carbon monoxide poisoning in children
Introduction
Introduction to carbon monoxide poisoning in children Carbon monoxide is a colorless, odorless, non-irritating odor gas. Carbon monoxide poisoning (gasmonoxide poisoning) is mostly caused by gas pipeline leakage, gas switch failure and operational errors, and roomless ventilation equipment, or gas water heater bathing and ammonia synthesis, coking, steel smelting And household coal stove heating, poor ventilation or improper protection, inhaled carbon monoxide, through the alveoli into the blood circulation, mainly with hemoglobin to form carboxyhemoglobin (HbCO). Because the affinity of CO and Hh is 240 times higher than that of O2 and Hb, the oxygen carrying capacity of blood is decreased. When HbCO is formed, its dissociation is slower than oxidized hemoglobin (HbO2) (only 1/3600), and HbCO The presence also affects the dissociation of HbO2, hinders the release and transmission of oxygen, leads to hypoxemia, causes hypoxia in tissues, and causes death in severe cases. basic knowledge The proportion of illness: the probability of illness in infants and young children is 0.64% Susceptible people: children Mode of infection: non-infectious Complications: cerebral edema pneumonia epilepsy dementia delayed encephalopathy after carbon monoxide poisoning
Cause
Causes of carbon monoxide poisoning in children
(1) Causes of the disease
Carbon monoxide poisoning in children is caused by excessive concentration of carbon monoxide in the living environment.
1. The gas pipe is leaking or the valve is not closed.
2. Carbon monoxide can not be discharged outside, especially when using coal stoves or stoves for heating in cold winter homes. Because of the absence of chimneys in the room or unreasonable installation, the flue blockage and door and window closure are not good, and carbon monoxide cannot be quickly discharged. , causing carbon monoxide accumulation.
3. Engine exhaust and gunpowder explosion Engine exhaust and gunpowder explosions contain a large amount of carbon monoxide, work in a closed workshop, the engine runs for a long time, and the poor ventilation of the workshop causes carbon monoxide accumulation to cause poisoning.
Various other reasons
1. A large amount of carbon monoxide gas can pollute the environment and can also cause poisoning.
2. Suicide or murder.
(two) pathogenesis
1. Carbon monoxide is inhaled and discharged through the respiratory tract. The inhaled CO rapidly diffuses into the blood through the alveolar bubble, and rapidly combines with hemoglobin to form a carboxyhemoglobin which is not easily dissociated. The affinity of CO and hemoglobin is 200-300 times greater than that of oxygen, and the dissociation speed is higher. It is 3600 times slower than oxyhemoglobin. Carbon black hemoglobin not only does not have oxygen carrying capacity, but the presence of carboxyhemoglobin can inhibit the dissociation of oxyhemoglobin, causing the oxygen function of the blood to be impeded, due to the double hypoxia effect of the tissue, the result Causes hypoxemia, causes a series of poisoning symptoms such as tissue hypoxia, and even death.
2, the central nervous system is the least tolerant to hypoxia, cerebral vascular first sacral expansion, increased permeability, severe acute brain edema and focal softening or necrosis, clinical manifestations of increased intracranial pressure, and even the formation of brain hernia. Cerebral ischemia and cerebral edema can be secondary to cerebral circulatory disorders. In severe cases, extensive demyelinating lesions appear, which constitutes a sequela of CO poisoning, causing delayed mental disorders in some patients.
3. At high concentrations, CO also binds to the ferrous iron of reduced cytochrome oxidase, inhibits the activity of enzymes, inhibits cellular respiration and oxidation, and blocks the utilization of oxygen by cells; and muscle red with ferrous iron. Protein binding affects the diffusion of oxygen from the capillaries into the mitochondria within the cell, thereby impairing mitochondrial function.
Prevention
Childhood carbon monoxide poisoning prevention
1. Strengthen publicity and attract people's attention to widely publicize how to prevent carbon monoxide poisoning and carbon monoxide poisoning when winter indoor coal fire is used for heating.
2. Have safety inspection measures to properly use liquefied gas or natural gas, have safety inspection measures, pay attention to ventilation, and prevent carbon monoxide poisoning.
3. Coal stoves must have chimneys and wind hoppers. Pay attention to regular inspections to prevent clogging of the flue and keep the flue.
4. Good ventilation equipment For the production and use of carbon monoxide, such as the factory floor, there must be good ventilation equipment, regular check of the concentration of carbon monoxide in the air, if necessary, install an automatic alarm device to ensure the safety of the production environment.
5. It is forbidden to discharge the exhaust or exhaust gas of the car beyond the standard.
Complication
Pediatric carbon monoxide poisoning complications Complications, cerebral edema, pneumonia, epilepsy, dementia, delayed encephalopathy after carbon monoxide poisoning
1. Myocardial damage, pneumonia, pulmonary edema, etc.
2. Cerebral edema, increased intracranial pressure to form cerebral palsy.
3. The sequelae of CO poisoning include epilepsy, paralysis, memory loss or loss, dementia, and delayed encephalopathy.
Symptom
Symptoms of carbon monoxide poisoning in children Common symptoms Facial congestion is cherry red vertigo, coma, dizziness, nausea, flushing, flushing, abnormality, shortness of breath, short limbs, chills
Due to the different concentrations of carbon monoxide in the environment, the inhalation time is different, so the concentration of carboxyhemoglobin in the blood is different, but the degree of poisoning is proportional to the concentration of carboxyhemoglobin in the blood of the patient. According to the course of disease, it is divided into light, medium and severe.
(1) Mild poisoning, dizziness, headache, dizziness, chest tightness, tinnitus, vertigo, nausea, vomiting, palpitations, fatigue, weakness of the limbs, inconvenience and general malaise, or transient uneasiness.
(2) Moderate poisoning can be seen as flushing, lips are cherry red, sweating is more, heart rate is faster, expression is indifferent, lethargy, or irritability, blood pressure rises first and then falls, and finally enters a coma.
(3) Severe poisoning is unconscious.
1 In the early stage of coma, muscle tension may increase or paroxysmal spasm, abdominal wall reflexes disappear, sputum reflexes increase, breathing is shallow and fast, body temperature rises, and incontinence is incontinent.
2 When the coma is dark, the face is pale, the pupil is narrowed or scattered, the asymmetry is slow, the blood is slow, the blood pressure is decreased, the pulse is weak, the muscle tension is reduced, the tendon is removed, the limbs are cold, the limbs are soft or the hair is strong and convulsions. Serious complications often occur.
Examine
Examination of carbon monoxide poisoning in children
Determination of carbon monoxide concentration in blood:
1 mild poisoning HbCO saturation 10% to 20%.
2 Moderate HbCO saturation is 30% to 40%.
3 severe HbCO saturation is above 50%.
Quick detection method:
1. The child's blood is cherry red.
2. Take 1 to 2 drops of blood and add 1 cup of clear water to red. Normal people are yellow.
3. After 10 ml of distilled water and 3 to 5 drops of blood from the patient, the normal blood is brown and the HbCO blood is red.
4. Take 4ml of 4% bleaching solution and add 2 drops of blood to mix. The normal blood is green or greenish brown, and the blood containing HbCO is pink to dark red.
5. Take 1 to 2 drops of blood in 4 ml of distilled water, add 2 drops of 10% sodium hydroxide solution, and mix the normal blood to be grass yellow. If there is HbCO, it will be pale pink, and it will turn into grass yellow after several seconds.
6. Take 0.5ml of blood and add 1ml of formaldehyde. The normal blood is dark brown clot, while the blood containing HbCO is pink clot.
The HbCO value is expressed in ml/100 ml, and 1 ml/100 ml is equivalent to 5%. Converting ml to mmol should be divided by 2.24:
Mum%=(ml%÷2.24)
If the result of HbCO is in ml%, then: mmol = (1.39 × Hb × HbCO) ÷ 100
According to clinical needs, blood gas analysis, chest X-ray, brain CT and other examinations were selected.
Diagnosis
Diagnosis and diagnosis of carbon monoxide poisoning in children
diagnosis
A clear history of poisoning and clinical manifestations can be confirmed in combination with laboratory findings.
Differential diagnosis
Different from other causes of coma and disturbance of consciousness, it relies mainly on clinical manifestations and laboratory findings.
