St. Petersburg State Medical University

named after academician I.P. Pavlova

Department of Mobilization Training of Public Health and Extreme Medicine

"Carbon monoxide poisoning"

Completed:

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St. Petersburg

Introduction 3

General characteristics of CO 5

Pathophysiology 6

Clinical manifestations 13

Laboratory and instrumental diagnostics 15

Patient groups at high risk

disability or death due to CO 17 poisoning

First aid for carbon monoxide poisoning 17 Medical assistance for CO poisoning 17

Forecast 20

Conclusion 21

References 22

Introduction

“I feel bad, my head is splitting. Look, and the dog is sick. We must have eaten something. Nothing, everything will pass. There is no need to worry anyone." These were the last words spoken on September 28, 1902 by the great French writer, who died of carbon monoxide poisoning due to a malfunction of the stove in his Paris apartment.

Emile Zola said this to his wife. 1

Carbon monoxide (CO) is one of the most common poisonous gases in nature, polluting the environment in modern world with intensive use of energy. The main source of CO is the incomplete combustion of fossil fuels, especially coal. Exhaust gases are one of the main sources of CO formation in the environment. Its next source is cigarette smoke containing 3-6% CO, which is 8 times higher than its permissible concentration in the air of industrial facilities. People are especially susceptible to CO poisoning indoors. Passive inhalation of cigarette smoke contributes to the poisoning of non-smokers; it is especially dangerous for children and pregnant women.

Carbon monoxide is the most common industrial poison and is found wherever there are processes of incomplete combustion of carbon. The danger of poisoning of workers with CO exists in blast-furnace, open-hearth, forge, foundry, thermal shops, when working on vehicles (exhaust gases contain significant amounts of CO), at chemical enterprises where carbon monoxide is a raw material (synthesis of phosgene, ammonia, methyl alcohol, etc.). ).

In recent years, due to severe winters and an energy crisis around the world, the number of various domestic heating sources has increased, which, in the absence of proper ventilation, greatly increases the possibility of CO poisoning. Such poisoning often occurs in everyday life: while taking baths, while cooking in dishes with a large bottom surface. With poor access to oxygen, incomplete combustion occurs, resulting in the formation of CO from carbon compounds contained in natural gas. There was a belief that natural gas is completely safe and does not emit into the atmosphere during combustion, which means that there is no threat of poisoning. However, combustion does not mean that natural gas evolution is impossible. Ventilation pipes can often become clogged, or an exhaust hood can be installed above the gas stove.

Carbon monoxide is a ubiquitous product of the incomplete combustion of coal and other fuels - gas, gasoline. Because CO is odorless, colorless, tasteless, non-irritating and easily mixed with air, and spreads freely, it has been called the "silent killer". It is often difficult to recognize a potential hazard, therefore, CO poisoning from stoves (so-called fumes) is often encountered due to premature closing of the damper, the presence of cracks in the stove, or even as a result of CO emission from red-hot parts of gas columns.

Carbon monoxide is also a component of various industrial gases that are emitted from blast furnaces of coke plants and electric boilers.

General characteristics with

Carbon monoxide is a colorless and odorless gas, lighter than air (relative density in air 0.97), liquefies at a temperature of -191.5°C, freezes at a temperature of -204°C. Slightly soluble in water and blood plasma (about 2% by volume). Poorly sorbed by activated carbon, silica gel. Carbon monoxide forms an explosive mixture with air (volume fraction in the range of 16.2-73.4%). It can enter into combination with some metals, forming carbonyls (Ni(CO)4), which decompose in the presence of a catalyst with the release of CO and metal. 2

CO is formed during the incomplete combustion of almost any carbon-containing substance, including fuel for space heating, as well as in large quantities - during fires in buildings. CO poisoning peaks in autumn and winter, when heating devices are widely used. Deliberate or accidental poisoning from car exhaust and inhalation of smoke from residential fires is the second most common cause of CO intoxication.

A unique source of CO is methylene chloride, a solvent contained in paint remover. It is formed from inhaled methylene chloride during metabolism in the liver.

Sources and conditions of CO toxic action:

Smoke from burning organic materials (such as cigarettes)

Faulty heating appliances (fireplaces, heaters, water heaters) that use various types of fuel (wood, coal, fuel oil, kerosene, propane

Emissions from indoor devices powered by gasoline, diesel, propane (electric generators, cars, forklifts, ice machines)

Methylene chloride (paint remover).

Carbon monoxide was first produced by the French chemist Jacques de Lasson in 1776 by heating zinc oxide with coal, but was initially mistaken for hydrogen because it burned with a blue flame. The fact that this gas contains carbon and oxygen was discovered in 1800 by the English chemist William Cruikshank. Carbon monoxide outside the Earth's atmosphere was first discovered by the Belgian scientist M. Mizhot (M. Migeotte) in 1949 by the presence of the main vibrational-rotational band in the IR spectrum of the Sun.

Carbon monoxide (CO) has never been used as an independent poisonous substance, but not a single war has passed without poisoning with this gas. Carbon monoxide poisoning also consistently occupies one of the leading places in the statistics of acute poisoning in the Armed Forces in peacetime. At the end of World War II, the Allies bombed fascist cities with napalm: within just one night, Hamburg, Dresden, and Kassel were burned to the ground. When they later analyzed the cause of death, it turned out that 60% of the townspeople died from carbon monoxide poisoning.

Pathophysiology

CO has several mechanisms of toxic action. It is able to disrupt the delivery of oxygen to tissues, its utilization and, possibly, provoke the occurrence of oxidative stress. High-affinity binding of CO to hemoglobin (and the affinity of hemoglobin for carbon monoxide is 200-250 times greater than for oxygen) leads to: 1) the formation of carboxyhemoglobin (HbCO), 2) the replacement of oxygen in hemoglobin and a decrease in the oxygen transport capacity of the blood, and 3) shift of the oxyhemoglobin dissociation curve to the left. In addition, CO is able to attach to other heme-containing proteins, such as myoglobin and some cytochromes, which play a leading role in the production of energy by cells. However, it has not yet been established how clinically significant this interaction is. According to the latest experimental data, CO triggers a cascade of reactions, including lipid peroxidation of the brain, which causes temporary and irreversible dysfunction.

A classic example of a damaging effect on the blood with a violation of its respiratory function due to the inactivation of the blood pigment - hemoglobin, is the formation of carboxyhemoglobin (HbCO) under the influence of carbon monoxide. The conversion of hemoglobin to HbCO leads to a change in the spectral characteristics of the blood, which formed the basis for its quantitative determination in the blood. HbCO is formed as a result of the interaction of carbon monoxide (CO) with hemoglobin iron, which deprives it of its ability to oxygenate, leads to a violation of the transport function and, as a result, causes the development of hemic hypoxia. The appearance of HbCO is a consequence of the entry of CO into the lungs with inhaled air. The formation of HbCO begins from the periphery of erythrocytes already in the pulmonary capillaries. Subsequently, with an increase in the CO content in the inhaled air, HbCO is formed not only in the peripheral sections of the erythrocyte, but also in its central sections. Moreover, the rate of formation of HbCO is directly proportional to the concentration of CO in the inhaled air, and its maximum in the blood is determined by the time of contact. The ability of hemoglobin to bind O 2 and CO is the same, provided that 1 g of hemoglobin can bind 1.53-1.34 ml of O 2.

This dependence is called the Hüfner constant. At the same time, the affinity of hemoglobin for CO is 250-300 times greater than for O 2 . It is noteworthy that the shell of erythrocytes serves as a kind of protective barrier in the formation of HbCO, since in a suspension of erythrocytes this hemoglobin derivative forms 20% less than in a hemoglobin solution. The valency of iron in HbCO remains unchanged; only the Fe 2+ bonds are rearranged. All unpaired electrons participate in the formation of HbCO. In parallel with the formation of bonds between CO and Fe 2+, the nature of the bond between iron and globin and porphyrin changes. It loses its ionic character and becomes covalent. Interaction of CO with HbO 2 expressed by mutually conjugated reactions.

HbO 2 + CO → HbCO + O 2

HbCO + O 2 → HbO 2 + CO

The rate of these reactions and the formation of HbCO are determined by the partial pressure of CO and O 2 in the air. In this case, the amount of HbCO formed is proportional to the pressure of CO in the environment and inversely proportional to the pressure of O 2 . Despite the high affinity of CO for hemoglobin, as mentioned above, its association with hemoglobin occurs 10 times slower than that with O 2 . However, the dissociation of HbCO proceeds 3600 times slower than the dissociation of HbO 2 . For this reason, CO accumulates very quickly in the blood even with a relatively low CO content in the inhaled air. Thus, in addition to turning off part of the hemoglobin from oxygen transport, another pathogenetic link in the violation of the respiratory function of the blood against the background of carboxyhemoglobinemia is the slowdown in the dissociation of oxyhemoglobin under the influence of HbCO, which is known as the Holden effect. So, under physiological conditions, an increase in the concentration of CO 2 in the blood contributes to the accelerated elimination of O 2 from HbO 2, in the presence of HbCO this balanced process is disturbed. It is generally accepted that the essence of the Holden effect lies in the fact that when CO interacts with hemoglobin, the CO that enters the blood combines with only 3 of the 4 iron atoms in the hemoglobin molecule, while O 2 combines with the 4th iron atom, whose affinity for this atom iron increases sharply, which, naturally, makes it difficult for the dissociation of oxyhemoglobin. Another causal factor in the inhibition of the dissociation of HbO 2 under the influence of CO is the decrease in the level of the intermediate metabolite 2,3-diphosphoglycerate, which is formed during the glycolysis reaction. 2,3-diphosphoglycerate has the ability to enhance the process of HbCO dissociation due to the conformational changes in hemoglobin caused by it, so it is natural that the deficiency of this metabolite indirectly inhibits the release of O 2 from HbO 2 . 3

So, the main trigger for the development of specific hemic hypoxia during CO poisoning is the formation of HbCO, which loses its ability to carry oxygen in combination with a depressing effect on the process of dissociation of HbO 2 . Irrefutable evidence that the primary cause of CO-intoxication is carboxyhemoglobinemia is a direct relationship between the level of HbCO in the blood and the severity of intoxication. Thus, according to VEHenderson 4 , when the content of HbCO in the blood is 10%, only shortness of breath is noted during physical exertion; 60 % leads to death. In any case, in people who fall into a coma or die from acute poisoning CO, HbCO content, as a rule, not less than 50%. but there is not always a direct relationship between the content of HbCO in the blood and the severity of poisoning. There are cases when a severe form of poisoning developed already at 20% HbCO and, conversely, at 60% HbCO, mild forms of poisoning occur. This is largely due to a rather large individual sensitivity to CO, which is associated with a genetic factor.

The real confirmation of oxygen starvation due to carboxyhelobinemia in severe acute CO intoxication is a decrease in the oxygen content in arterial blood to 13.4-12.4 vol.% compared with 18-20 vol.% in the norm. At the same time, the arterial-venous difference in the content of O 2 decreases from 6-7 vol.% to 3.0-2.2 vol.%, the utilization of oxygen by tissues decreases, based on the value of the corresponding coefficient, the content of CO 2 in the blood decreases to 35 vol. % in comparison with the norm.

The formation of HbCO under the influence of CO is not the only disturbance of porphyrin metabolism. So, in acute CO poisoning, when CO is inhaled at concentrations of 40-600 mg / m 3, the content of proto- and uroporphyrin in erythrocytes increases, and copro- and uroporphyrinuria develops. Moreover, the growth of coproporphyrins in the urine is due to the formation of products of CO synthesis with tissue iron porphyrins, which, entering the blood, are then excreted in the urine. In especially severe cases, an increase in the content of porphobilinogen was observed. An increase in the level of methemoglobin and the appearance of sulfhemoglobin in the blood are possible. And finally, under the influence of CO, the content of the key hemoglobin synthesis product deltaaminolevulinic acid in plasma and erythrocytes increases, which, apparently, indicates the inhibition of hemoglobin synthesis under the influence of CO.

For a long time, it was believed that the mechanism of the toxic action of CO is determined solely by a violation of the respiratory function of the blood due to the formation of HbCO. However, over time, this concept has been revised. It has been convincingly proven that CO acts on many biologically active systems organisms containing iron, namely: myoglobin, cytochrome-containing respiratory enzymes, such as cytochrome P-450, cytochrome oxidase (cytochrome a 3), cytochrome c, peroxidase, catalase. five

When CO interacts with myoglobin, carboxymyoglobin is formed, although the affinity of CO for myoglobin is less than for hemoglobin. At the same time, the affinity of myoglobin for CO, according to various sources, is 25-50 times greater than for oxygen.

Thus, during CO poisoning, along with the formation of HbCO, the formation of carboxymyoglobin also occurs. At the same time, its growth in the muscles proceeds parallel to the growth of this hemoglobin derivative in the blood. It is possible that the appearance of carboxymyoglobin in muscles plays a certain role in the pathogenesis of CO2 intoxication; in any case, muscle damage is unequivocally associated with the effect on myoglobin. There is evidence that the ratio of carboxymyoglobin and HbCO, regardless of the level of exposure to CO, is 0.52. In severe poisoning, more than 25% of myoglobin can be associated with CO.

The results of numerous studies testify in favor of the fact that in the pathogenesis of CO intoxication, the interaction of CO with the system of cytochromes - iron-containing respiratory enzymes, plays an important role, which leads to inhibition of tissue respiration. As it turned out, the severity of disorders in the body due to this mechanism significantly exceeds those caused by a banal oxygen deficiency associated with a deficiency of O 2 in the inhaled air.

Until a certain time, the main attention in assessing the toxic effects of CO on the body was given to acute poisoning that occurs under the influence of this gas. Despite the fact that the trigger for the development of acute CO intoxication is its interaction with hemoglobin and other iron-containing biochemical structures, the clinical picture of intoxication is primarily dominated by symptoms of CNS disorders, the severity of which, as a rule, depends on the content of HbCO in the blood.

Given that the pathogenesis of acute CO poisoning is initially determined by the damaging effect on the blood, it is appropriate to characterize how the morphological and biochemical composition of the blood changes in this case. At the height of intoxication, the number of erythrocytes increases to 5.5 - 6.6 * 10 12 / l, which is due, on the one hand, to contraction of the spleen due to reflexes from the carotid sinuses and the entry of deposited erythrocytes into the blood, and on the other hand, the cause of erythrocytosis there may be a direct stimulation of CO formation of erythropoietin. Finally, hypoxia cannot be ruled out as another causal factor in the increase in the number of erythrocytes. Erythrocytosis is most often a temporary phenomenon, but sometimes polycythemia vera develops either immediately after acute intoxication, or as an aftereffect months or even years later. With repeated CO poisoning against the background of lymphocytosis, normoblasts appear in the blood with an increased content of reticulocytes. It is noteworthy that changes in the hemoglobin content during CO intoxication are not very characteristic.

In some cases, the outcome of red blood damage in CO poisoning is the development of Birmer-type anemia in combination with neutropenia. 6

According to A.M. Rashevskaya and L.A. Zorina 7 , changes in the white blood are more common than those in the red. This is manifested by neutrophilic leukocytosis, sometimes up to 20-25*10 9 /l with a shift to the left against the background of lympho- and eosinopenia with a decrease in phagocytic activity. It is believed that the mechanism of leukocytosis is associated with stress, and inhibition of phagocytosis is associated with inhibition of cytochrome oxidase activity in neutrophils. In people with CO poisoning, an increase in the activity of neutrophil alkaline phosphatase was recorded.

As for the bone marrow, its cells undergo degenerative changes during irritation, as evidenced by an increase in nucleated elements with a shift in the formula to the left with a peak in the area of ​​myelocytes and metamyelocytes.

Some changes of a biochemical nature seem to be essential in CO intoxication: an increase in non-hemoglobin iron in the blood (can reach 50%), which is directly related to the state of red blood. With repeated acute poisoning, there is a parallel decrease in the iron content in the tissues due to the combination with CO, which is regarded as a detoxification mechanism. Some other biochemical changes in the peripheral blood in acute CO poisoning have been studied quite well. So, on the part of carbohydrate metabolism, violations in the form of hyperglycemia and glucosuria were revealed. According to some authors, these shifts may be the result of changes in the central mechanisms of regulation of carbohydrate metabolism, according to others, the reason is in the increased breakdown of liver glycogen due to the intensive release of adrenaline. At the same time, an increase in the content of lactic acid in the blood with an increase in the level of HbCO up to 30% is considered quite natural. Violations of nitrogen metabolism in acute CO intoxication is mainly reduced to an increased accumulation of nitrogenous slags in the blood, namely urea, which is due to violations of the antitoxic function of the liver. From the side of lipid metabolism, stimulation of the oxidation of free fatty acids and a decrease in the production of triglycerides were traced. Electrolyte metabolism is manifested by an imbalance in the content of calcium, magnesium, and especially potassium and sodium in the blood and tissues. The latter leads to disruption of the activity of the heart muscle.

For a long time, the possibility of developing chronic CO poisoning was questioned. It is now generally accepted that this form of pathology exists. However, due to the fact that it is difficult to differentiate the true chronic effects of CO from repeated acute poisonings, the issue was unambiguously resolved on the basis of experimental data.

Chronic CO poisoning in humans can occur with prolonged inhalation of air containing CO at a concentration of about 10-50 mg/m 3 . Usually, 3-13% HbCO2 is found in the blood, while the content of HbCO2 in the blood of non-smokers is 1.5-2 %. From the side of red blood in conditions of chronic CO poisoning, an increase in the content of hemoglobin and erythrocytes, sometimes against the background of reticulocytosis, a shift of the leukocyte formula to the left, more rarely thrombocytosis is observed. In this case, the content of erythrocytes can reach values ​​of 6*10 12 /l and higher. However, in the later stages of intoxication, and sometimes already at its initial stages, anemia may develop. Even isolated cases of pernicious and hyperchromic anemia with degeneration into paramyeloblast leukemia are described, which usually ended in death. It is noteworthy that under conditions of chronic exposure to CO on people with an average content of HbCO in the blood of 4% in erythrocytes, the content of deltaaminolevulinic acid increased to 2.7–6.9 μg/ml compared with the initial (0.7–2.5 μg/ml). ml). Subsequently, this was accompanied by a violation of the synthesis of porphyrins and heme. In general, the direct effect of CO on heme biosynthesis in the cell cannot be ruled out. To a certain extent, the content of deltaaminolevulinic acid in erythrocytes can be used to judge the body's sensitivity to CO. Changes in the white blood are characterized by multidirectionality, in particular, both leukocytosis and leukopenia can occur against the background of eosinopenia, lymphocytosis, monocytosis. Toxic granularity of neutrophils has also been described. Under chronic exposure to CO, an increase in DNA and a decrease in RNA were found in neutrophils, provided that peroxidase activity in them decreased. When studying the effect of CO on a person at concentrations of the order of 10–20 mg/m %, an increase in non-hemoglobin serum iron to 149 μg% at 127 μg% in the initial state (in the case of a CO concentration of about 20 mg / m 3) and a decrease in the catalase index. As mentioned above, there is not always a direct relationship between the content of HbCO in the blood and the severity of clinical symptoms. However, this phenomenon occurs especially often in the analysis of cases of chronic poisoning. This greatly complicates its diagnosis. The explanation for such facts, when the symptoms of poisoning persist with a progressive decrease in the level of HbCO in the blood down to normal values, is that the CO that enters the body is fixed by hemoglobin in the form of HbCO and is excreted from the body after its destruction. Studies by a number of authors have shown that CO can be fixed in the cells of a number of organs, in particular the liver, spleen, muscles, and brain. This is combined with an increase in the content of non-hemoglobin plasma iron in chronic CO poisoning, as a result of which CO is out of contact with hemoglobin for a long time. The increase in non-hemoglobin serum iron can also explain the increase in the content of the β-globulin fraction of serum proteins, which contains the transport form of iron - transferrin. This assumption is directly confirmed by a series of relevant works, which show that in chronic CO intoxication, an increase in serum iron and protoporphyrinuria are combined with an increase in the β-globulin fraction of serum proteins. 8

It is well known that the clinic of both acute and chronic CO poisoning is replete with symptoms of damage primarily to the central nervous system, as well as other organs and systems, which is primarily due to the result of developing hemic hypoxemia and hypoxia, as well as, to a certain extent, blockade of enzyme systems containing iron porphyrin structures. Chronic exposure is characterized by CNS disorders; asthenic syndrome, vegetative dystonia and angiodystonic syndrome with a tendency to angiospasms, as well as changes in the mental sphere. It has been proven that chronic CO intoxication is accompanied by dysfunction of the cardiovascular system, subject to varying degrees of damage to the heart muscle due to hypoxia. Changes in blood pressure are possible both in the direction of hypo- and especially hypertension. Somewhat less natural, but, nevertheless, the occurrence of deviations from the side endocrine system, including the genital area, as well as indicators of the functions of the thyroid gland and adrenal glands.

And, finally, there are data on disturbances of the sense organs under the influence of chronic CO2 intoxication. This applies to the organ of hearing (the cochlear and vestibular parts of the inner ear), as well as the organ of vision with impaired convergence, accommodation, color perception, visual acuity, narrowing of the visual fields, and, finally, changes in the fundus in the form of retinal vascular pathology of varying intensity.

Poisoning by combustion products - the main cause (80% of all cases) of deaths in fires. Over 60% of them are due to carbon monoxide poisoning. Let's try to understand and remember the knowledge of physics and chemistry.

What is carbon monoxide and why is it dangerous?

Carbon monoxide (carbon monoxide, or carbon monoxide, chemical formula CO) is a gaseous compound formed during combustion of any kind. What happens when this substance enters the body?

After entering the respiratory tract, carbon monoxide molecules immediately appear in the blood and bind to hemoglobin molecules. A completely new substance is formed - carboxyhemoglobin, which prevents the transport of oxygen. For this reason, oxygen deficiency develops very quickly.

The biggest danger- carbon monoxide is invisible and not noticeable in any way, it has neither smell nor color, that is, the cause of the ailment is not obvious, it is not always possible to detect it immediately. Carbon monoxide cannot be felt in any way, which is why its second name is the silent killer. Feeling fatigue, loss of strength and dizziness, a person makes a fatal mistake - he decides to lie down. And, even if he then understands the reason and the need to go out into the air, as a rule, he is not able to do anything. Knowledge could save many symptoms of CO poisoning- knowing them, it is possible to suspect the cause of the ailment in time and take the necessary measures to save.

Symptoms and signs

The severity of the injury depends on several factors:

• the state of health and physiological characteristics of a person. Weakened, with chronic diseases, especially those accompanied by anemia, the elderly, pregnant women and children are more sensitive to the effects of CO;
• the duration of the effect of the CO compound on the body;
• the concentration of carbon monoxide in the inhaled air;
• physical activity during poisoning. The higher the activity, the faster the poisoning occurs.

Severity

(Infographics available by clicking the download button after the article)

Light degree severity is characterized by the following symptoms:

• general weakness;
• headaches, mainly in the frontal and temporal regions;
• knocking in the temples;
• noise in ears;
• dizziness;

• blurred vision - flickering, dots before the eyes;
• unproductive, i.e. dry cough;
• rapid breathing;
• shortness of breath, shortness of breath;
• lacrimation;
• nausea;
• hyperemia (redness) skin and mucous membranes;
• tachycardia;
• increase in blood pressure.

Symptoms medium degree severity is the preservation of all the symptoms of the previous stage and their more severe form:

• blurred consciousness, possible loss of consciousness for a short time;
• vomit;
• hallucinations, both visual and auditory;
• violation of the vestibular apparatus, uncoordinated movements;
• pressing chest pains.

Severe degree poisoning is characterized by the following symptoms:

• paralysis;
• long-term loss of consciousness, coma;
• convulsions;
• pupil dilation;
• involuntary emptying of the bladder and intestines;
• increased heart rate up to 130 beats per minute, but at the same time it is weakly palpable;
• cyanosis (blue) of the skin and mucous membranes;
• breathing disorders - it becomes superficial and intermittent.

Atypical forms

There are two of them - fainting and euphoric.

Syncope symptoms:

• pallor of the skin and mucous membranes;
• lowering blood pressure;
• loss of consciousness.

Symptoms of the euphoric form:

• psychomotor agitation;
• violation of mental functions: delirium, hallucinations, laughter, oddities in behavior;
• loss of consciousness;
• respiratory and heart failure.

First aid for the injured

It is very important to act promptly, as irreversible consequences occur very quickly.

First, it is necessary to remove the victim as soon as possible to Fresh air. In cases where this is difficult, then the victim should be put on a gas mask with a hopcalite cartridge as soon as possible, and given an oxygen cushion.

Secondly, it is necessary to facilitate breathing - to clear the airways, if necessary, unbutton the clothes, lay the victim on his side in order to prevent a possible sinking of the tongue.

Thirdly, stimulate breathing. Bring ammonia, rub the chest, warm the limbs.

And most importantly - you need to call an ambulance. Even if a person at first glance is in a satisfactory condition, it is necessary that he be examined by a doctor, since it is not always possible to determine the true degree of poisoning only by symptoms. In addition, timely initiated therapeutic measures will reduce the risk of complications and mortality from carbon monoxide poisoning.

If the victim is in a serious condition, it is necessary to carry out resuscitation measures before the arrival of doctors.

Sources of danger

In our time, cases of poisoning happen a little less often than in those days when residential heating was predominantly stove, but there are still enough sources of increased risk now.

Potential hazards of carbon monoxide poisoning:

• houses with stove heating, fireplaces. Improper operation increases the risk of carbon monoxide penetration into the room, thus fading away in houses with entire families;
• baths, saunas, especially those that heat “on black”;
• garages;
• in industries using carbon monoxide;
• long stay near major roads;
• fire in a closed room (elevator, shaft, and other rooms that cannot be left without outside help).

Only numbers

• A mild degree of poisoning occurs already at a concentration of carbon monoxide of 0.08% - there is a headache, dizziness, suffocation, general weakness.
• An increase in CO concentration to 0.32% causes motor paralysis and fainting. Death occurs in about half an hour.
• At a CO concentration of 1.2% or more, a lightning-fast form of poisoning develops - in a couple of breaths a person receives a lethal dose, a lethal outcome occurs after a maximum of 3 minutes.
• In the exhaust passenger car contains from 1.5 to 3% carbon monoxide. Contrary to popular belief, it is possible to get poisoned while the engine is running not only indoors, but also outdoors.
• About two and a half thousand people in Russia are annually hospitalized with varying degrees of severity of carbon monoxide poisoning.

Carbon monoxide (carbon monoxide) // Harmful substances in industry. Handbook for chemists, engineers and doctors / Ed. N. V. Lazareva and I. D. Gadaskina. - 7th ed. - L .: Chemistry, 1977. - T. 3. - S. 240-253. - 608 p.

Carbon monoxide concentration and symptoms of poisoning

Prevention measures

In order to minimize the risks of carbon monoxide poisoning, it is enough to observe the following rules:

• operate stoves and fireplaces in accordance with the rules, regularly check the operation ventilation system and in a timely manner, and only professionals should trust the laying of stoves and fireplaces;
• do not stay near busy roads for a long time;
• always turn off the engine of the car in a closed garage. In order for the concentration of carbon monoxide to become lethal, only five minutes of engine operation is enough - remember this;
• when staying in the car for a long time, and even more so when sleeping in the car, always turn off the engine;
• make it a rule - if you experience symptoms that can be suspected of carbon monoxide poisoning, provide fresh air as soon as possible by opening the windows, or rather leave the room. Do not lie down if you feel dizzy, nauseous, or weak.

Remember - carbon monoxide is insidious, it acts quickly and imperceptibly, so life and health depend on the speed of the measures taken. Take care of yourself and your loved ones!

Of course, gasification in homes can hardly surprise anyone today (unless, of course, you have relatives in the Amazon jungle). But habit can also do a disservice.

There are two types of "home" gas: methane (the one that goes through the main pipe to your stove) and propane / butane (it is brought in red cylinders). An ordinary person will not only not distinguish these gases, he will not even detect them - they have no smell. However, it is precisely in order that their leakage can be detected that a substance is added to the gas that has a fairly bad smell. It is he who is associated with gas.

IT'S IMPORTANT TO KNOW

Methane is lighter than air and tends to rise.

Bottled gas is heavier - it accumulates below, penetrates under the floor if there are gaps.

If there is a leak from the cylinder, for example, in country house where there are often cellars and subfloors - even if the leak is small, there is a risk that gas can accumulate and at one fine moment one small spark from the switch will be enough for a disaster.

If there is no electricity in your cellar, you can simply inhale the gas.

According to statistics, main reason of all accidents with gas - ordinary negligence and neglect of established safety standards. Therefore, in order to be known as a zealous owner, follow a few rules:

1. Before ignition and during combustion gas appliances ventilate the room by slightly opening the window or window or by turning on the forced ventilation system.

2. . Check the draft in the smoke channels before lighting, periodically do this during combustion.

3. No matter how trite it may sound, but - do not leave the gas appliances turned on unattended.

4. Don't use gas stoves for heating! Why - see the section "Carbon monoxide".

5. Do not design, transfer or repair by yourself gas equipment! This is very dangerous and can lead to an explosion, unless of course you are a gas worker.

6. If there are no residents in the building for a long time, it is better to take the cylinders outside the building and turn off the gas equipment. Even minimally leaky systems can form explosive concentrations of gas with air over long periods in enclosed spaces!

And one more thing: if there is an accident on the highway and it is blocked, do not leave the valves open. Gas can be given at any time without warning, and you just won't notice. The consequences can be the most deplorable.

HOW TO DETECT A LEAK

Visually: Soap the alleged leaks - most often these are the joints in pipes and fittings. Where a bubble inflates from soapy water, there is a leak;

Aurally: in case of a strong leak, a characteristic hiss will tell you ... at least where it is worth soaping to check;

By smell: the characteristic odor becomes stronger near the leak. And the very fact of the appearance of the smell is the reason for the above measures.

And, of course, do not try to look for a leak with a lighter!

IF THERE IS A GAS LEAK

1. Do not use electrical appliances

Do not insert or remove plugs from sockets - any spark can cause an explosion. Don't do anything at all that could cause a spark or a rise in temperature.

2. Call service "04" immediately

Better from neighbors or by mobile.

3. Waiting for the "emergency gang", ventilate the apartment

Open the windows, make a draft, which should blow away everyone present in the apartment, except for you. There shouldn't be any extras. Let them go and meet the gas workers. And it is better to turn off the intercom and the bell (see point 1).

IF GAS FIRES AT A LEAK

If it is possible to shut off the supply before the leak, shut it off and everything goes out. If not - by no means do not mascara! At most, you can try to remove combustible objects from the area affected by the flame. But in this case, the fire is less dangerous than the open gushing of gas. The consequences of the explosion will be huge - there have been cases when, due to a gas leak, half the house was blown apart. Therefore, take all your people out of the apartment and run yourself, calling the emergency gas service on the run and fire department by phone 112.

With a balloon, everything is, of course, easier. But the principles are exactly the same.

If there is a leak from the cylinder, disconnect it from the fittings (if there is nothing, cut off the rubber hose) and take the cylinder outside. Be sure to take an assistant. In order not to drop it, it is fraught with at least ignition. Call the emergency gang on 112, and if the cylinder is not working, ask them for a conclusion in order to exchange it for a new one.

If suddenly gas caught fire at the site of a leak from a cylinder, try calling the “fire department” by calling 112, wrap your hands in a wet towel and turn off the valve. If the flame is small, throw the same wet towel over the spouting site, extinguish the flame, take the cylinder outside and wait for the emergency gang to arrive.

If the flame is large - it is not worth extinguishing it, so as not to let gas into the room - an explosion is possible.

However, no matter what decision you make - to run or to put out fire - you must act quickly. Otherwise, the balloon will heat up and explode anyway.

In addition to the explosiveness of gas, there is another important aspect - its toxic effect on the body. Not the last role in this process is played by the so-called carbon monoxide.

If there is a gas water heater in your apartment, you simply must know everything about it.

CARBON MONOXIDE

Carbon monoxide - carbon monoxide (CO) - a compound familiar from school. And it is extremely dangerous also because in everyday life there are too many options for its formation. In most cases, they are all associated with combustion. CO is one of the products of incomplete combustion of any substance. And, unlike household gas, it cannot be noticed without special devices - carbon monoxide has no color and smell.

During the combustion of almost all types of fuel in conditions of lack of oxygen, CO begins to actively form. Therefore, in ovens and household geysers with impaired ventilation, the formation of this poison is inevitable. If the damper is closed prematurely or too much, it will be dangerous to be in the room.

WHAT IS CARBON MONOXIDE DANGEROUS?

Inhaling carbon monoxide is tantamount to cutting your veins. No, you don't lose blood in the strict sense. However, it loses its main property - to deliver oxygen to the tissues. Carbon monoxide tightly binds to hemoglobin and makes it impossible for an oxygen molecule to attach to it. So with each breath, the efficiency of the blood decreases. The brain will be the first to suffer from oxygen starvation, which will not be able to control the body. And then - death.

FIRST AID FOR CARBON MONOXIDE POISONING

If you or someone around you has a dull headache, dizziness, vomiting, chest pains, confusion, lack of coordination, and bright red or bluish skin, all signs of poisoning are present.

The victim must be moved to a well-ventilated area (or better on the street), do not force him to go himself. And immediately call an ambulance. Provide him with the opportunity to breathe easily, calm. In no case do not give alcohol - it will cause even more toxicity.

Subject: Carbon monoxide. Household gas.

First aid for gas poisoning.

Objectives: to familiarize students with the sources of carbon monoxide, symptoms of gas poisoning "

Learn to provide first aid for gas poisoning.

During the classes.

Organizing time.

1. Checking homework.

What is a fire. Causes of a fire.

Fire safety rules.

Factors of fire and its impact on the human body.

Rules of conduct in case of fire.

3 Post the topic of the lesson.

During holidays and festivities, balloons are sold on the streets of the city.

and inflatable toys that must be held tightly in your hands, otherwise they will fly away.

Who knows how they inflate balloons and toys?

Why do they behave like this?

These toys and balloons are inflated with a special gas that is lighter than air.

Therefore, balls and toys rush up.

Today our conversation is about various gases. We will learn where the gas is used, what harm it can do to a person and how to provide first aid in case of gas poisoning.

4. Work on the topic of the lesson.

Tell us what you know about this topic?

Carbon monoxide.

The scientific name for carbon monoxide is oxygen oxide.

In addition to its usual name, this gas has others, it is also called "invisible poison" and "humane killer."

Carbon monoxide is released during fires, in baths, in country and rural houses with stove heating. It turns out as a result of incomplete combustion of fuel in furnaces, when the furnace valve is prematurely closed.

Carbon monoxide can also form in urban kitchens with incomplete combustion. natural gas.

Carbon monoxide is highly toxic, colorless and odorless, making it impossible to see or feel. It is lighter than air, so it rises.

That is why when evacuating in a fire, you should move around by bending low or crawling.

Notebook entry.

Carbon monoxide, its characteristics.

Lighter than air.

Has no color and smell.

Poisonous.

The second gas we encounter on a daily basis is household gas, which enters gas stoves. Household gas has practically no color or smell, but in order to determine its presence in the apartment, microdoses of odoranite are added to it at the gas station to give it a specific smell.

Gas poisoning is dangerous.

Symptoms of gas poisoning.

Severe headache and dizziness.

Noise in ears.

Darkness in the eyes.

Nausea.

Muscle weakness.

Loss of consciousness.

5. Work on the textbook.

Selective reading and answering questions, pages 46-49.

Find and read where else you can get carbon monoxide poisoning?

(This gas is the cause of death of people in the cold season, who fell asleep in a car with the engine running).

Read where underground (ground) gases accumulate, which also have no color or smell ?.

(They accumulate in basements, mines, water and sewer wells, landfills and swamps.)

Read What are the steps to take first aid for gas poisoning?.

First aid for gas poisoning.

Remove victim to fresh air.

Rub the body, wrap the patient, put heating pads at the feet.

Short-term inhalation of ammonia.

When breathing stops, give artificial respiration.

Call for an ambulance.

If there is a gas leak, you can't.

Touch electric switches, ring electric bells, use the elevator.

Use matches and lighters.

Check for gas leaks with fire (matches). Leakage can be checked with soapy water.

Necessary:

Shut off the gas, do not turn on the light.

Open windows and doors.

If the cause of gas contamination is not clear, call the gas service by calling 04.

6. The result of the lesson.

Why is carbon monoxide called "invisible poison", "humane killer"?

(A person dies in a dream, does not experience pain and suffering.)

You have set to warm up dinner. The draft blew out the burner, and the kitchen filled with gas. Your actions?

(Hold your breath. Turn off the gas. Open windows and doors for ventilation)

7. Homework.

Textbook, page 46-49. Answer the questions on page 49.

Notes in a notebook.

reference

Lecturer-organizer OBZH.

Akopdzhanyan Nikolay Ivanovich

on the topic: "Carbon monoxide and household gas. First aid for gas poisoning.

I used the following materials during the lesson.

Life safety textbook, grade 5,

Methodological guide on life safety,

used the resources of the Internet,

Microsoft Office/

Preview:

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Slides captions:

Subject: Carbon monoxide. Household gas. First aid for gas poisoning Objectives: to acquaint students with the sources of carbon monoxide, symptoms of gas poisoning. To learn how to provide first aid for gas poisoning.

Carbon Monoxide The scientific name for carbon monoxide is oxygen oxide. In addition to its usual name, this gas has others, it is also called "invisible poison" and "humane killer." Carbon monoxide is released during fires, in baths, in country and rural houses with stove heating. It turns out as a result of incomplete combustion of fuel in furnaces, when the furnace valve is prematurely closed. Carbon monoxide can also form in urban kitchens when natural gas is not completely burned. Carbon monoxide is highly toxic, colorless and odorless, making it impossible to see or feel. It is lighter than air, so it rises. That is why when evacuating in a fire, you should move around by bending low or crawling.

Carbon monoxide is lighter than air. Has no color and smell. Poisonous.

Symptoms of gas poisoning Severe headache and dizziness. Noise in ears. Darkness in the eyes. Nausea. Muscle weakness. Loss of consciousness.

First aid for gas poisoning Remove the victim to fresh air. Rub the body, wrap the patient, put heating pads at the feet. Short-term inhalation of ammonia. When breathing stops, give artificial respiration. Call for an ambulance.

No gas leak! Touch electric switches, ring electric bells, use the elevator. Use matches and lighters. Check for gas leaks with fire (matches). Leakage can be checked with soapy water.

It is necessary: ​​Shut off the gas, do not turn on the light. Open windows and doors. If the cause of gas contamination is not clear, call the gas service by calling 04.

Lesson summary Why is carbon monoxide called "invisible poison", "humane killer"? (A person dies in his sleep, does not experience pain and suffering.) You have set to warm up dinner. The draft blew out the burner, and the kitchen filled with gas. Your actions? (Hold your breath. Turn off the gas. Open windows and doors for ventilation)

State educational institution of secondary vocational education Health Committee of the Administration of the Volgograd Region " Medical College№1» 900igr.net

Carbon monoxide Carbon monoxide is released into the atmosphere during any type of combustion. In cities, mainly in the composition of exhaust gases from internal combustion engines. Carbon monoxide actively binds to hemoglobin, forming carboxyhemoglobin, and blocks the transfer of oxygen to tissue cells, which leads to hemic-type hypoxia. Carbon monoxide is also involved in oxidative reactions, disrupting the biochemical balance in tissues.

Risk group Poisoning is possible: - in case of fires; -in production, where carbon monoxide is used to synthesize the series organic matter(acetone, methyl alcohol, phenol, etc.); - in garages with poor ventilation, in other unventilated or poorly ventilated rooms, tunnels, as the car exhaust contains up to 1-3% CO according to the standards and more than 10% with poor adjustment of the carburetor engine;

Continuation (about the risk group) - with a long stay on a busy road or near it. On major highways, the average concentration of CO exceeds the poisoning threshold; - at home in case of leakage of lighting gas and in case of untimely closed stove dampers in rooms with stove heating (houses, baths); - when using low-quality air in breathing apparatus.

Symptoms. With mild poisoning: headache, pounding in the temples, dizziness, chest pain, dry cough, lacrimation, nausea, vomiting, visual and auditory hallucinations, reddening of the skin, carmine-red color of the mucous membranes, tachycardia, increased blood pressure; In case of moderate poisoning: drowsiness, motor paralysis is possible with preserved consciousness;

in case of severe poisoning: loss of consciousness, convulsions, involuntary discharge of urine and feces, respiratory failure, which becomes continuous, dilated pupils with a weakened reaction to light, sharp cyanosis (blue) of the mucous membranes and skin of the face. Death usually occurs at the scene as a result of respiratory arrest and a drop in cardiac activity.

Complications When leaving a coma, the appearance of a sharp motor excitation is characteristic. Possible re-development of coma. Severe complications are often noted: - cerebrovascular accident; - subarachnoid hemorrhages; - polyneuritis - phenomena of cerebral edema; - impaired vision, hearing; -possible development of myocardial infarction; - Skin and trophic disorders are often observed (bubbles, local edema with swelling and subsequent necrosis); - With prolonged coma, severe pneumonia is constantly noted.

First Aid To provide first aid, you must: call an ambulance; quickly remove the victim from the carbon monoxide zone, provide fresh air (open windows, doors, turn on the fan, etc.); give the victim a breath of oxygen; put a cold compress or ice pack on the head and chest; if the victim is unconscious, give him a sniff every 5 minutes ammonia.

Prevention -Work to carry out in well-ventilated areas; - Check the opening of dampers when using stoves and fireplaces in homes;

Description of the presentation on individual slides:

Lesson topic: Carbon monoxide poisoning.

Etiology - Carbon monoxide enters the atmospheric air during any type of combustion. In cities, mainly in the composition of exhaust gases from internal combustion engines.

Pathogenesis - Carbon monoxide actively binds to hemoglobin, forming carboxyhemoglobin, and blocks the transfer of oxygen to cells, which leads to hypoxia.

Risk groups - fires; in production; garages with poor ventilation; when you stay on a busy road or near it for a long time; at home with stove heating (houses, baths).

The impact of CO on the body - With a content of 0.08% CO in the air, a person feels headache and suffocation. At a CO concentration of up to 0.32%, paralysis and loss of consciousness occur (death occurs within 30 minutes). At a concentration above 1.2% - consciousness is lost after 2-3 breaths, a person dies in less than 3 minutes.

Symptoms: With mild poisoning: knocking in the temples, dry cough, vomiting, possible hallucinations, increased blood pressure.

Symptoms: in case of moderate poisoning: drowsiness, motor paralysis with preserved consciousness.

Symptoms: in severe poisoning: loss of consciousness, convulsions, respiratory failure, severe cyanosis (blue) of the mucous membranes and skin of the face. Death occurs on the spot as a result of respiratory and cardiac arrest.

Complications: violation of cerebral circulation, visual impairment, the development of myocardial infarction is possible in coma, severe pneumonia is noted.

Hand color after carbon monoxide poisoning

First aid - Fresh air. Start CPR. Rubbing the body, heating pads to the feet, short-term inhalation of ammonia.

Treatment- Patients with severe poisoning are subject to hospitalization with oxygen treatment.

Prevention - Ventilate gassed rooms, Check the opening of dampers when using stoves and fireplaces in homes.

The use of respirators when working in a gassed room:

Consolidation of the material covered (3): 1.Clinic of the 1st degree of CO poisoning. 2. Why death occurs in case of CO poisoning. 3. How is the treatment of severe.

• Mazeina Elena EfimovnaWrite 4111 29.07.2016

Material Number: DB-148425

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CARBON MONOXIDE POISONING

Carbon monoxide is a product of incomplete combustion various kinds fuel, wood, garbage, etc. This gas is odorless, colorless, non-irritating to the eyes and therefore cannot be felt.

Why is this gas so dangerous?

It replaces oxygen in the blood. As a result, the blood carries too little oxygen to nourish body tissues. Inhalation of even a small amount of it can cause serious illness, and in some cases, death.

Know When There's Danger

Carbon monoxide is released into the atmosphere during any type of combustion.

POISONING IS POSSIBLE

When you stay on a busy road or near it for a long time (on major highways, the average concentration of gas exceeds the poisoning threshold).

Having closed the stove damper until the firewood, coal is burned (in a house with stove heating or a bath).

IN winter time in the interior of cars with a faulty internal combustion engine, when people are trying to warm themselves in the cabin, waiting for something. I fall asleep and don't wake up again.

Poisoning is most likely in garages with poor ventilation, in other unventilated or poorly ventilated areas, tunnels, since this gas is found in car exhaust.

At home, in case of leakage of lighting gas, faulty gas oven in an unventilated area.

Carbon monoxide poisoning occurs due to violation of the rules for the operation of gas appliances, furnace heating and neglect of elementary safety rules.

The main signs and symptoms of carbon monoxide poisoning are headache, nausea; choking, confusion, muscle weakness, red complexion. Prolonged exposure to carbon monoxide can cause death.

immediately go out into the fresh air and call an ambulance - check that the gas equipment is turned off and open the windows. Never light a light or fire, as this may cause an explosion. -when going outside, call the fire department or the gas network repair service

If you are helping a victim of poisoning

Make sure you have support (someone is waiting for you outside and ready to help you) - entering the room you yourself can become a victim of poisoning - Entering the room where the victim is located - open windows and doors, do not turn on the light or fire -Try to take the victim outside as soon as possible, put him on his back, free him from tight clothes, let him smell the ammonia. - if the victim is not breathing, start artificial respiration immediately - call an ambulance