First aid and medication of common pesticide poisoning--organic nitrogen pesticide poisoning

Organic nitrogen pesticides are mainly used to control pests of rice, cotton, fruit trees and other plants, and are widely used in rural areas
.
Commonly used organic nitrogen insecticides include mitamidine, mitamidine, amitamidine (mite), and debenzamidine
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Insectamidine and its metabolites can turn normal hemoglobin in the body into methaemoglobin, leading to hypoxia in tissues and organs.
Because of its chemical structure similar to lidocaine, the clinical manifestation is lethargy; it is mainly excreted through the kidneys and can damage the urinary tract mucosa.
, Hemorrhagic bladder damage, etc.
; inhibited the activity of monoamine oxidase, leading to cerebral edema, increased intracranial pressure, and the patient was in a coma
.
[Clinical manifestations and diagnosis points] 1.
The main clinical manifestations are drowsiness, cyanosis, and hemorrhagic cystitis
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(1) nervous system symptoms of dizziness, fatigue, drowsiness or lethargy, ataxia, trance, slurred speech, slow reactions, ranging from large pupils, apnea
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(2) Methemoglobinemia? Cyanosis of the lips, nose tip, and extremities; but the shortness of breath is not significant, and it is easy to be misdiagnosed as nitrite poisoning
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(3) Hemorrhagic cystitis is more common when symptoms such as frequent urination, urgency, dysuria, hematuria, proteinuria, etc.
appear 1 to 2 days after poisoning, and there is no tubular urine under microscope
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(4) Cardiovascular manifestations include low blunt heart sounds, slower heart rate, lower blood pressure, and prolonged ECG QT interval
.
2.
Determination of 4-chloro-o-toluidine in the urine can assist in the diagnosis and indicate the degree of poisoning; 4 to 8 hours after poisoning, denatured globin bodies are produced in the blood for 3 to 7 days.
A positive person can prompt the diagnosis, but there is no specificity
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[Prevention measures and medication] 1.
Get out of the poisoned environment
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Wash the poison and remove the contaminated clothing immediately
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Wash skin with soap and water
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For oral poisoning, 2% sodium bicarbonate can be used for repeated gastric lavage, and then 50ml of 33% magnesium sulfate can be used for catharsis
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2.
? Methylene blue (Melanine) detoxification
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①Slightly intoxicated (the concentration of methaemoglobin in the blood is less than 30%), methylene blue is added to hypertonic glucose injection at 1 mg/kg for slow intravenous injection
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②Severely poisoned patients (the concentration of methaemoglobin in the blood is 60% ~ 70%), methylene blue is added to hypertonic glucose injection at 2 mg/kg and slowly injected intravenously, if necessary, it can be used repeatedly for 2 to 3 hours, but the total amount of 24 hours is not suitable More than 600mg
.
3.
Symptomatic treatment
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① Those with signs of cerebral edema should be intubated or incised as soon as possible, administer medication, and provide mechanical oxygen if necessary
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②The rapid intravenous drip of 250ml of 20% mannitol injection reduces intracranial hypertension
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③Apply glucocorticoids as appropriate, such as dexamethasone, hydrocortisone, and even methylprednisolone
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④For patients with hemorrhagic bladder damage, sulfetamide, carbachol and other drugs can be used to stop the bleeding
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⑤ Use antibiotics as appropriate to prevent infection
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⑥ To accelerate the oxidation and excretion of poisons, 10% glucose injection and vitamin C can be injected intravenously, and alkaline solution is added to alkalinize the urine and accelerate the excretion of poisons
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⑦In the event of peripheral circulatory failure, cold limbs, etc.
, atropine sulfate or scopolamine hydrobromide (654-2) can be given intravenously
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