Most critically ill patients is unknown substance that causes a poisoning. In many respects it complicates the choice of optimal therapy. And so to all patients with acute poisoning admitted to the intensive care unit, you must:
- Catheterization or puncture a vein for infusion therapy;
- To introduce a permanent catheter into the bladder;
- A probe into the stomach.
Blood, urine and stomach contents (wash waters) immediately sent to the laboratory that conducts a chemical investigation. After determining of the toxicity drugs becomes possible introduction of antidotes. But this is only part of the therapeutic measures which are carried out in the treatment of acute poisoning.
Removing toxic substances from the body
1. Gastric lavage through a tube is performed in all cases, even if after the poisoning has passed 8-10 h. After the introduction of a thick gastric tube sucked off a small amount of content for a chemical analysis. Washing is carried out with plenty of water (10-15 liters) at room temperature, thus preventing possible chemical reactions with an unknown poison.
2. Forced diuresis – achieved by introducing a large amount of fluid and the appointment of diuretics. Within an hour, is transfused 2 liters of liquid (5% glucose solution, isotonic sodium chloride solution) is then introduced diuretics. After administration of diuretics continue infusion therapy with solutions containing electrolytes. In total, the volume of introduced fluid is 3-5 liters.
At carrying out of this method is possible to achieve a the volume of of urination up to 600-1000 ml of urine per hour, which promotes the excretion of toxic substances from the body, and prevents the development of acute renal failure.
The method is contraindicated in cardiovascular disease and impaired renal function. It is necessary to control the content of electrolyte (potassium, sodium, calcium) in the blood since as forced diuresis accompanied by a considerable excretion of electrolytes with urine.
3. Peritoneal Dialysis – Introduction antidotes.
4. Extracorporeal hemodialysis with the help of apparatus “artificial kidney”. Principle – the selective penetration of substances through a semipermeable membrane (cellophane).
5. Hemosorption – perfusion of blood through activated carbon or other sorbents followed by sorption of toxic substances.
- Maintaining of functions body, which selectively is affected from this toxic drug.
- Implementation of of reanimation measures, if necessary (in case of poisoning nitrogen oxides and phosgene occurs a toxic pulmonary edema, with antifreeze poisoning, mercuric chloride, acetic essence may Is developed a acute renal failure; in case of poisoning quinacrine, mushrooms – arises toxic hepatitis).