The difference between poisoning and accidental first aid

The core difference between poisoning and accidental first aid is essentially "complete differences in the priority of tracing the source of inducements, the first action of handling, and the boundaries of taboos." This is the most intuitive feeling I have accumulated after spending 6 years in a community first aid station and performing more than 300 on-site rescues.

Last Wednesday, our station received two police calls from the same community on the same day. Aunt Zhang’s wife on the third floor was cleaning the window and fell down when she fell, causing her head to be covered in blood. Aunt Li’s 4-year-old son on the fifth floor secretly swallowed half a bottle of adult nifedipine. The two groups of people arrived at the scene almost at the same time, and their handling ideas were very different.

When the old man fell, our first reaction was to touch the carotid artery, pat his shoulders and call his name to confirm his consciousness. Then we used sterile dressing to compress the arterial bleeding point on his forehead. We did not dare to move his neck casually during the whole process, for fear of injuring his cervical spine when he fell, and causing secondary damage if he moved randomly. As for why he fell? Whether it was because of a sudden stroke or because of a cerebral infarction that caused dizziness and falling down. This is something that can only be asked slowly after the bleeding has stopped and the vital signs have stabilized. It cannot be delayed.

But it is different for children who have taken antihypertensive drugs. The first thing we asked when we entered the door was: "How much did you take, how long did you take it, and where is the medicine bottle?" ”Without even taking his temperature, he first picked out the remaining drug residue in his mouth to confirm that he had not swallowed corrosive drugs. He immediately used a tongue depressor to induce vomiting. After he had almost vomited, he took his blood pressure and put him on ECG monitoring.

Ten years ago, there was a popular saying in the emergency circle that "all unexplained faintings should be treated as trauma first." Later, after encountering several cases of gas poisoning, people fainted and broke their heads, everyone gradually changed the consensus: In this kind of compound situation, the priority of poisoning is much higher than that of trauma - no matter how fast you stop the bleeding, the person has been breathing high-concentration carbon monoxide for half an hour, and still can't save him. Even when it comes to "whether to induce vomiting first when poisoning", there is no absolutely unified standard in the industry: if you eat corrosive poisons such as strong acids, strong alkalis, and toilet cleaners, you must not induce vomiting. The refluxed corrosive liquid will burn the esophagus and throat more severely when vomiting. The year before last, I received a patient who accidentally ingested oxalic acid. The family was so panicked that they forced him to drink soapy water to induce vomiting. In the end, the esophagus became narrow and he couldn't even swallow liquid food.

Many ordinary people are confused about the taboo boundaries between the two situations. For example, if you encounter a trauma and fracture, if you move casually, you will only poke the bone stubble into nearby blood vessels and nerves. In severe cases, you may even become paraplegic.； But as long as the poisoned patient is still conscious, it doesn't matter if you drag him a few steps or hold his head while inducing vomiting. The key point is to quickly expel the unabsorbed poison and don't stay in the body and act like a monster. Oh, yes, there is also a folk trap. Many people are given mung bean soup and milk when they are poisoned, saying that it can detoxify. According to clinical guidelines, only medical activated carbon is clearly capable of broad-spectrum adsorption of poisons. Milk can only temporarily relieve the irritation of corrosive poisons on the stomach wall when there is no activated carbon. If you really drink pesticides or eat poisonous mushrooms, no matter how much milk you give, it will not be as effective as sending the hospital to the hospital for gastric lavage.

Last time, a novice volunteer who had just passed the exam followed the police and met a man who had drunk half a bottle of dichlorvos. When he came up, he wanted to lay the man down and pinch him, but I pulled him away - he can still hum. Why pinch him? I should induce vomiting first! He just treated the poisoning as an ordinary unexpected fainting, almost delaying the golden half hour.

The most common pitfall for ordinary people is poisoning that looks like an accident. Last winter, there was a young man who was burning charcoal in a rented house for heating. He fainted and fell off his chair, with a big bump on his forehead. When his roommate came back from get off work, his first reaction was, "Oh, I hit my head, please send me to the hospital for a CT scan." If his roommate had kept the door closed for a few minutes while carrying him, he might have died if he had taken two more puffs of carbon monoxide.

Speaking from my heart-felt experience, if you encounter something and you really can't tell whether it's poisoning or an accident, don't blindly Baidu it yourself. When you call 120, report everything you can see clearly - whether there are empty medicine bottles on the ground, whether there is a strange pungent smell, whether the person suddenly collapsed or fainted after falling. The dispatcher will teach you on the phone what to do immediately, which is 10,000 times better than trying to figure it out on your own. After all, when it comes to first aid, a difference of three to five minutes makes a huge difference.