有机磷中毒患者的救护PPT课件

2018/6/27,有机磷农药中毒Organophosphorus Poisoning,护理学院 卢海霞 2014.06.05,1,Emergency Nursing,患者，女，48岁，喝下敌敌畏后出现恶心、呕吐、流涎、口吐白沫、抽搐、神志模糊，医护人员检查发现双侧瞳孔缩小，闻到大蒜性臭味，迅速送入医院抢救。1、案例中发生了什么情况？2、如何判断及急救？,Case,Contents,掌握有机磷农药中毒的临床表现掌握有机磷农药的急救原则及措施,Toxic Mechanisms,乙酰胆碱（Ach）在体内积聚,胆碱能神经兴奋和中枢神经调节功能紊乱,M受体平滑肌、分泌腺,N受体心血管、骨骼肌,神经系统,Signs and symptoms,Muscarinic Effects【毒覃碱样症状】A、平滑肌：缩瞳、恶心、呕吐、腹痛、腹泻、支气管痉挛B、分泌腺：口吐白沫、大汗淋漓C、心血管：血压下降 可用阿托品对抗,呼吸衰竭,Nicotinic Effects【烟碱样症状】 A、心血管：血压升高，心率加快，病情进展时出现心率减慢，心律失常 B、骨骼肌：先兴奋，肌束颤动；而后转入肌无力，产生呼吸肌麻痹,Signs and symptoms,呼吸衰竭,CNS effects头痛、头昏，乏力，烦躁；抽搐、脑水肿、昏迷。呼吸、循环衰竭而死亡。,Signs and symptoms,呼吸衰竭,Take Notice,OdourMiosis is often a helpful diagnostic sign since the other signs may be confused with other conditions.The primary cause of death is respiratory failure,患者，女，48岁，喝下敌敌畏后出现恶心、呕吐、流涎、口吐白沫、抽搐、神志模糊，迅速送入医院抢救。医护人员检查发现双侧瞳孔缩小，闻到大蒜性臭味。,Case,Lab investigations,Specific test：Cholinesterase assays,General Strategy,Detox Resuscitation Airway、Breathing 、CirculationDrugs,Detox-first aid,remove patient from the place of exposure remove contaminated clothing skin, eyes washed thoroughly assess breathing, circulation place patient in left lateral position with head lower than feet to reduce risk of aspiration,Detox,EmesisGastric LavageKatharsis,Occasion:越早越好【6小时内】Liquid:2小苏打洗胃最佳【敌百虫除外】Temperature:2530Outcome:颜色、气味,Resuscitation-A+B+C,Airway:开放呼吸道【吸痰】Breathing:维持呼吸，给氧，气管切开Circulation:维持循环,Due to muscle fasciculations (twitching), the diaphragm may be paralysed, so they is a need to elective intubation and ventilation.,Drugs,Atropine & PralidoximeEarly,Enough,Combined,RepeatAtropinization：阿托品化,Comparison,Conclusion,Signs and Symptoms Muscarinic, Nicotinic, CNS Respiratory Failure Treatment DABCD,References,张波,桂莉. 急危重症护理学M,2013,第三版,北京.人民卫生出版社. Coulson JM.The efficacy of pralidoxime in organophosphorus poisoning: a commentaryJ.J Postgrad Med. 2014,60(1):31-32.Ahmed SM, Das B, Nadeem A,et al.Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospitalJ.Indian J Anaesth. 2014