1、11/2/2018,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
2、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
3、 衰竭,Take Notice,Odour Miosis 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
4、 assays,General Strategy,Detox Resuscitation Airway、Breathing 、Circulation Drugs,Detox-first aid,remove patient from the place of exposure remove contaminated clothingskin, eyes washed thoroughlyassess breathing, circulationplace patient in left lateral position with head lower than feet to reduce r
5、isk of aspiration,Detox,Emesis Gastric Lavage Katharsis,Occasion:越早越好【6小时内】 Liquid:2小苏打洗胃最佳【敌百虫除外】 Temperature:2530 Outcome: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 t
6、o elective intubation and ventilation.,Drugs,Atropine & Pralidoxime Early, Enough, Combined, Repeat Atropinization：阿托品化,Comparison,Conclusion,Signs and Symptoms Muscarinic, Nicotinic, CNSRespiratory Failure TreatmentDABCD,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 pral
7、idoxime 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. 2014,58(1):11-17.,Thinking,有机磷农药中毒的临床表现为？ 有机磷农药中毒急救原则？ 在急救的过程中需要注意哪些问题？ QQ： 2335995415,11/2/2018,Thank You ！,The End,
