How to nurse patients with organophosphorus pesticide poisoning

Critical patients with acute organophosphorus pesticide poisoning are in a dangerous condition, with many changes and rapid development. It should be rescued and treated accurately and timely, and at the same time, it should be closely observed and properly cared to prevent complications and make patients turn the corner. (1) Remove the poison quickly, stay away from the scene, take off the contaminated clothes, and thoroughly clean the contaminated hair and skin. Except for trichlorfon poisoning, all contaminated skin can be thoroughly cleaned with cold soapy water or 2% sodium bicarbonate solution. Trichlorfon poisoning can be cleaned with clean water to prevent residual poisons from being absorbed. Gastric lavage should be done immediately when oral poisoning occurs, and repeated gastric lavage should be required as soon as possible to ensure thoroughness. Conscious patients, after drinking warm water, stimulate the throat to induce vomiting. If the author disagrees, immediately insert a gastric tube and wash the stomach with 2% sodium bicarbonate solution or warm water. Trichlorfon poisoning should not be washed with sodium bicarbonate. Because trichlorfon can be quickly transformed into more toxic dichlorvos when it meets alkaline solution, warm water is chosen for gastric lavage (see general introduction to poisoning). For patients with mild to moderate poisoning, the total amount of gastric juice that needs gastric lavage is 10000 ~ 30000 ml, and for patients with severe poisoning, it needs more than 30000~40000ml. Until the eluate has no smell of pesticide garlic. After gastric lavage, inject 50% magnesium sulfate or sodium sulfate for 40 ~ 50ml for catharsis. If intubation fails due to heart spasm and gastrostomy and gastric lavage are feasible, the poison in the stomach can be removed in time. (2) Detoxification treatment: Use anticholinergic drugs and cholinesterase reactivating agents as soon as possible. ① Atropine. Has the effect of antagonizing acetylcholine, and can eliminate or alleviate muscarinic symptoms. Administration principle: early enough until atropinization, and pay attention to prevent the prognosis from being affected by insufficient dose and repeated illness. The tolerance of patients to atropine and the dosage required for atropinization vary from person to person. We should closely observe the changes of the disease, increase or decrease the dose at will, and pay attention to observe and judge the clinical manifestations of atropinization and poisoning. Atropine: Pupils gradually expand, but do not shrink, but respond to light, salivation and runny nose stop or decrease obviously, cheeks flush, skin is dry, heart rate is accelerated and powerful, and lung rales decrease or disappear obviously. After atropinization, pay attention to gradually reducing the dose or extending the interval of medication to prevent atropine poisoning or repeated illness. Atropine poisoning symptoms: fidgety, even hallucination, mania and other mental symptoms, dilated pupils, delayed or disappeared response to light, anhidrotic high fever above 40℃, tachycardia, 65438 060 beats/min, urinary retention. Patients with severe atropine overdose can turn to inhibition, leading to coma and respiratory center failure. Antagonists such as cholinergic drugs, pilocarpine, physostigmine and neostigmine can be used in atropine poisoning, which can increase the infusion volume and promote excretion. ② Choline ester energy restorer. Chlorpromazine and pralidoxime are oxime compounds, which can restore the activity of inhibited acetylcholinesterase and relieve nicotine-like toxicity, but only have an effect on newly formed phosphorylcholinesterase. After a few days, phosphorylcholinesterase "aged" and its activity was difficult to recover. Therefore, early use of such drugs has a good poisoning effect, but it is ineffective for chronic poisoning. Pholidoxime has a good effect on 1605, 1059, Tepp and ethion, but it has a poor or ineffective effect on dichlorvos, dimethoate, trichlorfon and malathion. The effect of chlorophosphonamide on trichlorfon and dichlorvos is poor, but it is suspicious or ineffective on dimethoate and malathion. This medicine must be mixed with atropine to improve its curative effect. (3) Symptomatic treatment and nursing: ① Closely cooperate with the treatment, ensure timely and accurate intravenous administration, and observe the drug action and reaction. ② Closely observe the patient's consciousness, pupil, complexion, skin, urine volume, body temperature, pulse, respiration, blood pressure, respiratory secretions and lung rales, be familiar with the signs of atropinization, be alert and prevent atropine overdose at any time, and reduce the dosage of atropine in time when poisoning is found. (3) Record the nursing records and the quantity in and out in detail to ensure the liquid supply and prevent dehydration and electrolyte disorder. ④ Keep the respiratory tract unobstructed, because organophosphorus poisoning can cause increased secretion of bronchial mucosa, congestion and edema, and severe cases are often accompanied by pulmonary edema, respiratory muscle paralysis or respiratory center depression, so it is extremely important to keep the respiratory tract unobstructed and maintain respiratory function. In case of cardiac insufficiency, the infusion speed should be strictly controlled, and cardiotonic, diuretic, rational use of oxygen, respiratory stimulants and antibiotics should be given in time according to the doctor's advice to treat pulmonary edema and prevent infection. For patients with respiratory failure, tracheotomy and mechanical ventilation are necessary means to save lives. ⑤ When coma and convulsion are caused by moderate or severe poisoning, routine nursing should be carried out according to coma, and the head should be tilted to one side to prevent suffocation when vomiting. Strengthen safety protection measures to prevent self-injury or bed fall. Toxic substances and heat dissipation obstacles often cause high fever after a large amount of atropine is used, and physical cooling or antipyretic agents can be used. Patients with urinary retention can be treated by bladder compression, acupuncture and catheterization. Catheterization should be strictly sterile, and the catheter should be removed in time to prevent urinary tract infection. In case of brain edema, in addition to the treatment of head ice pack or ice cap, oxygen inhalation and dehydration, move slowly when changing positions to prevent encephalopathy. ⑥ Observe whether there is gastrointestinal bleeding after poison stimulation and repeated gastric lavage. If there is hematemesis or bloody stool, report it to the doctor as soon as possible. ⑦ Strictly implement the shift change system, and pay attention to the rebound phenomenon caused by organophosphorus pesticide poisoning. The reasons are: incomplete gastric lavage, reabsorption of gastrointestinal residual poisons, or rapid reduction of atropine. Causes the original symptoms to reappear or worsen, and its premonitory symptoms are: chest tightness, loss of appetite and obvious increase in saliva secretion, which should be treated in time. Today, those who commit suicide by taking poison should do psychological care and strengthen protection to prevent suicide again.