Severe dehydration usually occurs before death.

In addition, develops hyperhidrosis of the skin of the feet and palms, blepharitis, nail destruction, hair loss.

Hepatotropy is a characteristic feature of dioxin. After a short period after the poison enters the body, functional tests indicate a deterioration in the excretory properties of the liver. The cellular immune response is suppressed. Toxic hepatitis, polyneuritis, cardiovascular and renal failure can occur on days 14-20. Depression-like changes are more common in the CNS.

This poison is most characterized by carcinogenic, mutagenic and teratogenic effects. Thus, during the disease the affected lose up to a third of body weight. This is facilitated by severe anorexia, a sharp reduction in water consumption. Severe dehydration usually occurs before death. In the blood plasma of poisoned a sharp decrease in the amount of protein. A characteristic sign of intoxication is edema, mainly subcutaneous localization, but part of the fluid is found in the abdomen, chest and pericardium. Fluid leakage may be accompanied by moderate pulmonary edema.

Another feature of toxic action is the presence of a "delayed effect" when the symptoms of the lesion may develop several years after exposure to the poison, and the manifestations of the disease are similar to the symptoms of the acute phase of intoxication.

General principles of treatment:

Treatment is symptomatic.

Personal protective equipment – filter gas masks, respirators, skin protection.

Effective dioxin degassing agents have not been developed.

Thus, the high toxic properties of SDOR, considered in this matter, require from us a clear knowledge of the peculiarities of the formation of foci of chemical contamination in the destruction of HNO, which are necessary for a set of measures to eliminate the consequences of accidents on HNO.

Organization of medical care at EME

The clinic of SDOR lesions is characterized by polysyndrome, which complicates nosological diagnosis and choice of antidote therapy.

However, the syndromic principle of poisoning diagnosis in combination with the data of early prognosis and medical intelligence, even in the absence of results of poison indication, is leading in the organization of medical care and determines the content of emergency care in case of mass influx of victims.

Today, the organization of medical care for victims of emergencies caused by the release of SDOR is based on a two-stage system of medical and evacuation measures with evacuation by appointment. Its essence is to provide first aid to the victims in preparation for their evacuation to inpatient facilities.

The first stage is the provision of first aid, first aid to the affected. Medical care is provided by rescuers, ambulance crews, specialized emergency crews and specialists in disaster medicine units in appropriate amounts.

The second stage is the provision of qualified medical care and treatment in specialized medical institutions to the end result.

In an emergency, much depends on sorting, especially with a large number of victims and under the influence of several SDOR. The principle of sorting is to divide the affected into groups, based on the need for uniform treatment and evacuation measures.

When sorting, the following categories of victims are distinguished:

1 – affected, who need to be provided only one-time assistance (category of lightly injured); 2 – who received non-life-threatening lesions and need hospital treatment (moderate); 3 – with life-threatening lesions that require emergency medical care (severely injured).

Elimination of manifestations of intoxication and related disorders of homeostasis is carried out by influencing the various levels of its regulation by means and methods of etiotropic, pathogenetic and symptomatic therapy in both toxicogenic and somatogenous stages of poisoning.

There are 3 phases when the medical service should be involved.

The first phase (lasting up to 30 minutes) – after direct contact of people with the toxicant. It is necessary to remove the victims from the chemical focus, decontamination and emergency symptomatic treatment aimed at eliminating disorders of vital functions (pulmonary edema, laryngeal and bronchospasm, etc.).

The second phase (hours): – providing special medical care, taking into account information about the nature of the toxicant, the possibility of antidote therapy; in the presence of a latent period, the use of preventive treatment is possible.

The third phase (days, weeks) – rehabilitation, taking into account the nature of the poison.

The first phase is carried out in the prehospital, and the second and, in part, the third phase of treatment – in the hospital stages.

According to modern ideas it is necessary to consider the following directions of treatment of poisonings:

cessation of local action of the poison and its subsequent resorption; forced excretion of poison from the body; use of specific antidotes (antidotes); maintenance of vital functions of the body, sustainability of the internal environment; elimination of pathological changes on the part of individual organs and systems; prevention of complications and their treatment.

Priority measures include measures aimed at stopping the local action of the poison and its resorption through the use of individual means of protection, exit (removal) of victims outside the infected area, sanitation. The use of a wide range of pathogenetic and symptomatic drugs is indicated for severe pain, acute respiratory and cardiovascular failure, coma, psychomotor agitation, convulsions, which are often observed directly in the lesions. Poison can be removed from the blood by stimulating natural excretory processes (forced diuresis and hyperventilation).

Among the syndromes, one of the leading is central nervous system dysfunction, which is most often manifested by disorders of consciousness (somnalence, convulsions, coma, acute psychosis), generalized convulsions and hyperthermia, which develop due to neurotropic effects of poisons, hypoxia, central hemodynamic disorders, cerebral edema.

The measures of pathogenetic and symptomatic therapy, with such disorders include:

prevention of mechanical injuries (at spasms, psychomotor collectionJenny); prevention and elimination of acute respiratory failure of central and aspiration genesis; introduction of drugs that improve brain metabolism and the state of central hemodynamics; with cerebral edema, it is advisable to give an elevated body position, a bubble with ice on the head, diuretics, glucocorticoids, lumbar puncture according to the indications, artificial lung ventilation; at spasms, psychomotor excitement appoint diazepam, sodium oxybutyrate.

Dysfunction of external respiration under the influence of SDOR can be manifested by respiratory tract irritation, aspiration-obstructive and restrictive syndromes. At the phenomena of irritation of the upper respiratory tract introduction of codeine, euphylline, antihistamines is shown.

Restrictive syndrome (pulmonary form of acute respiratory failure) in affected SDOR, caused mainly by toxic edema or burn of the lungs, which may develop in the near future after exposure to a toxic substance, regardless of the phenomena that occur during reflex reactions.

Usually the beginning of pulmonary edema is considered to be the appearance of more or less pronounced clinical symptoms. However, interstitial edema of the intermediate tissue, which leads to hypoxia, is histologically determined in the first minutes after exposure to the toxicant. Less often, the restrictive syndrome, which occurs against the background of shock, due to the development of the so-called shock lung.

In this regard, the currently developed set of therapeutic measures for the treatment of victims of exposure to toxic substances of irritating and mixed action primarily involves:

the victim with a semi-sitting position; elimination of respiratory tract irritation; restoration of airway patency and, in particular, elimination of bronchospasm; prevention and correction of oxygen starvation; normalization of the cardiovascular system and kidneys; correction of water-electrolyte homeostasis, oxygen-alkaline state, etc.

To perform these tasks, oxygen therapy, bronchodilators, antihistamines, glucocorticoids, sedatives, antifoams, diuretics, cardiota vasotonics are widely used in medical practice; in severe cases, bloodletting, tracheostomy, etc. are performed.

In addition to the above syndromes in poisoning by some SDOR (benzene, toluene, bromomethyl) may damage the parenchymal organs – liver and kidneys. Frequent manifestations of inhalation poisoning by industrial poisons also include gastrointestinal disorders. In most cases, these are functional disorders of the stomach, accompanied by dyspepsia and vomiting (mostly recurrent).

In severe forms of SDOR lesions, there may be serious violations of water-electrolyte balance, oxygen-alkaline state, hemocoagulation (such as disseminated intravascular coagulation syndrome), the correction of which is carried out in accordance with the general principles of intensive care.

The organization of staged treatment of toxic substances of irritating and mixed action, which cause pulmonary edema, is based on the following provisions:

victims, regardless of condition, should be considered as stretcher patients; at all stages of evacuation warming of victims should be provided (wrapping, hot-water bottles, warm drink); evacuation of victims to an inpatient medical institution should be carried out no later than three hours after contact with the toxicant; affected in a state of severe pulmonary edema with severe respiratory and cardiovascular disorders are untransportable; all persons who were in the center of defeat by toxicants of this group, should be observed (for one day) then, in the absence of the phenomena of intoxication, can be considered practically healthy.

First of all, the indications for emergency therapy for poisoning by toxic substances of irritating and mixed action are:

asphyxia, which occurs during reflex reactions due to spasm of the glottis and bronchi, as well as the development of swelling of the tissues of the larynx and vocal muscles and leads to hypoxic hypoxia; clinical manifestations of toxic pulmonary edema, which are accompanied by the development of first hypoxic, and then – circulatory and tissue hypoxia.

The organization and provision of medical care in emergencies is the main part of the doctor’s activity and since various medical units, units and institutions of both the Armed Forces (AF) and civil defense formations (CA) will be involved in the elimination of the consequences of HNO destruction, it is important to study these issues. for doctors of all professions.