The amount of nitrogen, ammonia, creatinine increases in the urine, glucosuria is possible.
Differential diagnosis is very complicated. Death can occur in a few hours with the phenomena of resorptive action.
At defeat by mustard gas along with the local processes developing on skin and mucous membranes, and at all types of defeat it is possible to note symptoms of the general (resorptive) action which are caused:
direct action of the absorbed OR or its decay products; reflex neurotrophic disorders as a result of pathological impulses from the affected areas; absorption of toxic tissue breakdown products in the affected area.
The main manifestations of resorptive action
1. Temperature reaction. The change in temperature is observed in all forms of lesions from 37 C to 40 C and above depending on the severity of the lesion.
2. Central nervous system. In most cases, there is a suppression of its activities. There is a depressed state, drowsiness, general asthenia, in severe cases with an unfavorable prognosis, convulsions may occur.
3. Cardiovascular system. There is instability of its activity. Tachycardia is replaced by bradycardia. Then develops myocardial weakness, arrhythmia and drop in blood pressure.
4. Blood. In the first days of intoxication neutrophilic leukocytosis is observed. Then develops leukopenia with lymphopenia and the disappearance of basophils (shift to the right). From the red blood – gradually increasing anemia.
5. Digestive organs. Affected not only by local action, but also by resorptive action. There is hypersalivation, nausea, vomiting.
6. Kidneys. In severe cases, protein and cylinders appear in the urine, which last a long time. In addition, acute hemorrhagic nephritis may develop.
7. Metabolism. Clinically: metabolic disorders are characterized by weight loss and, over time, the development of mustard cachexia, which is a consequence of impaired protein, carbohydrate, fat and mineral metabolism. The amount of nitrogen, ammonia, creatinine increases in the urine, glucosuria is possible. Blood acidosis.
When affected by lewisitis, the manifestations of resorptive action are the same, but the symptoms increase more rapidly. Collapse may develop due to capillary paralysis. Pulmonary edema may develop (even if lewisite gets on the skin), and secondary anemia develops at a later date.
Thus, the mechanism of action of mustard gas is still unexplored. Mustard gas and lewisite affect all organs and systems, have a local and resorptive effect, which determines the severity of intoxication.
Prevention of lesions. Antidote and symptomatic therapy. the content of medical care for victims in chemical foci and at the stages of medical evacuation
Lesion prevention and basic principles of treatment. Respiratory and skin protection should be used in a timely manner to prevent skin lesions.
If drops of PR get on the skin or clothes in the first 5 minutes, carry out a partial sanitation with IPP-8. In addition to the topical agent, solutions of 2% monochloramine, 5-10% iodine solution can be used (for skin lesions or wounds with lewisite). After partial sanitation in the next 24 hours it is necessary to carry out full sanitation, ie 6-7 times hygienic washing of the body with soap.
If OP enters the gastrointestinal tract with contaminated water or food, immediately induce vomiting and, if possible, rinse the stomach and esophagus thoroughly with 0.02% manganese solution or water.
Treatment of affected skin rash should be carried out in several areas:
First, it is the treatment of local lesions that may occur due to contact of the skin, mucous membranes of the eyes, respiratory tract and gastrointestinal tract, which reduces the absorption of toxic metabolites formed in the foci and promotes faster recovery of the affected areas … Secondly, carrying out antidote treatment with unithiol lewisite lesions (there is no effective antidote for mustard gas). Third, the use of detoxification methods to remove toxins from the body through the excretory system. Fourth, it is a symptomatic and pathogenetic therapy that helps maintain the basic vital functions of the body.
Only when carrying out these methods of treatment success at rendering of medical care to the affected PR of dermaturic action is possible.
In case of local lesions of the skin, both conservative and surgical methods of treatment can be used. This method of choosing a method depends on the area, depth, location of the lesion, as well as the degree of stress and infection of the blisters.
At conservative treatment methods which are directed on protection of a skin defect against intervention of a secondary infection are used; necrolytic agents for scab rejection; drugs that translate colic necrosis into coagulation, which reduces the regeneration time; tools and methods that stimulate healing processes.
When providing medical care to those affected by oral ingestion of OP into the body, it is necessary to use oxidative solutions (0.02% write me an lab report free manganese solution) in combination with sorbents when gastric lavage.
In case of lesions of the mucous membranes, rinsing with water or 2% soda solution for lewisitis lesions or 0.5% chloramine solution for mustard lesions.
In lewis lesions, antidote treatment with unithiol is performed, which can be used to treat local lesions in the form of a 20% ointment or a bandage moistened with a 5% solution. In the resorptive form of unithiol is administered according to the following scheme: subcutaneously or intramuscularly 5 ml of 5% solution for 1 day 4-6 times with an interval of 4-6 hours; 2-3 days – 2-3 times with an interval of 8-12 hours, in the next 4-5 days 1 time a day.
Detoxification therapy is especially indicated for mustard lesions. Performed by intravenous infusion of 20 ml of 30% sodium thiosulfate solution, as well as canned blood or blood substitute. In lewis lesions – 100 ml of 25% glucose (saline is contraindicated due to possible pulmonary edema).
In complex local and general treatment, pathogenetic and symptomatic therapy corrects the vital processes of major organs and systems. So, at the phenomena of toxemia oxygen therapy is appointed; at disturbances of acid-base balance – alkalis; in cardiovascular insufficiency – cardiac glycosides, adrenaline drugs; with the development of mustard anemia – transfusion of the nuclear fraction of bone marrow and the introduction of vitamin B12, ATP, folic acid; at accession of a secondary infection – antibiotics, sulfanilamide drugs and other. Not the last place, especially at a mustard defeat, plays a balanced and rational food.
The content of medical care for victims in chemical foci and during the stages of medical evacuation. As a result of the application of skin dermal action, a stable focus of slow action is formed on the ground, which will determine the amount of medical care.
Scope of first aid (area of infection):
put on a gas mask after pre-treatment of the eyes with water from a flask and face containing IPP-8; carry out partial sanitation; when PR enters the stomach cause vomiting (outside the area of infection); the affected are evacuated from the infected area.
There are those affected with obvious symptoms of irritation of the eyes and mucous membranes of the respiratory tract, which are evacuated in the first place.
Volume of pre-medical care (BCH):
carry out repeated sanitation with IPP-8; at defeats of eyes and mustard they are washed out by 2% solution of sodium bicarbonate or 0.02% solution of potassium permanganate put syntomycin ointment for age; in case of lewisite – unithiol ointment; at defeat of respiratory organs wash out an oral cavity and a nasopharynx with 2% solution of sodium bicarbonate and give sorbent at hit of OP in a stomach; oxygen inhalation, introduction of camphor according to the indications.
Scope of first aid (PMC):
partial sanitation; at defeat by lewisite enter unithiol; apply a wet bandage with 1-2% solution of chloramine or anti-burn emulsion on the affected areas of the skin with mustard; in case of eye damage, they are washed with a solution of monochloramine (O, 25% – O, 5%) or 2% sodium bicarbonate solution. For ages lay 5-10% syntomycin ointment (for lesions of mustard) or 30% ointment of unithiol (for lesions of lewisite); wash the stomach with 0.02% solution of KMnO4 and give the sorbent; oxygen and cardiovascular drugs according to the indications.
Measures that can be postponed:
prophylactic administration of antibiotics; alkaline inhalations and symptomatic agents.
The severely injured are evacuated in the first place.
Volume of qualified medical care (omedb):
complete sanitation; at the expressed resorptive action enter solutions of hyposulfite of sodium, calcium chloride, glucose, cardiovascular means, alkalis; continue treatment with unithiol according to the scheme; antibiotics are administered; apply syntomycin eye ointment; prescribe antipruritics for skin lesions.
Measures that can be postponed:
alkaline inhalations of the affected respiratory organs; blood transfusion for severe lesions; release of skin blisters.
The lightly affected, in whom after rendering medical care symptoms of defeat are completely eliminated and the general state of health according to the conclusions of doctors is satisfactory, return to the system. Further treatment of the victims is carried out as needed in the relevant military field hospitals.
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