Resuscitation of Chinese medicine poisoning Patients with acute poisoning should be immediately given appropriate first aid and care regardless of the severity of their condition. The principles of dealing with Chinese medicine poisoning are: diagnosis and first-aid care together, inducing vomiting and diarrhea to expel the poison, enhancing detoxification function, accelerating the discharge of the poison, actively rescuing critical symptoms and preventing complications. I. Exclusion of unabsorbed toxins Commonly used Chinese medicines are mostly administered orally, and the drugs are absorbed slowly in the gastrointestinal tract. It has been reported that there are still residues in the stomach after 4 – 6h of oral administration. Therefore, the poison can be expelled from the body before it is fully absorbed. Commonly used methods are: 1, emetic: for early poisoning, 3-4h, the drug is still in the stomach, the general emetic can excite the vomiting center of the medulla oblongata, this effect through the medulla oblongata vomiting chemoreceptor area, or by the stimulation of the gastrointestinal tract, reflexively excite the vomiting center and cause vomiting. Therefore, coma patients should not use emetic, hypertension, esophageal varices, aortic aneurysms, atherosclerosis, heart disease, ulcer disease patients and maternity is also prohibited emetic method. Generally, fingers, tongue depressor, chopsticks, cotton sticks, feathers, etc. can be used to stimulate the mucous membrane of the throat to cause vomiting. If it does not work, drink a glass of concentrated salt water (3%) or a glass of concentrated soapy water. Still ineffective, the use of emetic. You can also use the following emetics, as appropriate, after drinking to stimulate the gastric mucosa, reflexively excite the vomiting center, causing vomiting. (1) 0,2%-0,5% copper sulfate (bile alum) 100-200ml, (2) 1% ZnS04 solution 100-200ml. (3) Iodine with 1ml mixed in 100m1 water. (4) 15-25ml of tincture of thujone, 1g of thujone, add one cup of water and take orally. (5) Guati San: sweet gourd, adzuki beans, tempeh 1g each, decoction of ground water to remove the dregs of warm, not vomiting again; or guati 3g, licorice 9g, decoction of ground water (to remove the dregs). (6) 1,5-3g of white alum, diluted with boiling water, taken internally after slightly warming. (7) 100-300ml of 1:2000 KMn04 solution. (8) 9g each of bitter clove and licorice, finely grinded and taken with water decoction. (9) Sanshing San:6g each of Liru and Bile Alum, lOg of Fangfeng, decoction in boiling water (remove the residue). The above emetic can cause vomiting within 15-30 min after oral administration, and so on several times until the vomiting liquid becomes clear. If oral emetic is not effective, subcutaneous injection of apomorphine (dehydrated morphine) 5-10mg, in 5-10min cause violent vomiting. 2, gastric lavage: where emetic failure or poor results, it is appropriate to use gastric lavage method. Generally in the poison into the body within 4-6h gastric lavage. However, patients suffering from upper gastrointestinal bleeding or gastric perforation, esophageal varices, severe heart disease or aortic aneurysm are prohibited this method. Gastric lavage should not be performed until the convulsions caused by poisoning have been controlled. Commonly used gastric lavage solutions are: (1) warm boiled water or warm strong tea: for acute poisoning of unknown origin. Avoid using hot solution to prevent vasodilatation and promote absorption of the poison, but care should be taken not to overdose, especially for children who have poor ability to tolerate electrolyte loss, and when their body fluids without electrolytes increase by 5%, it can cause water intoxication and induce convulsions or coma. (2) Saline or 1%-2% NaCI solution for arsenical poisoning. (3) 1:2000-1:5000 KMn04 solution, because it is a strong oxidizing agent, the undissolved particles should not be in contact with gastric mucosa or other tissues. (4) 1%-2% NaHC03 solution. Not suitable for strong acidosis because it can produce carbon dioxide and cause gastric perforation or gastric dilatation. (5) 0,2%-4% tannin solution (can be replaced by strong tea) can be used for poisoning with heavy metals and alkaloids, etc. (6) 3% hydrogen peroxide 10ml mixed in 100ml of water can be used for opioid, stannin, cyanide and other poisoning, which can easily produce gas. It is not used for poisoning by corrosive drugs. (7) 15 drops of tincture of iodine dissolved in 500ml of boiling water, can precipitate alkaloids. (8) 5% sodium thiosulfate solution, due to the poisoning of arsenic, mercury, cyanide, etc., can form non-toxic sulfide. (9) One tablespoon of carbon powder is added to 1000ml of water. (10) 5% formaldehyde sodium hyposulfite solution, used for mercury poisoning. (11) 0, 2%-0, 5% activated carbon suspension, except cyanide, can be used for all chemical substances. (12) general antidote (2 parts of medicinal charcoal, tannic acid, magnesium oxide mixture of 1 part each) 30g, add warm boiled water 500ml. Commonly used gastric lavage methods are: (1) oral method: if the patient is awake, can make him quickly drink 200-400ml of gastric lavage solution (generally not more than 500ml, such as too much is easy to flush the poison into the intestines, children at your discretion) and then use your fingers or tongue depressor, spoon handle to stimulate the pharynx cause vomiting, repeatedly, [total amount (1-5) × 104ml], until the wash out liquid clear as water injection. (2) Gastric tube method: The stomach contents should be pumped out as far as possible before lavage. The awake person should be seated and instructed to swallow the gastric tube by himself; the comatose patient should lie on his side with his head slightly lowered and his face on one side to prevent the lavage fluid from flowing into the trachea. Remove dentures, and give appropriate sedation to the extremely irritable first. (3) Gastric lavage method: This method can be used for those who can discharge part of the poison from the stomach after absorption. First, the stomach contents are pumped clean with a gastric tube, and then a tee glass tube is connected to the infusion bottle and gastric tube. 300ml of gastric lavage solution is injected each time, and the glass tube and drainage tube connected to the infusion bottle are opened and clamped in turn. 3, the introduction of diarrhea poison: into the body 5-6h, that is, into the intestinal tract, in order to prevent the absorption of toxic substances, in the emesis or gastric lavage, must be introduced into the diarrhea. Oral or gastric tube injection of salt laxatives to increase intestinal osmotic pressure, stimulate intestinal peristalsis and cause defecation. Commonly used laxatives are: (1) magnesium sulfate 10-30g, add water 200m1 (or 25% -50% solution 30-50ml). (2) sodium sulfate 15-30g, add water 200m1 (or 25% of a 50% solution 30-50ml). (3) Angelica sinensis 9g, rhubarb 30g, alum 30g, licorice 15g, decoction in water. (4) Tianming Jing 60g, Rhubarb 18g, Yuanming Powder 12g, decoction with water. (5) Dahuangmian 6g, Yuanming Powder 9g, taken with boiling water. (6) Da Cheng Qi Tang: Rhubarb 10g, Mangosteen 10g, Hou Pu 6g, Citrus aurantium 6g, decoction with water. (7) Single formula: 20g of Mannitol, 30g of Glycyrrhiza glabra, decoct the juice of Glycyrrhiza glabra, then dissolve the Mannitol and take it. Note: ① If the poison has caused severe diarrhea, it is no longer necessary to use laxatives. ② because magnesium ion is absorbed after the central nervous system inhibitory effect, so the intestinal canal has damage or bleeding, should not use magnesium sulfate, can use sodium sulfate instead. ③ central nervous system depressant poisoning, severe dehydration, corrosive poisoning magnesium sulfate is prohibited. Magnesium sulfate is not suitable for use when the renal function is reduced. Pregnant women try not to use. ④ poisoning caused by fatty poisons avoid the use of oil laxatives. 4, enema: the number of hours of poison eater, laxatives have not yet played a role, available enema method. Available warm water 200-500mI or saline, 1% soapy water, etc., heated about 400C, high enema, to exclude the intestinal tract of the poison, repeatedly. Each enema should be detailed in the amount of people out, especially when heavy metal poisoning enema. According to the condition and actual situation, the following methods can be used: 1. Precipitating agent: Precipitate with the poison to prevent or reduce the absorption of the poison. Commonly used precipitating agents are: (1) tannic acid: can be with strychnine, digitalis and some heavy metals to produce precipitation and prevent its absorption. However, it cannot precipitate the alkaloids contained in poppy husk, magenta, asparagus, etc.. Strong tea can replace tannic acid, but should not stay in the stomach for a long time, so as not to be harmful to the liver. (2) Protein-based foods: such as milk, egg whites, etc. can form precipitates with heavy metals. (3) 10-30 drops of tincture of iodine in 500ml of warm water orally or 1-2ml of compound iodine solution, can form precipitation with quinine, cistinine and lead, mercury, silver and other heavy metals (4) metal precipitating agent, such as magnesium sulfide can generate sulfide precipitation with metal. (5) 5% sodium bicarbonate can precipitate most alkaloids and iron sulfate, etc. 2, absorbent: activated carbon is a good absorbent, can absorb the toxic substances with its surface. Usually 20-30g of activated charcoal is taken internally or instilled. 3.Protective agent: It can protect the mucous membrane of F gastrointestinal tract and reduce the irritation and corrosion of the mucous membrane by toxic substances. Commonly used 5-10 egg whites, milk 100-200ml, soy milk 100-200ml, starch paste or batter, peanut oil, soybean oil or vegetable oil, milk of magnesia, white and powder, lotus root powder, etc. 4, neutralizer: acidosis, available weak alkali (magnesium oxide emulsion, magnesium oxide 0, 2-1g, soapy water, etc.), but can not use sodium bicarbonate, so as not to produce a large amount of carbon dioxide gas and cause gas bloating. Alkalosis, available weak acid (lemon juice, 5% acetic acid, 5%-10% raffinate, etc.) and neutralization. 5.Oxidant: usually use 1:2000 – 1:5000 potassium permanganate solution for gastric lavage to oxidize toxic organic substances and some alkaloids, such as opioids, stilbene, nicotine, toxic lentil, quinine, cyanide, etc. 6, general antidote: (1) activated carbon 4, magnesium oxide 2, tannic acid 2. (2) mung bean and licorice soup. 7, infusion detoxification: available saline, Ringer’s solution, glucose saline, 5%-10% glucose 1000-2000ml, for infusion, so that the body’s toxic substances quickly excreted. For patients with acidosis, in addition to the infusion of general fluids, sodium lactate should be added to correct acidosis. Promote the detoxification and excretion of absorbed toxic substances. 1. Enhance the detoxification function of liver: The detoxification function of liver depends on the content of liver glycogen, and vitamin C has the function of promoting the storage of liver glycogen, so the poisoned patient should be given enough vitamin C and glucose to enhance the detoxification function of liver. 2. (2) A large amount of rehydration can promote the excretion of toxic substances. Nausea and vomiting is feasible with intravenous fluids. (2) Intravenous injection of appropriate amount of saline, 5%-10% glucose or glucose saline. When the kidney function is reduced, extracorporeal circulation, hemodialysis, peritoneal dialysis or conjunctival dialysis method can be used to make the toxic substances eliminated as soon as possible. 3.Promote respiratory detoxification: For patients with volatile poisons and gas poisoning, 10% silicone aqueous solution or 20%-30% ethanol solution can be used in the oxygen wetting bottle, along with oxygen absorption through the mask to keep the respiratory tract unobstructed. 4.Application of special antidote drugs: For the absorbed poison, choosing the appropriate special antidote drugs is the key to success or failure of rescue. Such as cyanogenic glycosides poisoning, available methylene blue (methylene blue), sodium thiosulfate, sodium nitrite and isoamyl nitrite; atropine, scopolamine poisoning with hairy fruit rue alkaloids and toxic lentil base; half asia, tennantine poisoning with ginger, alum; strychnine poisoning with licorice, baicalin, etc. Symptomatic treatment Since poisoning damages the relevant organs to different degrees and produces various symptoms, symptomatic treatment should be carried out at the same time of detoxification and detoxification to avoid delaying the time of rescue and treatment. Commonly used methods are as follows: 1, analgesic: central nervous system damage caused by painful shock, then subcutaneous injection of morphine, 5-10mg per time, 0,1-0,2mg per kg of body weight in children, or intramuscular injection of pethidine hydrochloride (dulcolax) 2-10mg, but when the respiratory center failure or inhibition, morphine is prohibited, pethidine hydrochloride is used with caution, and acupuncture therapy is available. 2, stimulants: central nervous system overexcitation can lead to respiratory center failure or paralysis, it is appropriate to oxygenation, artificial respiration and give ammonia aspiration, or injection of Niclosamide 0, 25-0, 5g, dimethylfrine (Hui Su Ling) 8mg, sodium benzoate caffeine 0, 5g, sanguinarine 10mg, etc.; if the circulatory center failure or paralysis, it is appropriate to use intramuscular or intravenous injection of epinephrine, noradrenaline or Isoprenaline 1-2mg, 1% ephedrine 1-2mg each time (children discretion), nebulized inhalation of human hydroxylamine (Alamine), ascending agents, etc. 3, sedative: central nervous excitement caused by restlessness or convulsions, it is appropriate to briefly use barbiturates, such as sodium pentobarbital, sodium phenobarbital or sodium isopentobarbital 0, 1-0, 3g, intramuscular injection or intravenous injection. When ineffective, you can retain chloral hydrate enema (prohibited in cardiovascular, hepatic and renal insufficiency) or light anesthesia with ether. 4. Anti-infective agent: after 6-12h of poisoning, those with fever and coma should add antibiotics to fight infection. In a word, the antidote for most patients poisoned by Chinese medicine is carried out in an integrated way, and often several methods are carried out at the same time, which can improve the efficacy of the antidote. In order to save space in this book, methods that have been introduced in the general theory are only briefly introduced in each theory. Commonly used detoxification drugs Introduction 1, Western medicine (1) vitamin C: vitamin C is an essential nutrient for the body, maintaining the normal life activities of the body and participating in various metabolic processes of the body. It can promote the accumulation of liver glycogen and strengthen the detoxification function of the liver. Because vitamin C is a reducing agent, high dose application can reduce high iron hemoglobin to hemoglobin to reduce the occurrence of cyanosis, similar to small dose methylene blue. The vitamin C content in the blood of healthy people is 0,5mg% 1,4mg%, slightly higher in women, and the half-life of vitamin C is 16 days. (2) metal complexes: calcium disodium edetate (calcium disodium edetate, calcium ethylenediaminetetraacetic acid, calcium disodium edetate, CaNa2EDTA ), dimercaptopropanol, sodium dimercaptopropanesulfonate, sodium dimercaptosuccinate of which sodium dimercaptopropanesulfonate is the antidote of choice for mercury poisoning, also effective for arsenic poisoning, sodium dimercaptosuccinate is suitable for mercury , arsenic, lead and other metals poisoning. Properly selected metal complexes, injected intramuscularly or intravenously, can be combined with various metals in the body to form stable and soluble metal compounds, which are excreted from the urine and detoxified. (3) Mao Guo Yun Xiang Yin Nitrate (Pitocarpine Nitrate) can detoxify atropine, scopolamine, mandarins, belladonna, etc. 1% solution 0,5-1,0ml each time, subcutaneous injection, once every 15min; 0,1 mg/kg each time for children, subcutaneous or intramuscular injection (4) Atropine Sulfate: intramuscular or intravenous injection, used for a variety of poisoning, can stop glandular secretion, accelerate heartbeat, relax smooth muscle, etc. It can stop glandular secretion, accelerate heartbeat, relax smooth muscle, etc. Each time 0,5-2mg, oral, subcutaneous or intramuscular injection. (5)Propylene morphine (propylene morphine hydrochloride): propylene morphine is similar to morphine chemical structure, but the opposite pharmacological effect, can antagonize many effects of morphine. Each time 5-10mg, subcutaneous, intramuscular or intravenous injection, if necessary 15min later, should not exceed 40mg. (6) Isoamyl nitrite: This product can oxidize hemoglobin ( Fe2 + ) to high iron hemoglobin ( Fe3 + ), the latter combined with cyanide, can make the enzyme bound by cyanide to revive, in order to solve cyanide poisoning. Glaucoma patients are prohibited. (7) Sodium nitrite: The effect is the same as isoamyl nitrite. 3 % solution 10-15 ml is injected slowly intravenously. (8) methylene blue (methylene blue 3% solution 10-15m1, slowly injected intravenously. Hypo methylene blue):This product is a dye with redox effect. 1-2mg/kg of small dose to reduce methemoglobin to hemoglobin, treatment of various causes of methemoglobinemia. 2.Chinese herbal medicine licorice, mung bean, garlic, scutellaria, scutellaria, radish, ginger, white onion, honeysuckle, white fungus root, post plum Chinese herbal compound: (1) Glycyrrhiza glabra soup: 30g of licorice, 60g of mung bean, water decoction, for bitter almond poisoning. (2) Fang Feng 30g, Glycyrrhiza glabra 20g, decoction in water. It is used for poisoning by Cang Er Zi, Castor Seed and Mandarins. (3)Detoxification formula:30g of black bean, 30g of licorice, 15g of capsicum s, 3g of vermilion, add one bowl of cold boiled water, decoct into half a bowl and take with warmth. It is used for poisoning by gold and stone, grass and wood, insects, etc. (4) Detoxification formula: 120g of Panax quinquefolium, 30g of Guanzhong, 30g of Qing Dai, 30g of Licorice, grind together into a powder, mix with honey and make a pill as big as a tung seed, then grind powder of Qing Dai as a coat, take 10-20 capsules per serving with cool boiled water. It is used for various drugs and food poisoning.