化学物品中毒现场急救课件.ppt

Contents,Background General introduction Acute Organophosphate poisoningAcute carbon monoxide poisoningAcute sedatives-hypnotics poisoningAlcohol Intoxication /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,Background,There are about 9000000 kinds of chemiclaPeople have many opportunity to touch with poison,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,Background There are about 900,Background,There are 1751476 poisoning pts in USA in 1993Poison control center(PCC) is established in Chicago 1953。Major duty: component of poison; 4.informationDangerous 5. toxicologyfirst aid 6. general knowledge of preservation,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,BackgroundThere are 1751476 po,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,Background,Countryside city。Countryside-pesticide intoxication。City-food-poisoning, carbon monoxide poisoning ,Hypnotic intoxication。Establish PCC in Beijing,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。,What is poison?,A poison is anything someone eats ( ingestion), breathes (inhalation) , gets in the eyes (ocular exposure), or on the skin (dermal exposure) ,that can cause sickness or death if it gets into body or on the body. Poison can be found in four forms: solid, liquid, spray and gas.,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,What is poison?A poison is an,General introduction,toxic substance : drug ,chemical , bad food and so on.Acute poisoning：short time， large doseChronic poisoning ：long time、 small dose,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,General introductiontoxic subs,Etiopathogenisis and pathogenesy,Cause of a poisoning Occupational poisoningLife poisoningAccidental poisoning , 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,Etiopathogenisis and pathogen,Pathogenesy-Absorption,By mouth; inhalation （Powder dust、smoke、steam）, skin mucosa, muscle or intravenous injectionRectum 、 urinary canal、female sheath vagina、bladder、peritoneum、eyeInsect stings or bite,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-Absorption By mo,Pathogenesis - metabolism,spread all over body by blood liver metabolism,Poisonousness,Poisonousness,Oxidation,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 - metabolismspre,Pathogenesis - Eliminate,breathe out by respiratory tract（gas，volatile matter）Discharge by kidneyDischarge by alimentary tractSkin Milk,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 - Eliminatebrea,1.Local effect,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.Local effect强酸、强碱吸收组织水分与蛋白质,2.Hypoxia,Inhibition respiratory function：Change blood constituentInhibition cells respiratory ：cyanide，hydrogen sulfideDestroy Cardiovascular function,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.Hypoxia Inhibition respirato,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.Inhibitory enzyme activity,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+,Organophosphate poisoning，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Carbon tetrachloride poisoning，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,Organophosphate poisoning，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.Competition receptor,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.Interfere cell or organella physiologic function,carbon tetrachloride（CCl4）CHCl3（trichlormethane)肝细胞膜中的unsaturated fatty acidlipid peroxidationmitochondria(线粒体)、endoplasmic reticulum(内质网)变性hepatocyte(肝细胞)deathPhenols(酚类)线粒体内oxidative phosphorylation(氧化磷酸化) uncoupling(解偶联)inhibiting adenosine triphosphate(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.Interfere cell or organella,The factor of influence toxic action,Physico-chemical property of poison fine particle,solubility,evaporabilitySusceptibility of individual sex,age, nutrition, health status, living habit,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,The factor of influence toxic,Diagnosis poisoning,HistorySign and symptom conscious state breathing heart rate blood pressure pupil, 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,Diagnosis poisoningHistory逐塑哪,Laboratory examination,Detection of poison: blood, gastric juice and urineBlood ,urine examination,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,Laboratory examinationDetecti,Therapeutic principle,CPRGet rid of the environmentDecrease AbsorptionSpecific antidotes Cleaning poison in gastrointestinal tractHeteropathyPrevent Complication,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,Therapeutic principleCPR踢饼促月突,Emergent management,Breathing support Circulation supportTreatment comaTreatment convulsion,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,Emergent managementBreathing,SPECIFIC ANTIDOTES,Orgnaophosphorus -Pralidoxime Iodide，AtropineBenzodiazepinesFlumazenilPain -killerNaloxoneIsoniazidvitamin B6,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,SPECIFIC ANTIDOTESOrgnaophosph,Eliminate poison,Emetic Gastric lavageActivated carbon adsorptionCatharsis Whole-bowel irrigation,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,Eliminate poisonEmetic 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,Purpose of Gastric lavage,Eliminate poison in gastric, prevent absorbPreparation for operation or some examination,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,Purpose of Gastric lavageElim,Indication and contraindication,Indication Non-corrosive poisonContraindication Corrosive poisonstrong acid ,baseesophageal varix, aneurysm of aortaSevere heart disease，upper gastrointestinal bleeding，gastric perforation,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,Indication and contraindicatio,Principle of gastric lavage,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,Principle of gastric lavage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,Catharsis and Whole-bowel irrigation,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,Catharsis and Whole-bowel irri,Eliminate poison,Forced diuresis 强化利尿Blood purification（血液净化） hemodialysis HD（血液透析） hemoperfusion,HP（血液灌流） plasma exchange PE（血浆置换）High pressure oxygen 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,Eliminate poisonForced diures,Hemodialysis HD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、heavy metals, 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,Hemodialysis HD血液透析机理：血液经体外循环,Hemoperfusion HP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,Hemoperfusion HP血液灌流机理：血液流经灌流,lasma exchange PE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,lasma exchange PE血浆置换机理：将血液引,Acute Organophosphate poisoning,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,Acute Organophosphate poisonin,Acute Organophosphate poisoning,Feature ：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,Acute Organophosphate poisonin,Acute Organophosphate poisoning,Etiopathogenisis ：Accidental suicidePathogenesis ： Poison metabolism mechanism,acute poisoning;chronic poisoning,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,Acute Organophosphate poisonin,Organophosphate,Absorption: readily Distribution: blood brain barrier Metabolism: in the liver Elimination: primarily in the urine Half-life : 4 hours,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,Organophosphate Absorption:,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,CENTRAL NERVOUS SYSTEM,ACh(nic),Skeletal Muscle,Somatic Efferent system,ACh(nic),ACh(nic),ACh(nic),ACh(nic),NA,ACh(mus),ACh(mus),Blood vessels etcSweat GlandsAdrenal medulla,Sympathetic system,Salivary glandsetc,Para-sympathetic system,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,CENTRAL NERVOUS SYSTEMAChSkele,Choline receptor, Muscarinic receptor（M-R）毒蕈碱 heart : restrainblood vessel：dilatation smooth muscle：contractsphincter pupillae muscle: contractcontractglandular organ:secrete Nicotinic receptor（N-R） 烟碱N1-R：gangliocyte;ganglioneureexcited N2-R：skeletal musclecontract,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,Choline receptor Muscarinic,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,MECHANISM OF TOXICITY,The organophosphates are powerful inhibitors of carboxylic ester hydrolases, including acetylcholinesterase (found in nervous tissues and erythrocytes) and butyrylcholinesterase (plasma or pseudocholinesterase). As a result of this enzyme inhibition, the substrate acetylcholine accumulates,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,MECHANISM OF TOXICITY The orga,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、10min2h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、26h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,Symptoms and Signs,Muscarinic: SLUDGE, bronchorrhea, bradycardia and miosis.Nicotinic: muscle weakness, fasciculation or paralysis tarchycardia, 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,Symptoms and SignsMuscarinic:,Muscarinic effects 毒蕈碱（M）,UrinationMiosisBronchospasmEmesisLacrimationSalivationBradycardia hypotension,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,Muscarinic effects 毒蕈碱（M）Uri,nicotinic manifestations,.muscular twitching, 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,nicotinic manifestations室炭撇冰辩垒,central nervous system manifestations:,Headache头痛, Drowsiness 昏睡, Confusion 意识混乱, Slurred speech言语不清,Emotional lability 情感不稳,Ataxia 共济失调, Tremor 震颤, Delirium 精神错乱, Seizure 癫痫. Restrain center of breath and circulate,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,central nervous system manife,degree,Slight ：ChE 50-70%。 Muscarinic symptom and sign;Midrange ： ChE 30-50%, Muscarinic symptom and sign, nicotinic effectsHeavy： ChE 30%, Muscarinic, nicotinic ，central nervous system symptom and sign,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,degree Slight ：ChE 50-70%。蹦炽摊,Delayed neuropathy,急性中毒症状消失后2-3周motoriusthe lower limbs palsy麻痹, amyotrophy肌萎缩Nerve fibrofatty degeneration, nerve cell demyelinate脱髓鞘有机磷抑制神经病靶酯酶（neuropathy target esterase ，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,Delayed neuropathy急性中毒症状消失后2-3,Delayed neuropathy stages,Progression ：sense neuropathyStable phase：sensory disability last 312 monthremissive stage ：618 month motor function partly or complete recovery，spasm, motor nerve functional disturbance。,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,Delayed neuropathy stagesProg,Intermediate syndrome,发生在急性中毒恢复后14天瘫痪（颈屈肌、脑神经支配的肌肉、肢体近侧肌、呼吸肌）418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,Intermediate syndrome发生在急性中毒恢,Laboratory examination,serum cholinesterase Organophosphate metabolic product others,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,Laboratory examinationserum c,Diagnosis,History garlic-like odor蒜臭味typical symptom： Pupil size small, 胃肠道 症状、coma。Laboratory examination： serum cholinesterase, Organophosphate metabolic product。Atropine test：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,Diagnosis History 砂勃曹闲毡咸蝴烙涸桌伯阎,Differential diagnosis,Muscarinic poisonglobe fish poisonacute gastroenteritis;AGEHeatstroke Hypnotic intoxicationPesticide intoxication,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,Differential diagnosisMuscari,Therapeutic principle,Get rid of the environment Cannot use the hot waterEliminate the poison queasy、 gastric lavageSpecific antidotes Atropine、PAMHeteropathy Oxygen therapy、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,Therapeutic principleGet rid,Emergency Management,Airway Breathing Cardiopulmonary resuscitation;CPRCNS：convulsion use valium and phenobarbital，forbid use Succinylcholine or Morphine。Cerebral edema：mannitol、 glucocorticosteroidpneumonedema： Atropine，aminophylline and morphine cant be use,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,Emergency Management Airway 穴,Specific antidotes,Cholinesterase resurrecter胆碱酯酶复活剂N样症状效果好 碘解磷定(pyraloxime methoiodide) 氯磷定（pyraldoxime methylchloride）Atropine, block muscarinic receptors, causing inhibition of all muscarinic functions. 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,Specific antidotesCholinestera,阿托品类生物碱-