Paraquat (PQ), also known as gramoxone, is a pyridine-type herbicide. It is one of the most toxic herbicides widely used in rural areas of China. 1. Clinical information After taking the drug, there are nausea, vomiting, abdominal pain, difficulty in swallowing, and different degrees of respiratory function and renal and cardiac failure, and even coma. 2. Resuscitation 2.1 Gastric lavage Once oral administration is detected, gastric lavage should be performed as early as possible, repeatedly and thoroughly, with 5000-10000ml each time, starting 48h, 2 times/d. When intubating, pay attention to gentle movements and adequate lubrication to reduce the stimulation of the gastric tube on the pharynx and esophagus and avoid aggravating the damage to the upper gastrointestinal tract, and let the patient take a low left-sided position so that the gastric lavage fluid can fully dilute the toxic substances on the entire gastric mucosa and achieve the purpose of The purpose of thorough gastric lavage. The positive and negative pressure of the gastric lavage machine should not exceed 0.03 MPa, and the amount of gastric lavage should not exceed 500 ml per lavage, but 300-400 ml is the best, and the amount of lavage and suction should be balanced. During gastric lavage, the color and nature of the lavage solution should be closely observed, and the lavage solution should be taken locally. According to the characteristics of paraquat, choose water, 2% sodium bicarbonate solution, mud water, 30% bleaching earth solution, activated carbon suspension, soap water, washing powder water, etc. After gastric lavage, introduce adsorbent and keep gastric tube for injecting laxative, such as 20% mannitol, 33% magnesium sulfate solution or sodium sulfate solution, and inject food and medicine from gastric tube when you cannot eat, and perform gastrointestinal decompression to suck out residual poison if necessary, and know whether there is upper gastrointestinal bleeding in time. 2.2 Blood perfusion Paraquat will reach its peak 2h after it is absorbed by human body. After 15-20h, paraquat will combine less with plasma protein and accumulate in lung and other tissues in different degrees. There is a rapid exchange balance between paraquat in blood and organs rich in blood transport, such as liver, kidney and heart, and a slow exchange balance with lung; as the concentration of paraquat in blood decreases, paraquat in organs will be partially released. The clearance rate of paraquat by blood perfusion is 5-7 times higher than that by hemodialysis, especially for patients with moderate poisoning and unknown poisoning dose. The best period for cleansing and detoxification is within 10 hours after poisoning, and most of them miss the best period; therefore, early hemoperfusion is the most effective measure to reduce the damage of paraquat to target organs and improve the prognosis, especially for patients who cannot monitor blood and urine paraquat concentration, this effective measure of hemoperfusion should not be easily abandoned. Our clinical observation suggests that early blood perfusion can save the lives of some patients, but repeated perfusion often makes the disease rapidly aggravated, probably due to the adsorption of therapeutic drugs in the process of blood perfusion. 2.3 Adsorption and catheterization Similac, activated charcoal, bleaching earth and mannitol were used to adsorb and catheterize the toxic substances in the digestive tract to stop the continued absorption of toxic substances by the digestive tract mucosa. Operation method: Take 30g of Simethicone, 30g of activated charcoal, 50g of bleaching earth, and 250m of 20% mannitol, alternate with oral administration q6h or q8h depending on the amount of poisoning, and continue oral administration until the color of the patient’s stool changes from green to bleached white. In order not to affect the digestion and absorption of food, adsorbent laxative should be taken orally 2h before meal, and food should be taken only after 2h interval. The nurse should strictly observe the color of patient’s stool, the greener the stool color is, the more paraquat is in the intestine, and observe and record the number and amount of bowel movements in order to determine the toxic exclusion. If the patient has serious gastrointestinal bleeding, perforation and other complications, laxative is prohibited. 2.4 Drug treatment The mechanism of paraquat poisoning is not very clear. It is usually believed that paraquat is an electron receptor which can be distributed in various tissues and organs, especially via type I and II alveolar cells which actively take up paraquat from blood and accumulate in the lungs. Paraquat acts on intracellular redox reactions, generates free radicals in cells and causes lipid peroxidation in cell membranes, thus causing cellular tissue damage. At present, there is no special antidote for paraquat poisoning. Clinical treatment includes: (1) high-dose methylprednisolone and cyclophosphamide therapy, which aims to prevent pulmonary fibrosis; (2) antioxidants and free radical scavengers, such as high-dose vitamin C, vitamin E, vitamin B1 and reduced glutathione; (3) antibiotics to prevent secondary infection; (4) rehydration and diuresis to facilitate excretion of toxic substances; (5) symptomatic and supportive treatment. 3 , care 3.1 Oral and dietary care After oral absorption of poisoning, the whole digestive tract of the patient may cause burns, firstly, there is corrosion and ulceration of the mucosa of the oral cavity, pharyngeal cavity and esophagus, followed by bleeding of the digestive tract. During the acute period, fasting, good oral care, gentle movements to prevent bleeding, as well as observation of oral mucosal erosion, infection and bleeding. After eating, patients should be encouraged to eat. If they cannot eat due to oropharyngeal pain, 200ml of saline with 100mg of lidocaine can be used to allow patients to gargle to relieve pain. Start to eat milk, soybean milk, rice soup and other fluids as the main food, eat less and more meals, gradually increase eggs, lean meat and other highly nutritious food, if it is difficult to eat, can be nasal feeding through the gastric tube. During the recovery period, give a high-calcium diet and eat more bone broth and shrimp to prevent osteoporosis. 3.2 Monitoring and nursing of lung function The lung is the main target organ of paraquat poisoning and has active uptake and accumulation characteristics. Patients appear acute respiratory failure earlier and may develop into pulmonary fibrosis, with clinical manifestations of chest tightness, shortness of breath and progressive aggravation of dyspnea. When monitoring pulmonary function, in addition to observing the patient’s respiratory rate, rhythm, depth and color of the extremities and lips, oxygen saturation monitoring and blood gas analysis are more important indicators for monitoring pulmonary function. The patient should be advised to rest in bed absolutely, adopt semi-recumbent position, encourage the patient to breathe deeply, pat the back to assist the patient in sputum removal, and do all the life care. Keep the room quiet and fresh air, give low-flow oxygen inhalation or no oxygen inhalation, because high-flow oxygen inhalation can aggravate the pulmonary toxicity of paraquat, only give high-flow oxygen inhalation when PaO2<40mmHg and severe hypoxic symptoms appear. Early application of mechanical ventilation when respiratory failure and ARDS occur. It is appropriate to use nasal mask non-invasive ventilation to reduce patients' oral pain and facilitate oral care, and tracheotomy is performed in severe patients to implement invasive mechanical ventilation. 3.3 Blood purification care Patients with paraquat poisoning are mostly treated with blood perfusion to remove intra-plasma toxins. When performing blood perfusion treatment, closely observe the changes of patients' vital characteristics, record them every 15-30 min and report problems to the doctor in time. The puncture site should be bandaged with pressure, and the puncture site should be closely observed for blood oozing, and the patient should be observed for vomiting, hemoptysis and bleeding tendency. Patients with renal impairment mainly present with oliguric renal failure, and may suddenly develop acute renal failure in the absence of urine. Urine volume is the most direct indicator of renal function, so the 24-h urine volume should be accurately recorded in nursing work, and the color change of urine should be observed, and urine specimens should be collected daily for examination and blood collection to monitor changes in renal function. 3.4 Psychological care Patients are always in a clear state of mind and their psychological state is constantly changing. Different psychological care should be given according to the psychological state and personality characteristics of patients at different times. Usually, the early stage shows agitation, anger, irritability and non-cooperation with treatment; the middle stage shows regret and depression; and the late stage shows fear and sadness. Nurses should seize the key period of implementing psychological guidance, use psychological care such as understanding, sympathy, listening and caring, understand their inner emotional reactions, treat them with kind words and sincere love, so that they can establish confidence in life; help them analyze the reasons for conflicts and make sincere suggestions; and keep secrets to maintain patients' privacy and self-esteem, so as to facilitate a good recovery of patients' mental state The patient's mental state should be well recovered. While correctly guiding the patient, it is important to do a good job of visitors, visitors to the patient to understand and respect, more about the patient's past merits, the use of amiable, optimistic and open-minded attitude, avoid the reasons for drug consumption, fuss and even sarcastic blame. Medical and nursing staff and their families try not to talk about the condition and prognosis in front of the patient, timely feedback of good information to the patient, and as far as possible to meet the patient's needs in the ward system allows, so that their relatives accompany the patient, so that the patient's psychology to get a security and comfort. Individual patients are bent on seeking death, completely lose confidence in life, and have the tendency to commit suicide again after admission, manifested by very confrontational emotions, refusing treatment, care, visits and food, and attempting to unplug various monitoring leads and treatment tubes, even hitting the bed gear with their heads and struggling to get out of bed to seek death. Such patients should be strengthened early protection, fixed with guardrails and restraint belts, and guarded around the clock. When the emotions are stable, then reason with them, move them, tell them to be calm, seek common ground and keep small differences, resolve conflicts through normal channels, and finally dispel the idea of light-heartedness, establish a belief in life and a self-respecting and self-improving outlook on life, and actively cooperate with treatment and care.