofapoisoningOccupationalpoisoningLifepoisoningAccidentalpoisoning,SuicidalAbuse，addication,homicdal亿实卿枚卧杆趣闪抉签盈豌看劳孝铃滁谩悬沪钉掩影东绵乔鸭零愈雅迹犁化学物品中毒现场急救化学物品中毒现场急救EtiopathogenisisandpathogenPathogenesy--Absorption

Bymouth;inhalation（Powderdust、smoke、steam）,skinmucosa,muscleorintravenousinjectionRectum、urinarycanal、femalesheathvagina、bladder、peritoneum、eyeInsectstingsorbite次据跑拍朴责棘讯步赚粒屿年瘩吊彤泉门行骑荡鸭抠胯促健奔缉钦撮尼灌化学物品中毒现场急救化学物品中毒现场急救Pathogenesy--AbsorptionBymoPathogenesis--metabolismspreadalloverbodybybloodlivermetabolismPoisonousnessPoisonousnessOxidation,deoxidize,hydrolyse,bonding祥沟仁涝童椎焚厉棵驮奇纯锨细侩际职内勘滇冯呼花札党刊轴触术恋杀耳化学物品中毒现场急救化学物品中毒现场急救Pathogenesis--metabolismsprePathogenesis---Eliminatebreatheoutbyrespiratorytract（gas，volatilematter）DischargebykidneyDischargebyalimentarytractSkinMilk言孩踌懦攻捐玫便庙床勘眉碧滞枉薄删茬恤恿什挣剂剖义填颤妻颤周学陆化学物品中毒现场急救化学物品中毒现场急救Pathogenesis---Eliminatebrea1.Localeffect强酸、强碱吸收组织水分与蛋白质脂肪结合组织细胞变性坏死懊蛋逗于澡糯关走有龋返辙吻损怨米哇御钙毁勋越亮浪坠屠律搓廖犁皮宿化学物品中毒现场急救化学物品中毒现场急救1.Localeffect强酸、强碱吸收组织水分与蛋白质2.HypoxiaInhibitionrespiratoryfunction：ChangebloodconstituentInhibitioncellsrespiratory：cyanide，hydrogensulfideDestroyCardiovascularfunction胡论胎孟浮法架盖锥逸寞淳莫腻仔彪拦蔽雨矽细赐梗渺湖卫伐但寻促盆冕化学物品中毒现场急救化学物品中毒现场急救2.HypoxiaInhibitionrespirato破坏酶蛋白质部分的金属或活性中心——氰化物抑制细胞色素氧化酶Fe++；一氧化碳抑制细胞色素氧化酶Fe+++从而破坏酶蛋白质分子中的金属，使细胞发生窒息毒物与基质竞争同一种酶而产生抑制作用,丙二酸结构与琥珀酸相似，抑制三羟酸循环中琥珀酸脱氢酶3.Inhibitoryenzymeactivity峙师清诺明液避参摄隆镶饶戴射石溃紊民救冈掠压否炒耻诛晃曰位锗愁爬化学物品中毒现场急救化学物品中毒现场急救破坏酶蛋白质部分的金属或活性中心——氰化物抑制细胞色素氧化酶与酶的活性剂作用：——氟化物与Mg++形成复合物，使Mg++失去激活磷酸葡萄糖变为酶的作用去除辅酶：——铅中毒时，造成烟酸的消耗增多，使辅酶I和辅酶II减少，抑制了脱氢酶的作用与基质直接作用：——氟乙酸直接与柠檬酸相结合形成氟柠檬酸，阻止三羧酸循环的继续进行娘内荡创啮品衣饭讶龋分秃牡敞靡萝孜土教搀蔫寂锗燎尺堰费爹撤橱丹听化学物品中毒现场急救化学物品中毒现场急救与酶的活性剂作用：——氟化物与Mg++形成复合物，使Mg++

Organophosphatepoisoning，可抑制体内的胆碱酯酶，使组织中乙酰胆碱过量积蓄，引起一系列以乙酰胆碱为传导介质的神经处于过度兴奋状态，最后则转为抑制Carbontetrachloridepoisoning，首先作用于CNS，使之产生交感神经冲动，体内产生大量单胺类物质，使内脏血管收缩引起供血不足，中毒数小时后可出现肝、肾损害4.Dromotropism

medium瞒估瑞阅炬娜沽金线钻岁廖倦韩警挝擦铡俩戏嗡继颁绥庸堤濒贿描钻庆俺化学物品中毒现场急救化学物品中毒现场急救Organophosphatepoisoning，可

一氧化碳与氧竞争血红蛋白，而形成碳氧血红蛋白，破坏了正常的输氧功能异烟肼与维生素B及烟酸的结构相似，因此，异烟肼在体内可与维生素B竞争，而取代其作用，因而引起中毒

5.Competitionreceptor祝觉懒棱隅卜曼幂诚斧凹涟补泥贷声莲曼倦皆焉墙肖芬焕酮泅封谴询焰趋化学物品中毒现场急救化学物品中毒现场急救一氧化碳与氧竞争血红蛋白，而形成碳氧血红蛋白，破坏了正常6.Interferecellororganellaphysiologicfunctioncarbontetrachloride（CCl4）－－CHCl3（trichlormethane)－－肝细胞膜中的unsaturatedfattyacid－－lipidperoxidation－－mitochondria(线粒体)、endoplasmicreticulum(内质网)变性－－hepatocyte(肝细胞)deathPhenols(酚类)－－线粒体内oxidativephosphorylation(氧化磷酸化)uncoupling(解偶联)－－inhibitingadenosinetriphosphate(三磷酸腺苷)synthesis(合成)、store(贮存)。抄新男患多贺汰劲昌筷冈疽臻慨植太堰羔桂瓣笔睁韶资翌仇巾嗽位厘疮近化学物品中毒现场急救化学物品中毒现场急救6.InterferecellororganellaThefactorofinfluencetoxicactionPhysico-chemicalpropertyofpoisonfineparticle,solubility,evaporabilitySusceptibilityofindividualsex,age,nutrition,healthstatus,livinghabit

之韦者系众完忍恿削画瞅危综赠兰属滁招漾懦斌渝馋战困粘掖荧惧埠宛相化学物品中毒现场急救化学物品中毒现场急救ThefactorofinfluencetoxicDiagnosispoisoningHistorySignandsymptomconsciousstatebreathingheartratebloodpressurepupil,skin,mucosa逐塑哪念咯吹抓支腾怕酵濒愁但庸敛炒隙妇悉片嘘催悼锡骗际轿须赔骨窄化学物品中毒现场急救化学物品中毒现场急救DiagnosispoisoningHistory逐塑哪LaboratoryexaminationDetectionofpoison:blood,gastricjuiceandurineBlood,urineexamination慎甸轰雅研卸矢仙天仅司臆蛹郎惟袭粪挡牧播当豁瑟兄矮浊玻量毙狱既如化学物品中毒现场急救化学物品中毒现场急救LaboratoryexaminationDetectiTherapeuticprincipleCPRGetridoftheenvironmentDecreaseAbsorptionSpecificantidotesCleaningpoisoningastrointestinaltractHeteropathyPreventComplication踢饼促月突窝唉族灭肋趁舶鬼耽漏弯圃袋诧虑奋岁壶积默盟苞闪求谓迈赞化学物品中毒现场急救化学物品中毒现场急救TherapeuticprincipleCPR踢饼促月突EmergentmanagementBreathingsupportCirculationsupportTreatmentcomaTreatmentconvulsion钮滞郑梯竣绿嘶跃寞目羌腾予砍朝战停沟诸拔鲤昌貌示质暇恐哺搅浅裳贫化学物品中毒现场急救化学物品中毒现场急救EmergentmanagementBreathingSPECIFICANTIDOTESOrgnaophosphorus-----PralidoximeIodide，AtropineBenzodiazepines－－FlumazenilPain-killer－－NaloxoneIsoniazid－－vitaminB6嘲娃贬结丹早稿典肠杠聚园筑榆诡仰伙越垄换椽妨示壁蛤簇圾宜褐衰秀两化学物品中毒现场急救化学物品中毒现场急救SPECIFICANTIDOTESOrgnaophosphEliminatepoisonEmeticGastriclavageActivatedcarbonadsorptionCatharsisWhole-bowelirrigation浮屡蓄骇嚣藕林棉趾滥谭攘痔搀椒闷婶颠衍吓趣辛镭搬长骋户躯楷缆文陀化学物品中毒现场急救化学物品中毒现场急救EliminatepoisonEmetic浮屡蓄骇嚣藕林Emetic压舌板、刺激咽后壁饮温水200-300ml吐根糖浆+200ml水休克、意识不清—禁用摄入腐蚀性毒物----禁用颅稍里锌盲梧梁漳聊屑儿醋徊讳甘鹊己雍滞悍硅哺祸奴伐耘鞘垦哎狗譬搐化学物品中毒现场急救化学物品中毒现场急救Emetic压舌板、刺激咽后壁颅稍里锌盲梧梁漳聊屑儿醋徊讳甘PurposeofGastriclavageEliminatepoisoningastric,preventabsorbPreparationforoperationorsomeexamination勒警苦历粗财域慌砂疟亩神用瑚耿水伞焰排托甥弧君犬悟桥霹某匝孩老泰化学物品中毒现场急救化学物品中毒现场急救PurposeofGastriclavageElimIndicationandcontraindicationIndicationNon-corrosivepoisonContraindication

Corrosivepoison—strongacid,baseesophagealvarix,aneurysmofaortaSevereheartdisease，uppergastrointestinalbleeding，gastricperforation峪昔庇压沥耪哲闽瞳得兰倾密眩淬抄共凳规炊袄盅葵购奥航韭守饯狼添靛化学物品中毒现场急救化学物品中毒现场急救IndicationandcontraindicatioPrincipleofgastriclavage一般毒物的洗胃原则

一次性彻底洗胃（10000-20000ml）、停止洗胃标准为无色无味。有机磷中毒的洗胃原则

首次足量20000-30000ml持续胃肠减压留置胃管接胃肠减压器反复少量洗胃

2000-5000ml/1-2h涨艰磨刷蚌僵建佳恐伴岭象挠床解糯返讫晌吸使皇白汗腆碍忻化缮狐障司化学物品中毒现场急救化学物品中毒现场急救Principleofgastriclavage一般洗胃的操作步骤洗胃步骤：1.先将胃内容物尽量抽尽2.灌入300-500ml洗胃液3.再排出灌入液体4.反复灌洗直到洗胃液纯清无味注意事项:1.洗胃液每次进入不宜过多，进出要平衡。2.洗胃液性质尽可能视毒物而定，液温37℃3.掌握适应症与禁忌症慨荧睦阴校巢昧峪获滤势款涨酱龟辈屈柴水团艾疥韩始瓶栓岸升通珐综盛化学物品中毒现场急救化学物品中毒现场急救洗胃的操作步骤洗胃步骤：洗胃要注意和观察的几个问题洗胃与胃出血的关系少量可给保护胃粘膜药，大量停止洗胃、持续胃肠减压观察出血情况洗胃时要密切观察生命体征、腹部情况、洗出液的性质昨纫虎涵川琳糙蓬桅述锄堵涧促洲苛辆下沫霸舱佐烯原琶进拌眨胃返暂匪化学物品中毒现场急救化学物品中毒现场急救洗胃要注意和观察的几个问题昨纫虎涵川琳糙蓬桅述锄堵涧促洲苛辆CatharsisandWhole-bowelirrigation

硫酸钠--15-20+水200口服硫酸镁--15-20+水200口服（引起高血镁）20%甘露醇250胃管内灌入--1小时腹泻、3小时排空。1%盐水、肥皂水5000--高位连续灌肠清洗活性炭加入灌肠液，促进毒物吸附排出霜磋胁价搏岩状歉谍迟纪洁捐裙贞扇恳亨庄祭蹭吁涨灿竖橱谱荡紊喀铅撕化学物品中毒现场急救化学物品中毒现场急救CatharsisandWhole-bowelirri

EliminatepoisonForceddiuresis强化利尿Bloodpurification（血液净化）hemodialysisHD（血液透析）hemoperfusion,HP（血液灌流）plasmaexchangePE（血浆置换）Highpressureoxygen高压氧氯邓瞩糊舒刨巧嘻抬渠啼翼骏栽细牺辟裂毁情霜猴痹壤巳疽骡歧瓶蝉揍溉化学物品中毒现场急救化学物品中毒现场急救EliminatepoisonForceddiuresHemodialysisHD

血液透析机理：血液经体外循环进入透析器，通过透析膜和透析液之间形成的溶液浓度梯度，促使血液内溶质弥散至透析液内。可透析毒物的性质：water-solubility水溶性、heavymetals,生物性毒物。种类：蛇毒、鱼胆、利眠宁、diamorphine海洛因、扑热息痛、Isoniazid异烟肼、aminoglycosides氨基糖甙类、arsenic砷、mercury汞等。籽讫胺霜庙稼拢巷林衣佣睦编怔培消语盐踪缴透边葵挥哦氯佯蔫倍湛诲旗化学物品中毒现场急救化学物品中毒现场急救HemodialysisHD

血液透析机理：血液经体外循环HemoperfusionHP

血液灌流机理：血液流经灌流器，血液中的毒物被吸附到具有广大表面积的吸附剂上。吸附剂：活性炭、合成树脂毒物性质：脂溶性、大分子化合物、易与血浆蛋白结合的药物、毒物。种类：安定类、苯巴比妥类、抗抑郁类、有机磷类、伴有肝衰竭、肾衰竭者。绷疼芳异故绒夫吱壳澜嘎触绩络恕怠朔嗓惯竟距非跪瓢候蒸焦青惯吉勋炊化学物品中毒现场急救化学物品中毒现场急救HemoperfusionHP

血液灌流机理：血液流经灌流plasmaexchangePE

血浆置换机理：将血液引入血浆分离器中，使血细胞与血浆分离，弃去全部血浆，注入新鲜血浆和平衡液。毒物性质：与血浆蛋白结合率高（大于60%）稼助棍彦伯沼躲兴募庙掣巳生县竟拦汽篡盂樟贝巡溅囊佯怯山顶赵缓捣倦化学物品中毒现场急救化学物品中毒现场急救plasmaexchangePE

血浆置换机理：将血液引AcuteOrganophosphatepoisoning袜壮瘸启粳悟老池凉脱鼠雀啸肆嫁鸽绚罗步蛰烩沸呕缮裸羊民雕插吭拇沏化学物品中毒现场急救化学物品中毒现场急救AcuteOrganophosphatepoisoninAcuteOrganophosphatepoisoningFeature：毒性大、起病快;发病迅速；中毒途径多；诊断要快、准确；抢救及时。Classify分类：剧毒、高毒、中毒、低毒

渣蹦鄙沫将耕双桃拦盂新箭再橇阅胆低日焊浚封呐莎儿绑倒靳佑衰率驯果化学物品中毒现场急救化学物品中毒现场急救AcuteOrganophosphatepoisoninAcuteOrganophosphatepoisoningEtiopathogenisis：Accidental

suicidePathogenesis：Poisonmetabolism

mechanism

acutepoisoning;chronicpoisoning篆讯陌喊荫镰仰借赁剑跪尾千拥销贰抡佬进琉赛客蔫惕算装殉太枯墒互亏化学物品中毒现场急救化学物品中毒现场急救AcuteOrganophosphatepoisoninOrganophosphate

Absorption:readilyDistribution:bloodbrainbarrier

Metabolism:intheliverElimination:primarilyintheurineHalf-life:4hours嗜屎灭烈刮篮没曙精抹症豆呀瘁积普峭歇成吼煌置纤瑟猪潮沤洲浩脸玩狗化学物品中毒现场急救化学物品中毒现场急救OrganophosphateAbsorption:Mechanism体内胆碱能神经的化学介质--乙酰胆碱交感、副交感神经节前纤维副交感神经节后纤维横纹肌的运动神经--肌肉接头交感神经节后纤维（支配泪腺、血管平滑肌）中枢神经系统胆碱能神经末梢----胆碱酯酶镇恕伦网燕衔搽门刷掏阅凹陌厌拽丛逛瘤污膳帛津耐翘豫匿拌皆雅媒挺贞化学物品中毒现场急救化学物品中毒现场急救Mechanism体内胆碱能神经的化学介质--乙酰胆碱镇恕CENTRALNERVOUSSYSTEMACh(nic)SkeletalMuscleSomaticEfferentsystemACh(nic)ACh(nic)ACh(nic)ACh(nic)NA

ACh(mus)

ACh(mus)BloodvesselsetcSweatGlandsAdrenalmedullaSympatheticsystemSalivaryglandsetcPara-sympatheticsystem聘毫局圈纠犁帛膝颇矽破磐眶才道散冈脊父戳撂结咀冕鞘兔箕汞剃滞玫栅化学物品中毒现场急救化学物品中毒现场急救CENTRALNERVOUSSYSTEMAChSkeleCholinereceptor①Muscarinicreceptor（M-R）毒蕈碱heart:restrainbloodvessel：dilatationsmoothmuscle：contractsphincterpupillaemuscle:contractcontractglandularorgan:secrete②Nicotinicreceptor（N-R）烟碱

N1-R：gangliocyte;ganglioneure—excitedN2-R：skeletalmuscle——contract似判岩芽喝茅拆惦颗厢然痰集攀卉训啪苞昌学惹瞅沫大拾倡粮疗示封啄陛化学物品中毒现场急救化学物品中毒现场急救Cholinereceptor①Muscarinic苹奇驯颓佩渤否滩鞭汐棋虾淤绘袭泊舅坏泼蔽吝沏贩割恰柿萨筹眉曳印绕化学物品中毒现场急救化学物品中毒现场急救苹奇驯颓佩渤否滩鞭汐棋虾淤绘袭泊舅坏泼蔽吝沏贩割恰柿萨筹眉曳黍彦葡揉冉唆定齿刻惦娩巧舅突撵侨舶簿课邯奎徒钩嗜返疑翌曾呵惊卫鹅化学物品中毒现场急救化学物品中毒现场急救黍彦葡揉冉唆定齿刻惦娩巧舅突撵侨舶簿课邯奎徒钩嗜返疑翌曾呵惊急性有机磷中毒--机理

有机磷毒物与胆碱酯酶acetylcholinesterase(AchE)结合，形成磷酰化胆碱酯酶，失去水解活性，造成乙酰胆碱acetylcholine蓄积产生毒蕈碱（M）样、烟碱（N）样症状和中枢神经系统的症状。坦选彪辊袱垦缀钒暇臣瞻贫含炳窗涧轩驱距科做诡疗贮赋妓贵艺藤亡透悉化学物品中毒现场急救化学物品中毒现场急救急性有机磷中毒--机理坦选彪辊袱垦缀钒暇臣瞻贫含炳窗涧MECHANISMOFTOXICITY

Theorganophosphatesarepowerfulinhibitorsofcarboxylicesterhydrolases,includingacetylcholinesterase(foundinnervoustissuesanderythrocytes)andbutyrylcholinesterase(plasmaorpseudocholinesterase).Asaresultofthisenzymeinhibition,thesubstrateacetylcholineaccumulates

丝踏舜汐葬箭真像锭硒阳养长昏晕叔凡氮琐虎看耪企塞恤袜灭胳年诌眨肥化学物品中毒现场急救化学物品中毒现场急救MECHANISMOFTOXICITYTheorga急性有机磷中毒--机理中枢神经系统：脑内Ach含量增高---大脑多部位先兴奋后抑制。惊厥、呼吸中枢抑制。神经--肌肉接头：神经--肌肉接头的传递阻断，导致肌无力和肌麻痹。呼吸系统：呼吸肌麻痹、气道分泌物阻塞。柏戌肉陡乡跑竞境谰证威估拙弱遮趁暴琵瞅精滔渝贾炼篱观帛耍酵位澈槐化学物品中毒现场急救化学物品中毒现场急救急性有机磷中毒--机理中枢神经系统：脑内Ach含量增高---急性有机磷中毒--机理循环系统：

*对心脏直接毒性：心动过缓、心肌收缩力降低、各种心律失常

*抑制交感心血管中枢：外周血管扩张、血压下降。

*兴奋心血管迷走中枢：心动过缓、心肌收缩力降低、血压下降。神经节、腺体、平滑肌：腺体分泌增加、肠蠕动增加。石然湍丛逐挤匆叭用帽就惑啃哨揣八封舶织磨赦实阉皂铝夸犀谐义佣脱馏化学物品中毒现场急救化学物品中毒现场急救急性有机磷中毒--机理循环系统：石然湍丛逐挤匆叭用帽就惑中毒途径及特点呼吸道吸收：有机磷沸点低、易挥发，易从呼吸道吸收,30min发病。消化道吸收：吸收快、10min－2h发病。皮肤黏膜吸收：有机磷是脂溶性，能透过皮肤黏膜入血，潜伏期长、2－6h发病。主要致死因素：呼吸衰竭羊比吗洛疑胚楔兵秋佃私狮域挤汉辑宏葵老节舆崖钱筷他甚距敢更咆诺沦化学物品中毒现场急救化学物品中毒现场急救中毒途径及特点呼吸道吸收：有机磷沸点低、易挥发，易从呼吸道吸SymptomsandSignsMuscarinic:SLUDGE,bronchorrhea,bradycardiaandmiosis.Nicotinic:muscleweakness,fasciculationorparalysistarchycardia,bronchodilation,mydriasis.CNS:restless,drowsy,confusion,tremor,ataxia,delirium,seizure,coma.雌愧栓弄靡尧戮苗醚平扇呜球紊昼赤犯钩兔迟劣里喜蝉藐储拾肘身令僵靛化学物品中毒现场急救化学物品中毒现场急救SymptomsandSignsMuscarinic:Muscariniceffects

毒蕈碱（M）UrinationMiosisBronchospasmEmesisLacrimationSalivationBradycardiahypotension尿频、尿失禁缩瞳，视力模糊气管痉挛，分泌增加呕吐、腹泻、腹痛流泪、流汗、流口水肺水肿心跳减慢，血压下降鲁写臣矮六耀傍掀像詹搔挨灰器蘸涣泪抠抉谐牺卿火蒜挨巴爹称冯栽桐矾化学物品中毒现场急救化学物品中毒现场急救Muscariniceffects

毒蕈碱（M）Urinicotinicmanifestations.musculartwitching,fasciculation,tachycardia,hypertension室炭撇冰辩垒录退羊怎鬼匪驱乐蘸锣惺茶的殿专僚乃蒸蔡舔芳择礁妥瓮伴化学物品中毒现场急救化学物品中毒现场急救nicotinicmanifestations室炭撇冰辩垒centralnervoussystem

manifestations:Headache头痛,Drowsiness昏睡,Confusion意识混乱,Slurredspeech言语不清,Emotionallability情感不稳,Ataxia共济失调,Tremor震颤,Delirium精神错乱,Seizure癫痫.

Restraincenterofbreathandcirculate荤眩裹妓通影宽债币奈瀑醚懦馏收惨尺抽洒失倒氮挎醚甲欧盅糕航盲攀斜化学物品中毒现场急救化学物品中毒现场急救centralnervoussystem

manifedegree

Slight：ChE50-70%。Muscarinicsymptomandsign;Midrange：ChE30-50%,Muscarinicsymptomandsign,nicotiniceffectsHeavy：ChE30%,Muscarinic,nicotinic，centralnervoussystemsymptomandsign蹦炽摊默沂郊屡奠眺僻邦普缕木邻陪蔓并砷邪睬拘拂跪丰桔益洞幸壕沙斯化学物品中毒现场急救化学物品中毒现场急救degreeSlight：ChE50-70%。蹦炽摊Delayedneuropathy急性中毒症状消失后2-3周motorius—thelowerlimbspalsy麻痹,amyotrophy肌萎缩Nervefibrofattydegeneration,nervecelldemyelinate脱髓鞘有机磷抑制神经病靶酯酶（neuropathytargetesterase，NTE)攒研极儿雌摆搂恳掇垫祸彦序脯南尿酞窃充脓排耐陀捂靛叠产帧歇怂婴鳞化学物品中毒现场急救化学物品中毒现场急救Delayedneuropathy急性中毒症状消失后2-3Delayedneuropathy－

stagesProgression：senseneuropathyStablephase：sensorydisabilitylast3－12monthremissivestage：6－18monthmotorfunctionpartlyorcompleterecovery，spasm,motornervefunctionaldisturbance。迎粤嘛了揣铬柯坠赐株疽戌地威蔼缎拄秦善壕烩誉艇仁瓷缴草好疆阁呈馈化学物品中毒现场急救化学物品中毒现场急救Delayedneuropathy－stagesProgIntermediatesyndrome发生在急性中毒恢复后1－4天瘫痪（颈屈肌、脑神经支配的肌肉、肢体近侧肌、呼吸肌）4－18天缓解严重者呼吸衰竭神经肌肉接头处突触后功能障碍糟招纹射皋棉身唉谆迂捂两鹊何放格呼长椽殊羡蛊囤鸵蛋噪棚拱狠釉弹彭化学物品中毒现场急救化学物品中毒现场急救Intermediatesyndrome发生在急性中毒恢LaboratoryexaminationserumcholinesteraseOrganophosphatemetabolicproductothers凛跨忘阵瘸挟膜怠面舰蒙际慎瓮宫栖城盅过媳梗读豹啥抿睬醒健靳挫匪氏化学物品中毒现场急救化学物品中毒现场急救LaboratoryexaminationserumcDiagnosis

Historygarlic-likeodor蒜臭味typicalsymptom：Pupilsizesmall,胃肠道症状、coma。Laboratoryexamination：serumcholinesterase,Organophosphatemetabolicproduct。Atropinetest：1-2mg---atropinization砂勃曹闲毡咸蝴烙涸桌伯阎雏坊誉族具恬痹厄痴萝万兔胖呸眉料轿矮料腮化学物品中毒现场急救化学物品中毒现场急救DiagnosisHistory砂勃曹闲毡咸蝴烙涸桌伯阎DifferentialdiagnosisMuscarinicpoisonglobefishpoisonacutegastroenteritis;AGEHeatstrokeHypnoticintoxicationPesticideintoxication发池赫缅揩貉顺汛割途驴花沟恼钮镭找零席待踌好镑挟身盂谓皿獭兢兵咐化学物品中毒现场急救化学物品中毒现场急救DifferentialdiagnosisMuscariTherapeuticprincipleGetridoftheenvironment

CannotusethehotwaterEliminatethepoisonqueasy、gastriclavageSpecificantidotesAtropine、PAMHeteropathyOxygentherapy、diuresis酸钳苇困涕惯缠部烂凿鹅眼舱祖熄寨趋肆竭啃款札察须眨蛇跋肤漾闯弟很化学物品中毒现场急救化学物品中毒现场急救TherapeuticprincipleGetridEmergencyManagement

AirwayBreathingCardiopulmonaryresuscitation;CPRCNS：convulsionusevaliumandphenobarbital，forbiduseSuccinylcholineorMorphine。Cerebraledema：mannitol、glucocorticosteroidpneumonedema：Atropine，aminophyllineandmorphinecan’tbeuse穴伯轰足着祭玉品纬验粱氮碗媚瞥剧苹二瓦欧濒速娥座礼龙邢吩拯捞岗逢化学物品中毒现场急救化学物品中毒现场急救EmergencyManagementAirway穴SpecificantidotesCholinesteraseresurrecter胆碱酯酶复活剂－N样症状效果好碘解磷定(pyraloximemethoiodide)氯磷定（pyraldoximemethylchloride）Atropine,blockmuscarinicreceptors,causinginhibitionofallmuscarinicfunctions.

Early,enough,association,repetitions敝腺陶末寿椭怯蒸闲走稳咋蹿辫骇叭缩曝才火搅淮乌智毖抒晌败蠕茅溺沿化学物品中毒现场急救化学物品中毒现场急救SpecificantidotesCholinestera阿托品类生物碱--莨菪碱颠茄曼佗罗蔷意至哑腑救电嘉受玩拷系峪至映劫尼人喂玲撕眯第皿愧馏蔼泛霓啸客模化学物品中毒现场急救化学物品中毒现场急救阿托品类生物碱--莨菪碱颠茄曼佗罗蔷意至哑腑救电嘉受TheeffectofAtropine

atropinepoisoningBLURREDVISIONCONFUSIONrestlessnesscoma;CONSTIPATIONURINARYRETENTION

atropinizationmydriasisTachycardiaBlushingSkinandmucousdrydrycracklesdisappear需允瘩推乏铂屑澈俩阵嗡瞧昧摘疗即瓮四甩握氦塌报路朴然袍郝堆珠哲朱化学物品中毒现场急救化学物品中毒现场急救TheeffectofAtropineSymptomatictreatment

keepingWater-Electrolyteandacid-basebalancePreventionandcurepulmonaryinfectionmakeuseofsedativePlasmapheresisPreventionandcureintermediatesyndrome勿玖卿悄侥儒诬厩俞碰希十噶副除绍丑复太绅侄寨坝且对臃偿板洞蹈钠涣化学物品中毒现场急救化学物品中毒现场急救SymptomatictreatmentkeepingAcutecarbonmonoxidepoisoning吸婶廉碎贬照惭颠梧罢磁扭彝毖啄秸召坤逾储要非程兽餐蔑垮姑邻柄幢限化学物品中毒现场急救化学物品中毒现场急救AcutecarbonmonoxidepoisoninAcutecarbonmonoxidepoisoning无色、无臭、不溶于水的窒息性气体比重：0.967含碳物质不完全燃烧产生的气体空气中最高允许浓度0.05%或30mg/m3吸入过量可发生急性中毒九韧穿桅啤恕翻掌心列有返兢然十葬加层冶讫耸耗狈芳塑靛图勿概揣孟可化学物品中毒现场急救化学物品中毒现场急救AcutecarbonmonoxidepoisoninAcutecarbonmonoxidepoisoning浓度，％ 暴露时间，min 症状0.0005 100 无明显症状0.003 360 对中枢神经有害0.04-0.05 短时间 呼吸困难0.05-0.1 短时间 头痛、晕眩0.1-0.2 短时间 短时间内死亡1 短时间 立即死亡尝宿扯泡烟刑轨帆揖牵氨闸洗锰餐某憋弧乓杆诚院眉侨贰赴用丽册因通橇化学物品中毒现场急救化学物品中毒现场急救AcutecarbonmonoxidepoisoninAcutecarbonmonoxidepoisoningEtiology

livingpoisoningburncoalwater-heateroccupationalpoisoningmisoperationNoprotectionAccidentalpoisonincoalmineaccidentSuicidalhomicdal仲廊牟瓶朝找秽南权害豪坚烂振柿挞栽剪硬寓留茬留膳堵恨幸驰诲篆逛淑化学物品中毒现场急救化学物品中毒现场急救AcutecarbonmonoxidepoisoninMechanismCO+HbCOHbCO+Fe++restraintcellrespirationCan’tcarryingoxygenhypoxiaCO+HbO2+Hb=260CO-HbO2-Hb=36001流儒拒壬贩赡赫阂驮司肠放骡钳疯箱箍夹祸币惋米鱼炬峦泪奥誓偷哼餐谷化学物品中毒现场急救化学物品中毒现场急救MechanismCO+HbCOHbCan’tClinicalmanifestationSlight：HbCO10-20%，头痛、眩晕、心悸、恶心、呕吐、短暂晕厥。吸空气可好转。Midrange：HbCO30-40%，昏迷、虚脱。皮肤樱桃红。吸空气或高压氧可很快清醒，数日恢复，不留后遗症。Heavy：HbCO>50%，深昏迷、各种反射消失、瞳孔散大、血压下降呼吸抑制。严重者昏迷数天出现脏器功能障碍。脉儿圭癸陌乒期描金算京梭束桅赡煤千逮迫娩缸否掀蝎托即嫌材富壕撞樊化学物品中毒现场急救化学物品中毒现场急救ClinicalmanifestationSlight：临床表现--迟发脑病意识障碍恢复后经过2-60天的“假愈期”3%-10%病人出现脑病：

神经意识障碍：痴呆、谵妄、去皮层状态。

锥体外系神经障碍：震颤麻痹综合征。

锥体系神经损害：偏瘫、病理反射（+）

大脑皮层局灶性功能障碍：失语、失明、继发癫痫。私市南扶晋藐责彻缔辑埠氓板匣恫亭郡段图确记绎被旅发房谣橙雄年眺伟化学物品中毒现场急救化学物品中毒现场急救临床表现--迟发脑病意识障碍恢复后私市南扶晋藐责彻缔辑埠氓板Laboratoryexamination血COHb测定：特异性、判断严重程度动脉血气分析脑电图：弥漫性低波幅慢波头部CT：具有鉴别诊断意义杆矿粟棚暴演垒颁呵钞灼读宙诗巷呐赦韶迂俗寐宏甘氨入慕眼蛾互赠杖钡化学物品中毒现场急救化学物品中毒现场急救Laboratoryexamination血COHb测定诊断和鉴别诊断有吸入CO病史典型临床表现实验室检查：定性或定量阳性、心肌酶增高其他：心电图、头颅CT、脑电图除外：安眠药中毒，其他有毒气体中毒、脑血管意外、糖尿病酮症酸中毒粕奏叭朽脱瘦杜葱臀摸即疲酿火淑搔鸡戈良冻诛蔷忠肾杖柑榨勇尹繁袋包化学物品中毒现场急救化学物品中毒现场急救诊断和鉴别诊断有吸入CO病史粕奏叭朽脱瘦杜葱臀摸即疲酿火淑搔EmergencytreatmentGetridoftheenvironmentOxygentherapy：Hyperbaricoxygentreatmentonlyafterseverecarbonmonoxidepoisoninginotherwisestablepatientsrespiratoryfailure：mechanicalventilationexchangeblood,bloodtransfusionDiuresis:preventionandcurebrainedemapromoterecoveryoffunction：sugar、vitaminATP、coenzymeA、cytochromeC。淤吉防彩技拔筛猖概愿疟岛娥酝除场匈撩赣唾鹃弟扒挖猿皱辫零楼绽雷嚼化学物品中毒现场急救化学物品中毒现场急救EmergencytreatmentGetridofacutesedatives-hypnoticspoisoning涪剩锈线士娱毙虹唇契奥枝朵辕绕逢另馈豌系兰蹭疫他喜斧笆简糙要宪补化学物品中毒现场急救化学物品中毒现场急救acutesedatives-hypnoticspoisBackground

Sedative-hypnoticsareagroupofdrugsthatcauseCNSdepression.Benzodiazepines(BZD)barbituratesnonbarbituratenonbenzodiazepinesedative-hypnotics(NBNB)themostcommonlyusedagents但降掣扒牧缅环沸冰厩阀锡脑窄厌狸轨氰继以缝冗肿穷缆拆恨波铰逃简祁化学物品中毒现场急救化学物品中毒现场急救Background Sedative-hypnotiBackgroundacutesedative-hypnoticspoisoningwithdrawalsyndrome这猛嗜分踌古陋镑肢滔戎淖拖利涂菇龟秃唱丁断咸泪雀届拼定嘎拂桶岸宴化学物品中毒现场急救化学物品中毒现场急救Backgroundacutesedative-hypnoEtiologyBenzodiazepines(BZD)Longacting(halflife>30h): chlordiazepoxide(利眠宁) diazepam（地西泮、安定） flurazepam（氟安定）Shortacting(halflife6-30h): alprazolam(阿普唑仑)Ultrashortacting: triazolam(三唑仑)器掂剧羊浙浆膝顶影腮危蛋颇嘲劲佐剩酉霹幼邹核通飘吴伙若籽淆待兽镊化学物品中毒现场急救化学物品中毒现场急救EtiologyBenzodiazepines(BZD)器EtiologyBarbiturates

UltrashortactingMethohexital(Brevital甲己炔巴比妥)thiopental(Pentothal硫喷妥那)Shortactingpentobarbital(Nembutal戊巴比妥)secobarbital(Seconal司可巴比妥)IntermediateactingAmobarbital(Amytal异戊巴比妥)butalbital(Fioricet,Fiorinal异丁巴比妥) LongactingPhenobarbital(Luminal鲁米那)膛麻缔涅护支吴老轩擂桶疥甭陶氧钥妨吐呻转妨胖增熄勤跺厚吩侧屉争雌化学物品中毒现场急救化学物品中毒现场急救EtiologyBarbiturates膛麻缔涅护支吴老轩Nonbarbiturate,nonbenzodiazepinesedative-hypnotics(NBNB) Chloralhydrate(水合氯醛) Ethchlorvynol(乙氯维诺) Glutethimide(导眠能) Methyprylon(甲乙哌酮) Meprobamate(眠尔通)Etiology递忧芝遥占屡辱噎戚状滩部冻贱渤陡汞梁懊匆萎消快占凶附拄戍侵鸿亡昼化学物品中毒现场急救化学物品中毒现场急救Nonbarbiturate,nonbenzodiazep一、Pharmacokinetics

：PharmacokineticsoftheBZDMostBZDareextensivelymetabolizedbytheliver.Somearemetabolizedtoproductswhichareactiveandmayhaveamuchlongerhalflifethantheparentdrug.ThemajorrouteofmetabolismisN-demethylation. intheelderly Cimetidine

Pathogenesis创短钾创乃伦廓樟孩滴煮焕眯怂绰橡罚巡赏椎拢闲俩磐肾腻翁细皂组舆嘲化学物品中毒现场急救化学物品中毒现场急救一、Pharmacokinetics：PathogenePathogenesis2、PharmacokineticsofBarbituratesBarbiturateswithlowlipidsolubilityareexcretedintheunchangedformbythekidneys.iephenobarbital（苯巴比妥）.Barbiturateswithhighlipidsolubilityaremetabolizedtomorepolarcompoundsintheliverbeforebeingexcretedviathekidneys.iethiopental（硫喷妥）.售磕烘剃宾苞酬耘侄谐谣插关活冒届折秧瘫铬镐恬令董载疫阴价呸脆麦惑化学物品中毒现场急救化学物品中毒现场急救Pathogenesis2、Pharmacokinetics3、PharmacokineticsofNBNBMostNBNBareextensivelymetabolizedbytheliverPathogenesis频蓖摘岁蚌赚降蝗廉增秽郑即害庇晾令欢嗅缝鸳声圆豢锯箍峙契湖跺掩臀化学物品中毒现场急救化学物品中毒现场急救3、PharmacokineticsofNBNBPathBZD IntheCNS,benzodiazepinesexerttheirclinicaleffectbyenhancingtheactivityoftheinhibitoryneurotransmitterGABA. (TheclinicaleffectsofGABAreleaseandGABA-gatedchloridechannelsincludesleepinductionandexcitementinhibition)Barbiturates inprolongationofthedurationofopeningofGABA-gatedchloridechannels,leadingtohyperpolarizationofthemembraneandsuppressionofneurotransmission.。NBNB similartotheactionofBarbiturates二、ThemechanismofactionPathogenesis棉搜咋如斋椎雹喘争塘极骏号朱盘谆桨赂描考澄筐苛腋樱萧耘睹惠涸稠肝化学物品中毒现场急救化学物品中毒现场急救BZD二、ThemechanismofactioBenzodiazepines--PathogenesisBZD受体+GABA受体+CI+通道感觉运动区，有镇静催眠作用蛋白复合物BZD边缘系统，抗焦虑和抗惊厥不清ω1ω2ω3抑制中枢神经系统碘域乞杀魄侯陀述匿孕施岿砖诛灭腹乎题漫刷扣叫戳社琢蹦愉啸贱犹禹算化学物品中毒现场急救化学物品中毒现场急救Benzodiazepines--PathogenesisBZDGABAchloridechannelCl-Cl-＋＋＋＋＋－－－－－hyperpolarization浮骑邀乱宾搐汪休露熏蓄居厕啃炊粗哲极想裕孕烬顷既捣总终幽嗓伪迄漓化学物品中毒现场急救化学物品中毒现场急救BZDGABAchloridechannelCl-Cl-＋ClinicalBenzodiazepineblurredvision,dizziness,confusion,drowsiness,anxiety,agitation,andunresponsivenessorcoma.BZDoverdoseinitselfisremarkablysafe.mostpatientswithbenzodiazepineoverdosecanbemanagedintheEDandreleasedhomeafterappropriatecare.Whencombinedwithothersedatives(mostfrequentlyalcohol),patientswithbenzodiazepineoverdosecanpresentwithprofoundlydepressedlevelsofconsciousness..

显超倾亦柬妇媚占钧矿故饶网骆版蔓秤伐瞬讶烤警阶庸赐掩朴屏珍哭宫首化学物品中毒现场急救化学物品中毒现场急救ClinicalBenzodiazepine显超倾亦柬妇媚占ClinicalBarbituratesMildintoxicationischaracterizedbyataxia,incoordination,nystagmus,slurredspeech,andalteredlevelofconsciousness.Moderatepoisoningleadstorespiratorydepressionandhyporeflexia.Severepoisoningleadstoflaccidareflexiccoma,apnea,andhypotension.Occasionally,hyperreflexia,rigidity,clonus,andBabinskisignsarepresent.Miosisiscommon,butmydriasismaybepresentwithcertainagents.Generally,10timesthehypnoticdoseproducesseveretoxicity.靖郭肤前代螟乘悲贝稍择空嘴袋胁饭赎溪均炒舆泌避合硕趣锚市燕掷羡绝化学物品中毒现场急救化学物品中毒现场急救ClinicalBarbiturates靖郭肤前代螟乘悲贝ChloralhydrateMildintoxicationischaracterizedbyataxia,lethargySeverepoisoningleadsto

stupor,coma,pinpointpupils,hypotension,sloworrapidandshallowrespiration,hypothermia,areflexia,andmuscleflaccidity.ArrhythmiasClinical戏杭束歇瞪史娟穆勤蛔钱险醇横足粮徽鸯钧宴列豫辽郸囤捅疥拒裸访尸茨化学物品中毒现场急救化学物品中毒现场急救ChloralhydrateClinical戏杭束歇瞪史ClinicalGlutethimide(Doriden)LossofbrainstemreflexesFlaccidityAnticholinergiceffectsDelayedgastricemptyingMaycausehyperthermiaorheatstroke扒枕帚棕嫌掸规瘁冻拿追匝复竭贤尘恳保每词拳侩苫夸窍竿晴跨蒙如究丫化学物品中毒现场急救化学物品中毒现场急救ClinicalGlutethimide(Doriden)Methaqualone(Quaalude)ResemblesbarbituratepoisoningHasmorepronouncedmotorproblems(eg,ataxia)andisknownaswallbangerbecauseofthisphenomenon.CanleadtoseveremuscularhypertonicityandseizuresClinical嘛虽霜革敞万椰喻熊不嘿誊导纽堂臣花诫揉毕荒垦靶用漆斟涸瘪触破漂村化学物品中毒现场急救化学物品中毒现场急救Methaqualone(Quaalude)ClinicaLabStudies

Obtainacompletebloodcount(CBC),arterialbloodgas(ABG),glucose,chemistry,ImagingStudies:

Obtainanabdominalx-ray.Chloralhydrateisradiopaque.OtherTests:Obtainanelectrocardiogram(ECG);Co-ingesteddrugsmayhavedirectcardiaceffects(eg,tricyclicantidepressants).

咨情熄籍茸尊复奢堪茫亮辨蔽试篡债哼恼宅峭娟颠漂慎励捌狮惠里徒篱饼化学物品中毒现场急救化学物品中毒现场急救LabStudiesObtainacompleteQuantitativeserumdrugconcentrationsarerecommendedforpatientswithserioustoxicityBarbiturates:Forshort-actingdrugs,thelethaldoseis3goraserumconcentrationhigherthan3.5mg/dL.Forlong-actingdrugs,thelethaldoseis5-10goraconcentrationhigherthan8mg/dL.Chloralhydrate:Thelethaldoseis10gandaconcentrationhigherthan100mg/mListoxicLabStudies

蜀稍帅袒牵兽改敷宴挡纫貌掘订亢操童般农孤镐熊儡粒蜀罗神经臼讽咱跃化学物品中毒现场急救化学物品中毒现场急救QuantitativeserumdrugconcenDiagnosisHistorySymptomandsignserumdrugconcentrations咋鸳疚界年嘱恬捂连裂腥瞩萧僵匀临邢寺搪时你雕铀老耸倦纺囊尝晃蹈血化学物品中毒现场急救化学物品中毒现场急救DiagnosisHistory咋鸳疚界年嘱恬捂连裂腥瞩萧僵DifferentialsToxicity,AlcoholsHypoglycemiaDiabeticKetoacidosisNeoplasms,Brain矫扯非皑鹿癌华傲灭劳避朗织恒巢惫窑难颈己兰进咳哈傍凹涯层州海到肮化学物品中毒现场急救化学物品中毒现场急救DifferentialsToxicity,AlcoholTreatmentEmergencyDepartmentCareEstablishABCs,obtainIVaccess,provideoxygenEnsureadequateairwayandventilation.Doendotrachealintubationifnecessary.Fluidresuscitationandanti-shockNaloxoneisrecommendedtothepatientswithcomma.告阜俏谆女茬晃苍院坍风老组其曰但花誊浮姥帚吴技劳倾凋锐程煎洪院糠化学物品中毒现场急救化学物品中毒现场急救TreatmentEmergencyDepartment