The victim feels satisfactory and may not complain.

The victim feels satisfactory and may not complain.

Damage to the membranes is indicated by the presence in the edematous fluid of almost the same amount of protein as in the circulating plasma.

For TNL-causing substances, the target cells are preferably endothelial. But the primary biochemical disorders that occur in them are heterogeneous. The selectivity of the lesion is determined by the chemical structure of the lesion agent. Phosgene is characterized by reactions with NH2-, OH-, and SH- groups. The latter are widely represented as components of proteins and their metabolites, and the onset of intoxication may be related to the alkylation of these groups of radicals.

Membrane damage occurs by activation of lipid peroxidation. Biochemical disorders lead to inactivation of adenylate cyclase, drop in ATP content and intracellular water retention. Intracellular edema develops. Then there is damage to subcellular organelles, which lead to the release of lysosomal enzymes, disruption of ATP synthesis and lysis of target cells.

Local disorders include damage to the pulmonary surfactant. With toxic pulmonary edema, the surfactant content in the alveoli decreases, and in the edematous fluid increases, which contributes to the destruction of producer cells, acidosis and hypoxia. This leads to a decrease in the surface tension of the swollen exudate and the presence of additional obstruction to external respiration.

The permeability of the capillary and alveolar walls is disturbed at the same time. It has been observed that pulmonary edema can be divided into several phases.

And – interstitial – vascular fluid sweats in the interstitium from the vascular space. During the interstitial phase there is a compensatory acceleration of lymph outflow by about 10 times.

This reaction of the device is insufficient and the extravascular fluid breaks into the cavity of the alveoli.

Phase II develops – alveolar, which is characterized by the sudden appearance of clinical signs of pulmonary edema.

Significant inflow of fluid from the blood leads to its thickening (at the beginning of poisoning may be a short-term vacuum). The amount of hemoglobin increases to 140%, a significant increase in the number of erythrocytes, which leads to increased blood viscosity.

As a result, in the midst of intoxication, the blood becomes “viscous” tar-like in nature. Bleeding in this case causes significant difficulties. Coagulation at the height of pulmonary edema, compared to normal (150 sec.), Can be accelerated by 6 times, increased coagulation and blood viscosity are the cause of blood clots, which often complicate intoxication by suffocating PR.

The increase in blood viscosity creates a strong obstacle to blood circulation and has a very beneficial effect on the heart. Progressive hypoxia, as well as the accumulation in the blood of products of incomplete metabolism further complicate the activity of the myocardium and can lead to a weakening of the left heart.

All the moments that lead to an increase in tissue oxygen consumption in a person suffocated by suffocating PR can provoke an attack of acute pulmonary edema, which will cause hypoxia and death from cardiac arrest and respiration.

The main cause of death in intoxication with suffocating PR is hypoxia 123helpme.me, as a consequence of total pulmonary edema. At the same time, the mechanism of suppression of vital functions can be different, depending on a number of conditions.

Thus, under the action of very high concentrations of phosgene, death can occur as a result of depression of the respiratory and vascular center without the development of pulmonary edema. But this cause can also occur in the terminal stage of intoxication, which occurs with pulmonary edema.

Very often the death of poisoned occurs from cardiovascular failure, which develops against the background of severe oxygen starvation and impaired blood circulation caused by pulmonary edema.

The course of poisoning

Depending on the concentration of OP in the air and the time a person is in an infected atmosphere without protective equipment, severe, moderate and mild lesions can occur.

Easy degree. The initial stage is moderate, the latent period is longer. After that, the signs of pulmonary edema disappear, leaving only signs of tracheobronchitis. There is a slight shortness of breath, weakness, dizziness, palpitations, light cough. Objectively – runny nose, hyperemia of the throat, single dry rales. All these phenomena pass in 3-5 days, the affected person recovers.

Moderate degree of damage – after a period of apparent well-being (6-12 hours) develops pulmonary edema, which covers only parts of the lungs. There is partial pulmonary edema. At the beginning of pulmonary edema, the general condition of the victim deteriorates. Shortness of breath, cyanosis – moderate. On the second day from the beginning of the regression, the general condition of the victim improves. The length of stay in medical institutions is 2-3 weeks.

The clinic of severe phosgene damage in the dynamics of development can be divided into 5 stages: reflex, latent, severe symptoms of pulmonary edema, regression of poisoning, the stage of long-term consequences.

The reflex stage reflects the first manifestations of poisoning, which occur in the victim as soon as he entered the atmosphere of the PR without a gas mask. Subjectively, there is a characteristic smell of rotten hay, an unpleasant taste in the mouth. The victim complains of a small tingling in the eyes, a feeling of itching in the nasopharynx, some compression in the chest, dizziness, heaviness in the area under the xiphoid process, cough. Sometimes there is nausea and vomiting. All these symptoms may be inconspicuous or sufficiently pronounced. When in an atmosphere containing high concentrations of OP, reflex respiratory arrest or reflex laryngospasm and bronchospasm are possible.

During this period, the affected can objectively establish the acceleration of respiration, shortness of breath, as well as some slowing of the pulse.

When leaving the infected atmosphere, the subjective sensations persist for a few minutes and then disappear, feeling better – the lesion goes into a stage of latent action, which is called the stage of imaginary well-being. The duration of this stage can vary from 1 hour to 8 hours. In mild form, the latent period lasts at least 3-5 hours, in severe 1-3 hours. Thus, the greater the stage of imaginary well-being, the more favorable will be the course of the lesion.

At very high concentrations of phosgene, this stage may be absent.

Symptoms of the latent period are very complex. The victim feels satisfactory and may not complain. Diagnosing the lesion at this stage is quite difficult, but it should be emphasized that the latent period is not an asymptomatic period.

There are a number of objective signs that together allow you to diagnose the presence of the lesion. These include:

acceleration of respiration with a simultaneous slowing of the pulse, resulting in a change in the usual ratio between these values ​​(normally it is approximately 1: 4 -16 breaths at a pulse rate of 64 beats / min.); reduction of pulse pressure due to reduction of the maximum arterial pressure at preservation without changes of diastolic pressure; low condition of the diaphragm; reduction of absolute dullness of the heart; decrease in hemoglobin and in 1 mm of blood; there is some decrease in oxygen in the arterial blood; with exercise, shortness of breath and cyanosis occur more quickly.

It should be noted that a smoker, after inhaling phosgene, will feel immediately to tobacco. In the diagnosis of poisoning for this period is also important to take into account the anamnestic data (the reliability of being in the gas wave), the simultaneous receipt of a number of victims, the presence of characteristic odors of phosgene from the hair and uniforms of the victim.

The period of latent phenomena is often gradually, and sometimes suddenly changed by the stage of development of pulmonary edema.

Shortness of breath, which develops in the latent stage, increases, there is a strong anxiety of the victim. There is a general weakness, headache, cough, which gradually worsens, the body temperature rises.

In the clinical course of the lesion there is a symptom complex, which is called “blue” hypoxia. The teacher demonstrates the table “Blue and gray form of hypoxia” and the model “Blue form of hypoxia”.

The skin and visible mucous membranes turn blue, and the accessory muscles begin to take part in the respiratory act.

Percussion sound acquires a boxy hue. At auscultation at first asymmetry of breath is characteristic – its weakening mainly on one of the parties of a thorax. Then in the lower parts (under the shoulder blades) crepitation is manifested, then small-bubble rales are heard. With the development of edema, the number of rales increases, at the height of the edema, the breath becomes gurgling. With cough, serous, frothy sputum, sometimes from blood impurities, pink color. The amount of fluid released can be huge and reach 1.0-1.5 liters per day. F. Fleury figuratively characterizes phosgene poisoning as “drowning on land.”

Against the background of deteriorating respiration, cyanosis, which covers the skin of the face, hands, there are changes in the function of the cardiovascular system. The pulse accelerates sharply, becomes soft, easily compressed.

The maximum blood pressure is reduced and kept within 90-95 mm Hg. Heart tones are weakened, the pulmonary artery is accented, and sometimes its tone is split. Body temperature during this period rises sometimes 38-39oC. Affected complain of headache, weakness, and sometimes dizziness. Negative factors that contributed to this serious condition are physical exertion, prolonged transportation, hypothermia, and so on.

In severe cases, “blue” hypoxia can go away in a state of so-called “gray” hypoxia. Sometimes this condition can occur immediately at the first symptoms of pulmonary edema.

If in the “blue” type of hypoxia the condition of the cardiovascular system is still satisfactory, then in the “gray” type develops acute cardiovascular failure (collapse): the pulse accelerates to 120-140 beats. / min., weak filling and tension. Blood pressure drops catastrophically (less than 70 mm Hg).

The skin and visible mucous membranes acquire a gray-ashy earthy color, which is due to the desolation of superficial vessels and the accumulation of blood in the internal organs. There is a cold sticky sweat, shortness of breath (such as Cheyne-Stokes or Kussmaul).

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