化學(xué)物品中毒現(xiàn)場(chǎng)急救課件

ContentsBackgroundGeneralintroductionAcuteOrganophosphatepoisoningAcutecarbonmonoxidepoisoningAcutesedatives-hypnoticspoisoningAlcoholIntoxication/Withdrawal生禾拋澎夫舅謄病直瘸廄詠憂弄馬蹭藹歉泵圓紙個(gè)棟幽毆險(xiǎn)璃徑闡飄彼僥化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ContentsBackground生禾拋澎夫舅謄病直瘸廄BackgroundThereareabout9000000kindsofchemiclaPeoplehavemanyopportunitytotouchwithpoison休臨表腫呵攻服墊寞拼畢圾兔輔噓笛逐騁袒藉淮跡呀寶楊潤(rùn)蠅嬌狙亦若甕化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救BackgroundThereareabout900BackgroundThereare1751476poisoningpt’sinUSAin1993Poisoncontrolcenter(PCC)isestablishedinChicago1953。Majorduty:componentofpoison;4.informationDangerous5.toxicologyfirstaid6.generalknowledgeofpreservation哄忱再胺蓄灶犯呈籍過豆瑞蔫凍類雌溜濰搞刀夏缽稈但寥咎申肌捶旬令旬化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救BackgroundThereare1751476po萄柯謬崗注逢氛升去犧嫁屋溺褒隱宵砒踞措仁哥蘿怯性丘牌拆笑午焰侄汀化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救萄柯謬崗注逢氛升去犧嫁屋溺褒隱宵砒踞措仁哥蘿怯性丘牌拆笑午焰溝購(gòu)氟翌量現(xiàn)番餅仗浚屢糟醇彰煮慢疤磕揮據(jù)走宙哺榆筍涎唁硼家鄂跋誘化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救溝購(gòu)氟翌量現(xiàn)番餅仗浚屢糟醇彰煮慢疤磕揮據(jù)走宙哺榆筍涎唁硼家鄂鴦其踢飼寸辮簾神蘭濕雛導(dǎo)照查舅賞啞庸稅裕賭擴(kuò)書拉泳緬殃賣屎習(xí)趨鞭化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救鴦其踢飼寸辮簾神蘭濕雛導(dǎo)照查舅賞啞庸稅裕賭擴(kuò)書拉泳緬殃賣屎習(xí)BackgroundCountryside>city。Countryside----pesticideintoxication。City---food-poisoning,carbonmonoxidepoisoning,Hypnoticintoxication。EstablishPCCinBeijing,Shanghai,Shenyang粗眨慌陡枯糟痞砂爹應(yīng)矚圣政喬跨糧界知雅嚴(yán)刀講詣劫哨稗炳說賊臣翔臆化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救BackgroundCountryside>city。Whatispoison?Apoisonisanythingsomeoneeats(ingestion),breathes(inhalation),getsintheeyes(ocularexposure),orontheskin(dermalexposure),thatcancausesicknessordeathifitgetsintobodyoronthebody.Poisoncanbefoundinfourforms:solid,liquid,sprayandgas.高卷騁借撐藻盤釩漱伍剃噶叉幅徽膛句妝懇默緩妻雛仕鎖入轉(zhuǎn)勻?yàn)r瘟狡略化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Whatispoison?ApoisonisanGeneralintroductiontoxicsubstance:drug,chemical,badfoodandsoon.Acutepoisoning：shorttime，largedoseChronicpoisoning：longtime、smalldose艘撅謾襲冪盟怪憨插姑睜扛性吐偉誤小衷秋肘低宦人敷梧悔丟乳憚冰喝坷化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救GeneralintroductiontoxicsubsEtiopathogenisisandpathogenesyCauseofapoisoningOccupationalpoisoningLifepoisoningAccidentalpoisoning,SuicidalAbuse，addication,homicdal億實(shí)卿枚臥桿趣閃抉簽盈豌看勞孝鈴滁謾懸滬釘掩影東綿喬鴨零愈雅跡犁化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EtiopathogenisisandpathogenPathogenesy--Absorption

Bymouth;inhalation（Powderdust、smoke、steam）,skinmucosa,muscleorintravenousinjectionRectum、urinarycanal、femalesheathvagina、bladder、peritoneum、eyeInsectstingsorbite次據(jù)跑拍樸責(zé)棘訊步賺粒嶼年瘩吊彤泉門行騎蕩鴨摳胯促健奔緝欽撮尼灌化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Pathogenesy--AbsorptionBymoPathogenesis--metabolismspreadalloverbodybybloodlivermetabolismPoisonousnessPoisonousnessOxidation,deoxidize,hydrolyse,bonding祥溝仁澇童椎焚厲棵馱奇純锨細(xì)儈際職內(nèi)勘滇馮呼花札黨刊軸觸術(shù)戀殺耳化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Pathogenesis--metabolismsprePathogenesis---Eliminatebreatheoutbyrespiratorytract（gas，volatilematter）DischargebykidneyDischargebyalimentarytractSkinMilk言孩躊懦攻捐玫便廟床勘眉碧滯枉薄刪茬恤恿什掙劑剖義填顫妻顫周學(xué)陸化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Pathogenesis---Eliminatebrea1.Localeffect強(qiáng)酸、強(qiáng)堿吸收組織水分與蛋白質(zhì)脂肪結(jié)合組織細(xì)胞變性壞死懊蛋逗于澡糯關(guān)走有齲返轍吻損怨米哇御鈣毀勛越亮浪墜屠律搓廖犁皮宿化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救1.Localeffect強(qiáng)酸、強(qiáng)堿吸收組織水分與蛋白質(zhì)2.HypoxiaInhibitionrespiratoryfunction：ChangebloodconstituentInhibitioncellsrespiratory：cyanide，hydrogensulfideDestroyCardiovascularfunction胡論胎孟浮法架蓋錐逸寞淳莫膩?zhàn)斜霐r蔽雨矽細(xì)賜梗渺湖衛(wèi)伐但尋促盆冕化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救2.HypoxiaInhibitionrespirato破壞酶蛋白質(zhì)部分的金屬或活性中心——氰化物抑制細(xì)胞色素氧化酶Fe++；一氧化碳抑制細(xì)胞色素氧化酶Fe+++從而破壞酶蛋白質(zhì)分子中的金屬，使細(xì)胞發(fā)生窒息毒物與基質(zhì)競(jìng)爭(zhēng)同一種酶而產(chǎn)生抑制作用,丙二酸結(jié)構(gòu)與琥珀酸相似，抑制三羥酸循環(huán)中琥珀酸脫氫酶3.Inhibitoryenzymeactivity峙師清諾明液避參攝隆鑲饒戴射石潰紊民救岡掠壓否炒恥誅晃曰位鍺愁爬化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救破壞酶蛋白質(zhì)部分的金屬或活性中心——氰化物抑制細(xì)胞色素氧化酶與酶的活性劑作用：——氟化物與Mg++形成復(fù)合物，使Mg++失去激活磷酸葡萄糖變?yōu)槊傅淖饔萌コo酶：——鉛中毒時(shí)，造成煙酸的消耗增多，使輔酶I和輔酶II減少，抑制了脫氫酶的作用與基質(zhì)直接作用：——氟乙酸直接與檸檬酸相結(jié)合形成氟檸檬酸，阻止三羧酸循環(huán)的繼續(xù)進(jìn)行娘內(nèi)蕩創(chuàng)嚙品衣飯訝齲分禿牡敞靡蘿孜土教攙蔫寂鍺燎尺堰費(fèi)爹撤櫥丹聽化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救與酶的活性劑作用：——氟化物與Mg++形成復(fù)合物，使Mg++

Organophosphatepoisoning，可抑制體內(nèi)的膽堿酯酶，使組織中乙酰膽堿過量積蓄，引起一系列以乙酰膽堿為傳導(dǎo)介質(zhì)的神經(jīng)處于過度興奮狀態(tài)，最后則轉(zhuǎn)為抑制Carbontetrachloridepoisoning，首先作用于CNS，使之產(chǎn)生交感神經(jīng)沖動(dòng)，體內(nèi)產(chǎn)生大量單胺類物質(zhì)，使內(nèi)臟血管收縮引起供血不足，中毒數(shù)小時(shí)后可出現(xiàn)肝、腎損害4.Dromotropism

medium瞞估瑞閱炬娜沽金線鉆歲廖倦韓警撾擦鍘倆戲嗡繼頒綏庸堤瀕賄描鉆慶俺化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Organophosphatepoisoning，可

一氧化碳與氧競(jìng)爭(zhēng)血紅蛋白，而形成碳氧血紅蛋白，破壞了正常的輸氧功能異煙肼與維生素B及煙酸的結(jié)構(gòu)相似，因此，異煙肼在體內(nèi)可與維生素B競(jìng)爭(zhēng)，而取代其作用，因而引起中毒

5.Competitionreceptor祝覺懶棱隅卜曼冪誠(chéng)斧凹漣補(bǔ)泥貸聲蓮曼倦皆焉墻肖芬煥酮泅封譴詢焰趨化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救一氧化碳與氧競(jìng)爭(zhēng)血紅蛋白，而形成碳氧血紅蛋白，破壞了正常6.Interferecellororganellaphysiologicfunctioncarbontetrachloride（CCl4）－－CHCl3（trichlormethane)－－肝細(xì)胞膜中的unsaturatedfattyacid－－lipidperoxidation－－mitochondria(線粒體)、endoplasmicreticulum(內(nèi)質(zhì)網(wǎng))變性－－h(huán)epatocyte(肝細(xì)胞)deathPhenols(酚類)－－線粒體內(nèi)oxidativephosphorylation(氧化磷酸化)uncoupling(解偶聯(lián))－－inhibitingadenosinetriphosphate(三磷酸腺苷)synthesis(合成)、store(貯存)。抄新男患多賀汰勁昌筷岡疽臻慨植太堰羔桂瓣筆睜韶資翌仇巾嗽位厘瘡近化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救6.InterferecellororganellaThefactorofinfluencetoxicactionPhysico-chemicalpropertyofpoisonfineparticle,solubility,evaporabilitySusceptibilityofindividualsex,age,nutrition,healthstatus,livinghabit

之韋者系眾完忍恿削畫瞅危綜贈(zèng)蘭屬滁招漾懦斌渝饞戰(zhàn)困粘掖熒懼埠宛相化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ThefactorofinfluencetoxicDiagnosispoisoningHistorySignandsymptomconsciousstatebreathingheartratebloodpressurepupil,skin,mucosa逐塑哪念咯吹抓支騰怕酵瀕愁但庸斂炒隙婦悉片噓催悼錫騙際轎須賠骨窄化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救DiagnosispoisoningHistory逐塑哪LaboratoryexaminationDetectionofpoison:blood,gastricjuiceandurineBlood,urineexamination慎甸轟雅研卸矢仙天僅司臆蛹郎惟襲糞擋牧播當(dāng)豁瑟兄矮濁玻量斃獄既如化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救LaboratoryexaminationDetectiTherapeuticprincipleCPRGetridoftheenvironmentDecreaseAbsorptionSpecificantidotesCleaningpoisoningastrointestinaltractHeteropathyPreventComplication踢餅促月突窩唉族滅肋趁舶鬼耽漏彎圃袋詫慮奮歲壺積默盟苞閃求謂邁贊化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救TherapeuticprincipleCPR踢餅促月突EmergentmanagementBreathingsupportCirculationsupportTreatmentcomaTreatmentconvulsion鈕滯鄭梯竣綠嘶躍寞目羌騰予砍朝戰(zhàn)停溝諸拔鯉昌貌示質(zhì)暇恐哺攪淺裳貧化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EmergentmanagementBreathingSPECIFICANTIDOTESOrgnaophosphorus-----PralidoximeIodide，AtropineBenzodiazepines－－FlumazenilPain-killer－－NaloxoneIsoniazid－－vitaminB6嘲娃貶結(jié)丹早稿典腸杠聚園筑榆詭仰伙越壟換椽妨示壁蛤簇圾宜褐衰秀兩化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救SPECIFICANTIDOTESOrgnaophosphEliminatepoisonEmeticGastriclavageActivatedcarbonadsorptionCatharsisWhole-bowelirrigation浮屢蓄駭囂藕林棉趾濫譚攘痔攙椒悶嬸顛衍嚇趣辛鐳搬長(zhǎng)騁戶軀楷纜文陀化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EliminatepoisonEmetic浮屢蓄駭囂藕林Emetic壓舌板、刺激咽后壁飲溫水200-300ml吐根糖漿+200ml水休克、意識(shí)不清—禁用攝入腐蝕性毒物----禁用顱稍里鋅盲梧梁漳聊屑兒醋徊諱甘鵲己雍滯悍硅哺禍奴伐耘鞘墾哎狗譬搐化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Emetic壓舌板、刺激咽后壁顱稍里鋅盲梧梁漳聊屑兒醋徊諱甘PurposeofGastriclavageEliminatepoisoningastric,preventabsorbPreparationforoperationorsomeexamination勒警苦歷粗財(cái)域慌砂瘧畝神用瑚耿水傘焰排托甥弧君犬悟橋霹某匝孩老泰化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救PurposeofGastriclavageElimIndicationandcontraindicationIndicationNon-corrosivepoisonContraindication

Corrosivepoison—strongacid,baseesophagealvarix,aneurysmofaortaSevereheartdisease，uppergastrointestinalbleeding，gastricperforation峪昔庇壓瀝耪哲閩瞳得蘭傾密眩淬抄共凳規(guī)炊襖盅葵購(gòu)?qiáng)W航韭守餞狼添靛化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救IndicationandcontraindicatioPrincipleofgastriclavage一般毒物的洗胃原則

一次性徹底洗胃（10000-20000ml）、停止洗胃標(biāo)準(zhǔn)為無色無味。有機(jī)磷中毒的洗胃原則

首次足量20000-30000ml持續(xù)胃腸減壓留置胃管接胃腸減壓器反復(fù)少量洗胃

2000-5000ml/1-2h漲艱磨刷蚌僵建佳恐伴嶺象撓床解糯返訖晌吸使皇白汗腆礙忻化繕狐障司化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Principleofgastriclavage一般洗胃的操作步驟洗胃步驟：1.先將胃內(nèi)容物盡量抽盡2.灌入300-500ml洗胃液3.再排出灌入液體4.反復(fù)灌洗直到洗胃液純清無味注意事項(xiàng):1.洗胃液每次進(jìn)入不宜過多，進(jìn)出要平衡。2.洗胃液性質(zhì)盡可能視毒物而定，液溫37℃3.掌握適應(yīng)癥與禁忌癥慨熒睦陰校巢昧峪獲濾勢(shì)款漲醬龜輩屈柴水團(tuán)艾疥韓始瓶栓岸升通琺綜盛化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救洗胃的操作步驟洗胃步驟：洗胃要注意和觀察的幾個(gè)問題洗胃與胃出血的關(guān)系少量可給保護(hù)胃粘膜藥，大量停止洗胃、持續(xù)胃腸減壓觀察出血情況洗胃時(shí)要密切觀察生命體征、腹部情況、洗出液的性質(zhì)昨紉虎涵川琳糙蓬桅述鋤堵澗促洲苛輛下沫霸艙佐烯原琶進(jìn)拌眨胃返暫匪化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救洗胃要注意和觀察的幾個(gè)問題昨紉虎涵川琳糙蓬桅述鋤堵澗促洲苛輛CatharsisandWhole-bowelirrigation

硫酸鈉--15-20+水200口服硫酸鎂--15-20+水200口服（引起高血鎂）20%甘露醇250胃管內(nèi)灌入--1小時(shí)腹瀉、3小時(shí)排空。1%鹽水、肥皂水5000--高位連續(xù)灌腸清洗活性炭加入灌腸液，促進(jìn)毒物吸附排出霜磋脅價(jià)搏巖狀歉諜遲紀(jì)潔捐裙貞扇懇亨莊祭蹭吁漲燦豎櫥譜蕩紊喀鉛撕化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救CatharsisandWhole-bowelirri

EliminatepoisonForceddiuresis強(qiáng)化利尿Bloodpurification（血液凈化）hemodialysisHD（血液透析）hemoperfusion,HP（血液灌流）plasmaexchangePE（血漿置換）Highpressureoxygen高壓氧氯鄧矚糊舒刨巧嘻抬渠啼翼駿栽細(xì)犧辟裂毀情霜猴痹壤巳疽騾歧瓶蟬揍溉化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EliminatepoisonForceddiuresHemodialysisHD

血液透析機(jī)理：血液經(jīng)體外循環(huán)進(jìn)入透析器，通過透析膜和透析液之間形成的溶液濃度梯度，促使血液內(nèi)溶質(zhì)彌散至透析液內(nèi)?？赏肝龆疚锏男再|(zhì)：water-solubility水溶性、heavymetals,生物性毒物。種類：蛇毒、魚膽、利眠寧、diamorphine海洛因、撲熱息痛、Isoniazid異煙肼、aminoglycosides氨基糖甙類、arsenic砷、mercury汞等。籽訖胺霜廟稼攏巷林衣傭睦編怔培消語鹽蹤繳透邊葵揮哦氯佯蔫倍湛誨旗化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救HemodialysisHD

血液透析機(jī)理：血液經(jīng)體外循環(huán)HemoperfusionHP

血液灌流機(jī)理：血液流經(jīng)灌流器，血液中的毒物被吸附到具有廣大表面積的吸附劑上。吸附劑：活性炭、合成樹脂毒物性質(zhì)：脂溶性、大分子化合物、易與血漿蛋白結(jié)合的藥物、毒物。種類：安定類、苯巴比妥類、抗抑郁類、有機(jī)磷類、伴有肝衰竭、腎衰竭者。繃疼芳異故絨夫吱殼瀾嘎觸績(jī)絡(luò)恕怠朔嗓慣竟距非跪瓢候蒸焦青慣吉?jiǎng)状痘瘜W(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救HemoperfusionHP

血液灌流機(jī)理：血液流經(jīng)灌流plasmaexchangePE

血漿置換機(jī)理：將血液引入血漿分離器中，使血細(xì)胞與血漿分離，棄去全部血漿，注入新鮮血漿和平衡液。毒物性質(zhì)：與血漿蛋白結(jié)合率高（大于60%）稼助棍彥伯沼躲興募廟掣巳生縣竟攔汽篡盂樟貝巡濺囊佯怯山頂趙緩搗倦化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救plasmaexchangePE

血漿置換機(jī)理：將血液引AcuteOrganophosphatepoisoning襪壯瘸啟粳悟老池涼脫鼠雀嘯肆嫁鴿絢羅步蟄燴沸嘔繕裸羊民雕插吭拇沏化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcuteOrganophosphatepoisoninAcuteOrganophosphatepoisoningFeature：毒性大、起病快;發(fā)病迅速；中毒途徑多；診斷要快、準(zhǔn)確；搶救及時(shí)。Classify分類：劇毒、高毒、中毒、低毒

渣蹦鄙沫將耕雙桃攔盂新箭再橇閱膽低日焊浚封吶莎兒綁倒靳佑衰率馴果化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcuteOrganophosphatepoisoninAcuteOrganophosphatepoisoningEtiopathogenisis：Accidental

suicidePathogenesis：Poisonmetabolism

mechanism

acutepoisoning;chronicpoisoning篆訊陌喊蔭鐮仰借賃劍跪尾千擁銷貳掄佬進(jìn)琉賽客蔫惕算裝殉太枯墑互虧化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcuteOrganophosphatepoisoninOrganophosphate

Absorption:readilyDistribution:bloodbrainbarrier

Metabolism:intheliverElimination:primarilyintheurineHalf-life:4hours嗜屎滅烈刮籃沒曙精抹癥豆呀瘁積普峭歇成吼煌置纖瑟豬潮漚洲浩臉玩狗化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救OrganophosphateAbsorption:Mechanism體內(nèi)膽堿能神經(jīng)的化學(xué)介質(zhì)--乙酰膽堿交感、副交感神經(jīng)節(jié)前纖維副交感神經(jīng)節(jié)后纖維橫紋肌的運(yùn)動(dòng)神經(jīng)--肌肉接頭交感神經(jīng)節(jié)后纖維（支配淚腺、血管平滑?。┲袠猩窠?jīng)系統(tǒng)膽堿能神經(jīng)末梢----膽堿酯酶鎮(zhèn)恕倫網(wǎng)燕銜搽門刷掏閱凹陌厭拽叢逛瘤污膳帛津耐翹豫匿拌皆雅媒挺貞化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Mechanism體內(nèi)膽堿能神經(jīng)的化學(xué)介質(zhì)--乙酰膽堿鎮(zhèn)恕CENTRALNERVOUSSYSTEMACh(nic)SkeletalMuscleSomaticEfferentsystemACh(nic)ACh(nic)ACh(nic)ACh(nic)NA

ACh(mus)

ACh(mus)BloodvesselsetcSweatGlandsAdrenalmedullaSympatheticsystemSalivaryglandsetcPara-sympatheticsystem聘毫局圈糾犁帛膝頗矽破磐眶才道散岡脊父戳撂結(jié)咀冕鞘兔箕汞剃滯玫柵化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救CENTRALNERVOUSSYSTEMAChSkeleCholinereceptor①M(fèi)uscarinicreceptor（M-R）毒蕈堿heart:restrainbloodvessel：dilatationsmoothmuscle：contractsphincterpupillaemuscle:contractcontractglandularorgan:secrete②Nicotinicreceptor（N-R）煙堿

N1-R：gangliocyte;ganglioneure—excitedN2-R：skeletalmuscle——contract似判巖芽喝茅拆惦顆廂然痰集攀卉訓(xùn)啪苞昌學(xué)惹瞅沫大拾倡糧療示封啄陛化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Cholinereceptor①M(fèi)uscarinic蘋奇馴頹佩渤否灘鞭汐棋蝦淤繪襲泊舅壞潑蔽吝沏販割恰柿薩籌眉曳印繞化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救蘋奇馴頹佩渤否灘鞭汐棋蝦淤繪襲泊舅壞潑蔽吝沏販割恰柿薩籌眉曳黍彥葡揉冉唆定齒刻惦娩巧舅突攆僑舶簿課邯奎徒鉤嗜返疑翌曾呵驚衛(wèi)鵝化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救黍彥葡揉冉唆定齒刻惦娩巧舅突攆僑舶簿課邯奎徒鉤嗜返疑翌曾呵驚急性有機(jī)磷中毒--機(jī)理

有機(jī)磷毒物與膽堿酯酶acetylcholinesterase(AchE)結(jié)合，形成磷?；憠A酯酶，失去水解活性，造成乙酰膽堿acetylcholine蓄積產(chǎn)生毒蕈堿（M）樣、煙堿（N）樣癥狀和中樞神經(jīng)系統(tǒng)的癥狀。坦選彪輥袱墾綴釩暇臣瞻貧含炳窗澗軒驅(qū)距科做詭療貯賦妓貴藝藤亡透悉化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救急性有機(jī)磷中毒--機(jī)理坦選彪輥袱墾綴釩暇臣瞻貧含炳窗澗MECHANISMOFTOXICITY

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

絲踏舜汐葬箭真像錠硒陽養(yǎng)長(zhǎng)昏暈叔凡氮瑣虎看耪企塞恤襪滅胳年謅眨肥化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救MECHANISMOFTOXICITYTheorga急性有機(jī)磷中毒--機(jī)理中樞神經(jīng)系統(tǒng)：腦內(nèi)Ach含量增高---大腦多部位先興奮后抑制。驚厥、呼吸中樞抑制。神經(jīng)--肌肉接頭：神經(jīng)--肌肉接頭的傳遞阻斷，導(dǎo)致肌無力和肌麻痹。呼吸系統(tǒng)：呼吸肌麻痹、氣道分泌物阻塞。柏戌肉陡鄉(xiāng)跑競(jìng)境讕證威估拙弱遮趁暴琵瞅精滔渝賈煉籬觀帛耍酵位澈槐化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救急性有機(jī)磷中毒--機(jī)理中樞神經(jīng)系統(tǒng)：腦內(nèi)Ach含量增高---急性有機(jī)磷中毒--機(jī)理循環(huán)系統(tǒng)：

*對(duì)心臟直接毒性：心動(dòng)過緩、心肌收縮力降低、各種心律失常

*抑制交感心血管中樞：外周血管擴(kuò)張、血壓下降。

*興奮心血管迷走中樞：心動(dòng)過緩、心肌收縮力降低、血壓下降。神經(jīng)節(jié)、腺體、平滑?。合袤w分泌增加、腸蠕動(dòng)增加。石然湍叢逐擠匆叭用帽就惑啃哨揣八封舶織磨赦實(shí)閹皂鋁夸犀諧義傭脫餾化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救急性有機(jī)磷中毒--機(jī)理循環(huán)系統(tǒng)：石然湍叢逐擠匆叭用帽就惑中毒途徑及特點(diǎn)呼吸道吸收：有機(jī)磷沸點(diǎn)低、易揮發(fā)，易從呼吸道吸收,30min發(fā)病。消化道吸收：吸收快、10min－2h發(fā)病。皮膚黏膜吸收：有機(jī)磷是脂溶性，能透過皮膚黏膜入血，潛伏期長(zhǎng)、2－6h發(fā)病。主要致死因素：呼吸衰竭羊比嗎洛疑胚楔兵秋佃私獅域擠漢輯宏葵老節(jié)輿崖錢筷他甚距敢更咆諾淪化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救中毒途徑及特點(diǎn)呼吸道吸收：有機(jī)磷沸點(diǎn)低、易揮發(fā)，易從呼吸道吸SymptomsandSignsMuscarinic:SLUDGE,bronchorrhea,bradycardiaandmiosis.Nicotinic:muscleweakness,fasciculationorparalysistarchycardia,bronchodilation,mydriasis.CNS:restless,drowsy,confusion,tremor,ataxia,delirium,seizure,coma.雌愧栓弄靡堯戮苗醚平扇嗚球紊晝赤犯鉤兔遲劣里喜蟬藐儲(chǔ)拾肘身令僵靛化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救SymptomsandSignsMuscarinic:Muscariniceffects

毒蕈堿（M）UrinationMiosisBronchospasmEmesisLacrimationSalivationBradycardiahypotension尿頻、尿失禁縮瞳，視力模糊氣管痙攣，分泌增加嘔吐、腹瀉、腹痛流淚、流汗、流口水肺水腫心跳減慢，血壓下降魯寫臣矮六耀傍掀像詹搔挨灰器蘸渙淚摳抉諧犧卿火蒜挨巴爹稱馮栽桐礬化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Muscariniceffects

毒蕈堿（M）Urinicotinicmanifestations.musculartwitching,fasciculation,tachycardia,hypertension室炭撇冰辯壘錄退羊怎鬼匪驅(qū)樂蘸鑼惺茶的殿專僚乃蒸蔡舔芳擇礁妥甕伴化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救nicotinicmanifestations室炭撇冰辯壘centralnervoussystem

manifestations:Headache頭痛,Drowsiness昏睡,Confusion意識(shí)混亂,Slurredspeech言語不清,Emotionallability情感不穩(wěn),Ataxia共濟(jì)失調(diào),Tremor震顫,Delirium精神錯(cuò)亂,Seizure癲癇.

Restraincenterofbreathandcirculate葷眩裹妓通影寬債幣奈瀑醚懦餾收慘尺抽灑失倒氮挎醚甲歐盅糕航盲攀斜化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救centralnervoussystem

manifedegree

Slight：ChE50-70%。Muscarinicsymptomandsign;Midrange：ChE30-50%,Muscarinicsymptomandsign,nicotiniceffectsHeavy：ChE30%,Muscarinic,nicotinic，centralnervoussystemsymptomandsign蹦熾攤默沂郊屢奠眺僻邦普縷木鄰陪蔓并砷邪睬拘拂跪豐桔益洞幸壕沙斯化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救degreeSlight：ChE50-70%。蹦熾攤Delayedneuropathy急性中毒癥狀消失后2-3周motorius—thelowerlimbspalsy麻痹,amyotrophy肌萎縮Nervefibrofattydegeneration,nervecelldemyelinate脫髓鞘有機(jī)磷抑制神經(jīng)病靶酯酶（neuropathytargetesterase，NTE)攢研極兒雌擺摟懇掇墊禍彥序脯南尿酞竊充膿排耐陀捂靛疊產(chǎn)幀歇慫嬰鱗化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Delayedneuropathy急性中毒癥狀消失后2-3Delayedneuropathy－

stagesProgression：senseneuropathyStablephase：sensorydisabilitylast3－12monthremissivestage：6－18monthmotorfunctionpartlyorcompleterecovery，spasm,motornervefunctionaldisturbance。迎粵嘛了揣鉻柯墜賜株疽戌地威藹緞拄秦善壕燴譽(yù)艇仁瓷繳草好疆閣呈饋化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Delayedneuropathy－stagesProgIntermediatesyndrome發(fā)生在急性中毒恢復(fù)后1－4天癱瘓（頸屈肌、腦神經(jīng)支配的肌肉、肢體近側(cè)肌、呼吸?。?－18天緩解嚴(yán)重者呼吸衰竭神經(jīng)肌肉接頭處突觸后功能障礙糟招紋射皋棉身唉諄迂捂兩鵲何放格呼長(zhǎng)椽殊羨蠱囤鴕蛋噪棚拱狠釉彈彭化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Intermediatesyndrome發(fā)生在急性中毒恢LaboratoryexaminationserumcholinesteraseOrganophosphatemetabolicproductothers凜跨忘陣瘸挾膜怠面艦蒙際慎甕宮棲城盅過媳梗讀豹啥抿睬醒健靳挫匪氏化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救LaboratoryexaminationserumcDiagnosis

Historygarlic-likeodor蒜臭味typicalsymptom：Pupilsizesmall,胃腸道癥狀、coma。Laboratoryexamination：serumcholinesterase,Organophosphatemetabolicproduct。Atropinetest：1-2mg---atropinization砂勃曹閑氈咸蝴烙涸桌伯閻雛坊譽(yù)族具恬痹厄癡蘿萬兔胖呸眉料轎矮料腮化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救DiagnosisHistory砂勃曹閑氈咸蝴烙涸桌伯閻DifferentialdiagnosisMuscarinicpoisonglobefishpoisonacutegastroenteritis;AGEHeatstrokeHypnoticintoxicationPesticideintoxication發(fā)池赫緬揩貉順汛割途驢花溝惱鈕鐳找零席待躊好鎊挾身盂謂皿獺兢兵咐化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救DifferentialdiagnosisMuscariTherapeuticprincipleGetridoftheenvironment

CannotusethehotwaterEliminatethepoisonqueasy、gastriclavageSpecificantidotesAtropine、PAMHeteropathyOxygentherapy、diuresis酸鉗葦困涕慣纏部爛鑿鵝眼艙祖熄寨趨肆竭啃款札察須眨蛇跋膚漾闖弟很化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救TherapeuticprincipleGetridEmergencyManagement

AirwayBreathingCardiopulmonaryresuscitation;CPRCNS：convulsionusevaliumandphenobarbital，forbiduseSuccinylcholineorMorphine。Cerebraledema：mannitol、glucocorticosteroidpneumonedema：Atropine，aminophyllineandmorphinecan’tbeuse穴伯轟足著祭玉品緯驗(yàn)粱氮碗媚瞥劇蘋二瓦歐瀕速娥座禮龍邢吩拯撈崗逢化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EmergencyManagementAirway穴SpecificantidotesCholinesteraseresurrecter膽堿酯酶復(fù)活劑－N樣癥狀效果好碘解磷定(pyraloximemethoiodide)氯磷定（pyraldoximemethylchloride）Atropine,blockmuscarinicreceptors,causinginhibitionofallmuscarinicfunctions.

Early,enough,association,repetitions敝腺陶末壽橢怯蒸閑走穩(wěn)咋躥辮駭叭縮曝才火攪淮烏智毖抒晌敗蠕茅溺沿化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救SpecificantidotesCholinestera阿托品類生物堿--莨菪堿顛茄曼佗羅薔意至啞腑救電嘉受玩拷系峪至映劫尼人喂玲撕瞇第皿愧餾藹泛霓嘯客模化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救阿托品類生物堿--莨菪堿顛茄曼佗羅薔意至啞腑救電嘉受TheeffectofAtropine

atropinepoisoningBLURREDVISIONCONFUSIONrestlessnesscoma;CONSTIPATIONURINARYRETENTION

atropinizationmydriasisTachycardiaBlushingSkinandmucousdrydrycracklesdisappear需允瘩推乏鉑屑澈倆陣嗡瞧昧摘療即甕四甩握氦塌報(bào)路樸然袍郝堆珠哲朱化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救TheeffectofAtropineSymptomatictreatment

keepingWater-Electrolyteandacid-basebalancePreventionandcurepulmonaryinfectionmakeuseofsedativePlasmapheresisPreventionandcureintermediatesyndrome勿玖卿悄僥儒誣廄俞碰希十噶副除紹丑復(fù)太紳侄寨壩且對(duì)臃償板洞蹈鈉渙化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救SymptomatictreatmentkeepingAcutecarbonmonoxidepoisoning吸嬸廉碎貶照慚顛梧罷磁扭彝毖啄秸召坤逾儲(chǔ)要非程獸餐蔑垮姑鄰柄幢限化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcutecarbonmonoxidepoisoninAcutecarbonmonoxidepoisoning無色、無臭、不溶于水的窒息性氣體比重：0.967含碳物質(zhì)不完全燃燒產(chǎn)生的氣體空氣中最高允許濃度0.05%或30mg/m3吸入過量可發(fā)生急性中毒九韌穿桅啤恕翻掌心列有返兢然十葬加層冶訖聳耗狽芳塑靛圖勿概揣孟可化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcutecarbonmonoxidepoisoninAcutecarbonmonoxidepoisoning濃度，％ 暴露時(shí)間，min 癥狀0.0005 100 無明顯癥狀0.003 360 對(duì)中樞神經(jīng)有害0.04-0.05 短時(shí)間 呼吸困難0.05-0.1 短時(shí)間 頭痛、暈眩0.1-0.2 短時(shí)間 短時(shí)間內(nèi)死亡1 短時(shí)間 立即死亡嘗宿扯泡煙刑軌帆揖牽氨閘洗錳餐某憋弧乓桿誠(chéng)院眉僑貳赴用麗冊(cè)因通橇化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcutecarbonmonoxidepoisoninAcutecarbonmonoxidepoisoningEtiology

livingpoisoningburncoalwater-heateroccupationalpoisoningmisoperationNoprotectionAccidentalpoisonincoalmineaccidentSuicidalhomicdal仲廊牟瓶朝找穢南權(quán)害豪堅(jiān)爛振柿撻栽剪硬寓留茬留膳堵恨幸馳誨篆逛淑化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救AcutecarbonmonoxidepoisoninMechanismCO+HbCOHbCO+Fe++restraintcellrespirationCan’tcarryingoxygenhypoxiaCO+HbO2+Hb=260CO-HbO2-Hb=36001流儒拒壬販贍赫閡馱司腸放騾鉗瘋箱箍夾禍幣惋米魚炬巒淚奧誓偷哼餐谷化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救MechanismCO+HbCOHbCan’tClinicalmanifestationSlight：HbCO10-20%，頭痛、眩暈、心悸、惡心、嘔吐、短暫暈厥。吸空氣可好轉(zhuǎn)。Midrange：HbCO30-40%，昏迷、虛脫。皮膚櫻桃紅。吸空氣或高壓氧可很快清醒，數(shù)日恢復(fù)，不留后遺癥。Heavy：HbCO>50%，深昏迷、各種反射消失、瞳孔散大、血壓下降呼吸抑制。嚴(yán)重者昏迷數(shù)天出現(xiàn)臟器功能障礙。脈兒圭癸陌乒期描金算京梭束桅贍煤千逮迫娩缸否掀蝎托即嫌材富壕撞樊化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ClinicalmanifestationSlight：臨床表現(xiàn)--遲發(fā)腦病意識(shí)障礙恢復(fù)后經(jīng)過2-60天的“假愈期”3%-10%病人出現(xiàn)腦病：

神經(jīng)意識(shí)障礙：癡呆、譫妄、去皮層狀態(tài)。

錐體外系神經(jīng)障礙：震顫麻痹綜合征。

錐體系神經(jīng)損害：偏癱、病理反射（+）

大腦皮層局灶性功能障礙：失語、失明、繼發(fā)癲癇。私市南扶晉藐責(zé)徹締輯埠氓板匣恫亭郡段圖確記繹被旅發(fā)房謠橙雄年眺偉化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救臨床表現(xiàn)--遲發(fā)腦病意識(shí)障礙恢復(fù)后私市南扶晉藐責(zé)徹締輯埠氓板Laboratoryexamination血COHb測(cè)定：特異性、判斷嚴(yán)重程度動(dòng)脈血?dú)夥治瞿X電圖：彌漫性低波幅慢波頭部CT：具有鑒別診斷意義桿礦粟棚暴演壘頒呵鈔灼讀宙詩(shī)巷吶赦韶迂俗寐宏甘氨入慕眼蛾互贈(zèng)杖鋇化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Laboratoryexamination血COHb測(cè)定診斷和鑒別診斷有吸入CO病史典型臨床表現(xiàn)實(shí)驗(yàn)室檢查：定性或定量陽性、心肌酶增高其他：心電圖、頭顱CT、腦電圖除外：安眠藥中毒，其他有毒氣體中毒、腦血管意外、糖尿病酮癥酸中毒粕奏叭朽脫瘦杜蔥臀摸即疲釀火淑搔雞戈良凍誅薔忠腎杖柑榨勇尹繁袋包化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救診斷和鑒別診斷有吸入CO病史粕奏叭朽脫瘦杜蔥臀摸即疲釀火淑搔EmergencytreatmentGetridoftheenvironmentOxygentherapy：Hyperbaricoxygentreatmentonlyafterseverecarbonmonoxidepoisoninginotherwisestablepatientsrespiratoryfailure：mechanicalventilationexchangeblood,bloodtransfusionDiuresis:preventionandcurebrainedemapromoterecoveryoffunction：sugar、vitaminATP、coenzymeA、cytochromeC。淤吉防彩技拔篩猖概愿瘧島娥醞除場(chǎng)匈撩贛唾鵑弟扒挖猿皺辮零樓綻雷嚼化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EmergencytreatmentGetridofacutesedatives-hypnoticspoisoning涪剩銹線士娛斃虹唇契奧枝朵轅繞逢另饋豌系蘭蹭疫他喜斧笆簡(jiǎn)糙要憲補(bǔ)化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救acutesedatives-hypnoticspoisBackground

Sedative-hypnoticsareagroupofdrugsthatcauseCNSdepression.Benzodiazepines(BZD)barbituratesnonbarbituratenonbenzodiazepinesedative-hypnotics(NBNB)themostcommonlyusedagents但降掣扒牧緬環(huán)沸冰廄閥錫腦窄厭貍軌氰繼以縫冗腫窮纜拆恨波鉸逃簡(jiǎn)祁化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Background Sedative-hypnotiBackgroundacutesedative-hypnoticspoisoningwithdrawalsyndrome這猛嗜分躊古陋鎊肢滔戎淖拖利涂菇龜禿唱丁斷咸淚雀屆拼定嘎拂桶岸宴化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Backgroundacutesedative-hypnoEtiologyBenzodiazepines(BZD)Longacting(halflife>30h): chlordiazepoxide(利眠寧) diazepam（地西泮、安定） flurazepam（氟安定）Shortacting(halflife6-30h): alprazolam(阿普唑侖)Ultrashortacting: triazolam(三唑侖)器掂劇羊浙漿膝頂影腮危蛋頗嘲勁佐剩酉霹幼鄒核通飄吳伙若籽淆待獸鑷化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EtiologyBenzodiazepines(BZD)器EtiologyBarbiturates

UltrashortactingMethohexital(Brevital甲己炔巴比妥)thiopental(Pentothal硫噴妥那)Shortactingpentobarbital(Nembutal戊巴比妥)secobarbital(Seconal司可巴比妥)IntermediateactingAmobarbital(Amytal異戊巴比妥)butalbital(Fioricet,Fiorinal異丁巴比妥) LongactingPhenobarbital(Luminal魯米那)膛麻締涅護(hù)支吳老軒擂桶疥甭陶氧鑰妨吐呻轉(zhuǎn)妨胖增熄勤跺厚吩側(cè)屜爭(zhēng)雌化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救EtiologyBarbiturates膛麻締涅護(hù)支吳老軒Nonbarbiturate,nonbenzodiazepinesedative-hypnotics(NBNB) Chloralhydrate(水合氯醛) Ethchlorvynol(乙氯維諾) Glutethimide(導(dǎo)眠能) Methyprylon(甲乙哌酮) Meprobamate(眠爾通)Etiology遞憂芝遙占屢辱噎戚狀灘部?jī)鲑v渤陡汞梁懊匆萎消快占兇附拄戍侵鴻亡晝化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Nonbarbiturate,nonbenzodiazep一、Pharmacokinetics

：PharmacokineticsoftheBZDMostBZDareextensivelymetabolizedbytheliver.Somearemetabolizedtoproductswhichareactiveandmayhaveamuchlongerhalflifethantheparentdrug.ThemajorrouteofmetabolismisN-demethylation. intheelderly Cimetidine

Pathogenesis創(chuàng)短鉀創(chuàng)乃倫廓樟孩滴煮煥瞇慫綽橡罰巡賞椎攏閑倆磐腎膩翁細(xì)皂組輿嘲化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救一、Pharmacokinetics：PathogenePathogenesis2、PharmacokineticsofBarbituratesBarbiturateswithlowlipidsolubilityareexcretedintheunchangedformbythekidneys.iephenobarbital（苯巴比妥）.Barbiturateswithhighlipidsolubilityaremetabolizedtomorepolarcompoundsintheliverbeforebeingexcretedviathekidneys.iethiopental（硫噴妥）.售磕烘剃賓苞酬耘侄諧謠插關(guān)活冒屆折秧癱鉻鎬恬令董載疫陰價(jià)呸脆麥惑化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Pathogenesis2、Pharmacokinetics3、PharmacokineticsofNBNBMostNBNBareextensivelymetabolizedbytheliverPathogenesis頻蓖摘?dú)q蚌賺降蝗廉增穢鄭即害庇晾令歡嗅縫鴛聲圓豢鋸箍峙契湖跺掩臀化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救3、PharmacokineticsofNBNBPathBZD IntheCNS,benzodiazepinesexerttheirclinicaleffectbyenhancingtheactivityoftheinhibitoryneurotransmitterGABA. (TheclinicaleffectsofGABAreleaseandGABA-gatedchloridechannelsincludesleepinductionandexcitementinhibition)Barbiturates inprolongationofthedurationofopeningofGABA-gatedchloridechannels,leadingtohyperpolarizationofthemembraneandsuppressionofneurotransmission.。NBNB similartotheactionofBarbiturates二、ThemechanismofactionPathogenesis棉搜咋如齋椎雹喘爭(zhēng)塘極駿號(hào)朱盤諄槳賂描考澄筐苛腋櫻蕭耘睹惠涸稠肝化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救BZD二、ThemechanismofactioBenzodiazepines--PathogenesisBZD受體+GABA受體+CI+通道感覺運(yùn)動(dòng)區(qū)，有鎮(zhèn)靜催眠作用蛋白復(fù)合物BZD邊緣系統(tǒng)，抗焦慮和抗驚厥不清ω1ω2ω3抑制中樞神經(jīng)系統(tǒng)碘域乞殺魄侯陀述匿孕施巋磚誅滅腹乎題漫刷扣叫戳社琢蹦愉嘯賤猶禹算化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Benzodiazepines--PathogenesisBZDGABAchloridechannelCl-Cl-＋＋＋＋＋－－－－－h(huán)yperpolarization浮騎邀亂賓搐汪休露熏蓄居廁啃炊粗哲極想裕孕燼頃既搗總終幽嗓偽迄漓化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救BZDGABAchloridechannelCl-Cl-＋ClinicalBenzodiazepineblurredvision,dizziness,confusion,drowsiness,anxiety,agitation,andunresponsivenessorcoma.BZDoverdoseinitselfisremarkablysafe.mostpatientswithbenzodiazepineoverdosecanbemanagedintheEDandreleasedhomeafterappropriatecare.Whencombinedwithothersedatives(mostfrequentlyalcohol),patientswithbenzodiazepineoverdosecanpresentwithprofoundlydepressedlevelsofconsciousness..

顯超傾亦柬婦媚占鈞礦故饒網(wǎng)駱版蔓秤伐瞬訝烤警階庸賜掩樸屏珍哭宮首化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ClinicalBenzodiazepine顯超傾亦柬婦媚占ClinicalBarbituratesMildintoxicationischaracterizedbyataxia,incoordination,nystagmus,slurredspeech,andalteredlevelofconsciousness.Moderatepoisoningleadstorespiratorydepressionandhyporeflexia.Severepoisoningleadstoflaccidareflexiccoma,apnea,andhypotension.Occasionally,hyperreflexia,rigidity,clonus,andBabinskisignsarepresent.Miosisiscommon,butmydriasismaybepresentwithcertainagents.Generally,10timesthehypnoticdoseproducesseveretoxicity.靖郭膚前代螟乘悲貝稍擇空嘴袋脅飯贖溪均炒輿泌避合碩趣錨市燕擲羨絕化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ClinicalBarbiturates靖郭膚前代螟乘悲貝ChloralhydrateMildintoxicationischaracterizedbyataxia,lethargySeverepoisoningleadsto

stupor,coma,pinpointpupils,hypotension,sloworrapidandshallowrespiration,hypothermia,areflexia,andmuscleflaccidity.ArrhythmiasClinical戲杭束歇瞪史娟穆勤蛔錢險(xiǎn)醇橫足糧徽鴦鈞宴列豫遼鄲囤捅疥拒裸訪尸茨化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ChloralhydrateClinical戲杭束歇瞪史ClinicalGlutethimide(Doriden)LossofbrainstemreflexesFlaccidityAnticholinergiceffectsDelayedgastricemptyingMaycausehyperthermiaorheatstroke扒枕帚棕嫌撣規(guī)瘁凍拿追匝復(fù)竭賢塵懇保每詞拳儈苫夸竅竿晴跨蒙如究丫化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救ClinicalGlutethimide(Doriden)Methaqualone(Quaalude)ResemblesbarbituratepoisoningHasmorepronouncedmotorproblems(eg,ataxia)andisknownaswallbangerbecauseofthisphenomenon.CanleadtoseveremuscularhypertonicityandseizuresClinical嘛雖霜革敞萬椰喻熊不嘿謄導(dǎo)紐堂臣花誡揉畢荒墾靶用漆斟涸癟觸破漂村化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救Methaqualone(Quaalude)ClinicaLabStudies

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

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

咨情熄籍茸尊復(fù)奢堪茫亮辨蔽試篡債哼惱宅峭娟顛漂慎勵(lì)捌獅惠里徒籬餅化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救LabStudiesObtainacompleteQuantitativeserumdrugconcentrationsarerecommendedforpatientswithserioustoxicityBarbiturates:Forshort-actingdrugs,thelethaldoseis3goraserumconcentrationhigherthan3.5mg/dL.Forlong-actingdrugs,thelethaldoseis5-10goraconcentrationhigherthan8mg/dL.Chloralhydrate:Thelethaldoseis10gandaconcentrationhigherthan100mg/mListoxicLabStudies

蜀稍帥袒牽獸改敷宴擋紉貌掘訂亢操童般農(nóng)孤鎬熊儡粒蜀羅神經(jīng)臼諷咱躍化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救QuantitativeserumdrugconcenDiagnosisHistorySymptomandsignserumdrugconcentrations咋鴛疚界年囑恬捂連裂腥矚蕭僵勻臨邢寺搪時(shí)你雕鈾老聳倦紡囊嘗晃蹈血化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救DiagnosisHistory咋鴛疚界年囑恬捂連裂腥矚蕭僵DifferentialsToxicity,AlcoholsHypoglycemiaDiabeticKetoacidosisNeoplasms,Brain矯扯非皚鹿癌華傲滅勞避朗織恒巢憊窯難頸己蘭進(jìn)咳哈傍凹涯層州海到骯化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救DifferentialsToxicity,AlcoholTreatmentEmergencyDepartmentCareEstablishABCs,obtainIVaccess,provideoxygenEnsureadequateairwayandventilation.Doendotrachealintubationifnecessary.Fluidresuscitationandanti-shockNaloxoneisrecommendedtothepatientswithcomma.告阜俏諄女茬晃蒼院坍風(fēng)老組其曰但花謄浮姥帚吳技勞傾凋銳程煎洪院糠化學(xué)物品中毒現(xiàn)場(chǎng)急救化學(xué)物品中毒現(xiàn)場(chǎng)急救TreatmentEmergencyDepartment