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Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.
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Objective@#To report a case of rat poison with multiple hemorrhage after trauma.@*Methods@#The clinical data of a case of rodenticide poisoning with hemorrhage as the first symptom admitted to a third-class a hospital in July 2018 were analyzed and summarized.@*Results@#This patient is a rodent drug poisoning patient with hemorrhage as the first symptom.The disease was diagnosed as bromohamelin and bromadiolone poisoning through the analysis of poison detection because the rodent drug was taken in the market and the history of taking poison was concealed. The patient was given active comprehensive treatment of vitamin K1 and other drugs for clinical cure.@*Conclusion@#For patients with clinically unexplained hemorrhage, the possibility of rodenticide poisoning should be considered and the toxicant detection should be improved actively.
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Objective@#To investigate an occupational hazardous gas poisoning incident caused by gas leakage in the process of hazardous waste treatment.@*Methods@#An investigation was conducted on a case of occupational acute hazardous gas poisoning caused by waste treatment gas leakage in Shandong province in December 2017. Meanwhile, the clinical data of 5 cases of poisoning patients were analyzed, and the accident related poison test report and other relevant data were analyzed.@*Results@#The incident was caused by the toxic waste did not do labeling work, the workers' protection measures were not in place, the illegal operation and the blind rescue, resulting in a total of 5 people died on the spot, 12 people were hospitalized with poisoning. Among them, 5 patients admitted to our hospital showed varying degrees of damage to the nervous system and respiratory system. After active treatment, they all got better and were discharged.@*Conclusion@#The poisoning is mainly caused by hydrogen sulfide dichloromethane hydrogen cyanide gas leakage serious production liability accident, clinical main performance for the nervous system circulatory system respiratory system and other system damage.
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Objective@#To investigate a poisonous mushroom poisoning incident and analyze its clinical data.@*Methods@#Investigate a poisonous mushroom poisoning incident in a place in Shandong in July 2018, at the same time, the clinical data of 2 cases of mushroom poisoning were analyzed and summarized.@*Results@#The incident was caused by a poisoning incident caused by residents eating poisonous mushrooms. The poisonous mushroom in this incident was identified as a scaled white goose cream. Two patients with poisoning developed gastrointestinal symptoms such as nausea and vomiting, abdominal pain and diarrhea, and liver damage occurred later. After active rescue and treatment, one patient was discharged from hospital, and the other patient developed acute pulmonary embolism during the treatment. He was discharged after interventional thrombolysis and follow-up treatment.@*Conclusion@#After investigation, the incident was caused by the ingestion of poisonous mushrooms mainly based on the scalloped white goose cream. After active treatment, they were cured and discharged.
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Objective@#To explore the acute toxicity of Diquat in mice and to calculate the median lethal dose (LD50) of Diquat to rats and observe the pathological changes of tissues and organs in rats with different concentrations of Diquat.@*Methods@#Diquat solution of 50 mg/kg was prepared freshly with 1 000 mg of Diquat and dilute the solution with water to a total of 20 ml. A total of 99 healthy adult male Wistar rats were randomly divided into part one, part two and control groups. In the first part, 36 rats were randomly divided into 4 groups: 100 mg/kg group, 200 mg/kg group, 300 mg/kg group and 400 mg/kg group, which were treated with 100 mg/kg, 200 mg/kg, 300 mg/kg and 400 mg/kg of Diquat solution by gavage, respectively. The death and symptoms of poisoning after intragastric administration were recorded, and the maximum tolerated dose and absolute lethal dose were measured. In the second part, 54 rats were randomly divided into 6 groups: 200 mg/kg group, 220 mg/kg group, 240 mg/kg group, 260 mg/kg、280 mg/kg group and 300 mg/kg group, whichwere treated with 200 mg/kg, 220 mg/kg, 240 mg/kg, 260 mg/kg, 280 mg/kg and 300 mg/kg of Diquat solution by gavage, respectively. The survival of rats in different concentration of Diquat was observed and the LD50 was calculated by Excel processing the formula of Koch's method. The control group were given equal volume water under the same experimental conditions. And moreover, the lungs, kidneys, hearts, livers, and brain tissues were collected and fixed by formaldehyde, embedded by paraffin, and sectioned for histopathological light microscopy.@*Results@#The maximum tolerated dose was 240 mg/kg and the absolute lethal dose was 300 mg/kg. The LD50 of Diquat for Rats was 280.58 mg/kg. The high-dose group had significantly more organ damage than the low-dose group after diquat poisoning.@*Conclusion@#The determination of the half-lethal dose of diquat, at the same time observed multiple organs damaged in rats after the diquat quickly poisoned. Kidneys, lungs and heart might be the main organ which was heavily damaged. With the extension of observation time, the organ damage of rats exposed to small doses gradually stabilized.
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Objective@#To investigate an incident of mushroom poisoning and related clinical data.@*Methods@#A descriptive analysis was performed to investigate an incident of poisonous mushroom poisoning in Jinan, Shandong Province, China in July 2016. The clinical data of four patients were analyzed and summarized, and the causes of this incident and prevention and control measures were summarized.@*Results@#This incident of acute poisonous mushroom poisoning was caused by Lepiota brunneoincarnata. The patients mainly had digestive system symptoms, including nausea, vomiting, and severe abdominal pain, and later developed liver damage. After comprehensive rescue treatment, one patient died and three survived. The main clinical manifestation of the patient who died was multiple organ failure, especially liver failure.@*Conclusion@#This incident of poisoning was caused by Lepiota brunneoincarnata the residents ate by mistake.
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Objective@#To investigate the causes of peripheral vascular thrombosis in patients with paraquat poisoning.@*Methods@#The patients with paraquat poisoning who were admitted to our department in recent two years were observed to screen out the patients with large vessel thrombosis. The data on toxic exposure history, clinical features, and treatment were collected to analyze the causes of thrombosis in the patients with paraquat poisoning.@*Results@#Three patients had typical lower limb thrombosis. There was one case of right common femoral vein thrombosis, one case of bilateral calf muscle vein thrombosis, and one case of right calf superficial vein thrombosis and right calf muscle vein thrombosis.@*Conclusions@#After paraquat poisoning, the blood is in a hypercoagulable state and prolonged bed rest may increase the risk of thrombosis.
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Objective@#To investigation to an accident of occupational trichloroethylene explosion and analyze the clinical datas.@*Methods@#An investigation was carried out on the explosion of trichloroethylene in a place in shandong province in June 2016, and the clinical data of 4 patients with trichloroethylene poisoning were analyzed.@*Results@#The incident is caused by irregularities in workers, 4 patients were characterized by different levels of the respiratory system, nervous system, liver, and skin lesions. Among them, respiratory system damage was more prominent, mainly manifested as chemical bronchitis and pneumonia, after positive rescue and treatment all recovered and discharged.@*Conclusions@#Trichloroethylene leak can cause severe ex-plosion accidents, can cause workers of the respiratory system, nervous system, liver and skin lesions, mainly glucocorticoids comprehensive therapy has good curative effect.
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Objective@#To investigate and analyze the clinical data of tetramine poisoning in a family and prevent similar incidents from happening again.@*Methods@#The study was conducted in July 2016 in a fami-ly with thiamine poisoning in shandong province, and the clinical data were analyzed.@*Results@#In this case, there are six cases of poisoning caused by the tetramine poisoning, and the convulsions are the main clinical manifestations, and the blood perfusion can have a good effect on the severe patients. After positive treatment, all 6 patients were cured.@*Conclusions@#The tetramine poisoning can cause severe convulsion, although the country has banned the production and use of it, the tetramine poisoning case still exist and cannot be ignored.
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Objective@#To investigate an accident of occupational acute hydrogen sulfide poisoning, and to analyze related clinical data.@*Methods@#An investigation was performed for an accident of occupational acute hydrogen sulfide poisoning in a place in Shandong, China, in July 2016, and related clinical data were summarized.@*Results@#This was a typical accident of occupational acute hydrogen sulfide poisoning, and a lack of occupational protection and illegal operation were the major causes of this accident. Of all five patients, four experienced coma, toxic encephalopathy, and respiratory failure and were cured at last, and one had cortical syndrome after long-term treatment and died of pulmonary infection seven months later.@*Conclusions@#In case of occupational acute hydrogen sulfide poisoning, rescuers should help the persons who are poisoned reasonably and meanwhile ensure their own safety.
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Objective@#To observe the therapeutic efficacy of alanyl glutamine injection on patients with gastrointestinal function obstacle caused by severe phorate poisoning.@*Methods@#A total of 80 eligible patients with gastrointestinal function obstacle caused by severe phorate poisoning were randomly divided into the control group (n=40) and treatment group (n=40) . The control group was treated with the conventional therapy, which included forbidden diet, atropine, pralidoxime iodide, anti-inflammatory, albumin infusion, ω-3 fish oil fat emulsion, protection of organs function, blood perfusion, and Fat Emulsion, Amino Acids (17) and Glucose Injection. The treatment group was treated with alanyl glutamine injection plus the conventional therapy. To observe the time of recovering to normal of gastrointestinal function between the two groups, compared the AChE activity and changes of prealbumin, albumin and total protein of the two groups respectively. Furthermore, the total atropine dosage, the total pralidoxime iodide dosage and ICU stay time between the two groups were also compared.@*Results@#The gastrointestinal function recovery time of patients in the treatment group was less than the control group, the difference was statistically significant (P<0.05) . From the third day of treatment, the serum cholinesterase activity of the treatment group was higher than the control group, the difference was statistically significant (P<0.05) . On the 5th day and 10th day of the treatment, the prealbumin, albumin and total protein of the treatment group were significantly higher than these indexes of the control group in the same period, the difference were statistically significant (P<0.05) . The total atropine dosage, the total pralidoxime iodide dosage and ICU stay time in the treatment group were lower than the control group, the difference were statistically significant (P<0.05) .@*Conclusion@#Alanyl glutamine injection has a great therapeutic effect for gastrointestinal function obstacle patients caused by severe phorate poisoning.
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Objective@#To investigate a mass incident of bromadiolone poisoning and analyze related clinical data.@*Methods@#An investigation was performed for a mass incident of bromadiolone poisoning in a place in Shandong, China in December 2015, and related clinical data were analyzed and summarized.@*Results@#This incident was a mass incident of bromadiolone poisoning caused by spreading poison. The poisoned patients had major clinical manifestations of bleeding and coagulation disorder and all of them were cured after comprehensive rescue, especially after intravenous drip of vitamin K1.@*Conclusion@#Bromadiolone poisoning can cause severe visceral hemorrhage and coagulation disorder, and intravenous drip of vitamin K1 has a good therapeutic effect.
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Objective@#To establish to paraquat poisoning acute lung injury animal model to study the therapeutic effect of Salvia polyphenols acid salt of paraquat-induced acute lung injury.@*Methods@#Adult male Wister rats 120, were randomly divided into three groups: the paraquat exposure group, the start of the experiment to give a one-time 20% paraquat dope orally 50 mg/kg body weight of rats; salvianolate treatment group, the start of the experiment paraquat to give a one-time 20% the stock solution orally 50 mg/kg body weight of rats, and then given daily intraperitoneal injection of 200 mg/kg body weight of rats salvianolate; blank control group was given the same amount normal saline. The exposure group, the treatment group and control group rats were sacrificed after anesthesia in the 3rd, 7th, 14th, 21st day from the beginning of the experiment respectively, and taken out and preserved venous blood specimens and lung tissue to be tested. Venous detection heme oxygenase-1 (HO-1) , the lung tissue detection heme oxygenase-1 (HO-1) , hydroxyproline (HYP) . And do biopsy specimens from some of the lung tissue, HE and Masson staining observed by optical microscope.@*Results@#Compared with control group, model group 7, 14, 21 days had elevated levels of serum and lung tissue HO-1 (all P<0.05) ; Treatment group 3, 7, 14, 21 days increased (all P<0.05) , and 3, 7, 14 days is higher than the model group (compared with model group, P<0.05) . Compared with control group, treatment group 3 days and model group, 14, 21 days HYP content in lung tissue increased significantly (all P<0.05) ; 21 days, compared with model group, HYP content of treatment group reduce obviously, the difference was statistically significant (P<0.05) . Optical microscope observation, lung tissue damage and aggravated with the experimental increase in the number of days, inflammatory cell infiltration, alveolar septal fibrosis gradually formed. The treatment group experimental animal lung tissue to reduce inflammation, lung fibrosis relief.@*Conclusion@#Paraquat (50 mg/kg body weight) to fill the stomach can be induced model of acute lung injury in the rats. The serum HO-1 expression and HO-1, HYP content in lung tissue increased obviously in model rats. Salvia miltiorrhiza polyphenols acid salt to a certain degree and stage influenced the expression of HO-1 and HYP, relieve acute lung injury and pulmonary fibrosis, has certain curative effect in the treatment of paraquat poisoning.
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Objective@#To investigate a mass of occupational acute methyl bromide poisoning incident and analyzed their clinical data.@*Methods@#To investigate an incident a mass of occupational acute methyl bromide poisoning in occurred in Shandong province in November 2016, and the clinical datas of 3 cases of severe patients with methyl bromide poisoning were analysed.@*Results@#This event was a sudden occupational poisoning incident. Lack of vocational training and irregularities is the main reason for the accident 3 patients with nervous system, respiratory system, circulatory system, urinary system damage is given priority to, after comprehensive rescue treatment, 2 cases died and 1 case survived.@*Conclusions@#Methyl bromide can cause severe poisoning, has high mortality in patients with acute severe poisoning.
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Objective@#To study the therapy of cordyceps-astragalus-salvia miltiorrhiza in treating acute lung injury and pulmonary interstitial fibrosis induced by paraquat poisoning.@*Methods@#All 120 adult Wister male rats were randomly assigned to three groups, the paraquat poisoning group (rats were intragastric administration paraquat 50 mg/kg body weight once at the beginning) , the cordyceps-astragalus-salvia miltiorrhiza therapy group (rats were given cordyceps-astragalus-salvia miltiorrhiza 90 mg/kg body weight intragastric administration half an hour after paraquat was given, then the same dose was given once a day) ; control group (rats were intragastric administration with physiological saline) . At 7th, 14th, 21st, and 28th day rats were sacrificed postanesthetic respectively after paraquat exposure, sample of lung tissue, bronchoalveolar lavage (BAL) , and venous blood were collected. GSH, SOD, TNF-α, TGF-β1, and HYP in plasma, bronchoalveolar lavage (BAL) , and the lung homogenates were determined. Optical microscope was performed to examine pathological changes in lung.@*Results@#Each experimental time point paraquat group and the treatment group rats serum SOD content significantly lower than the control group (P<0.05) . Each experimental time point the treatment group rats serum SOD levels increased significantly than that of paraquat group (P<0.05) . Each experimental time point paraquat group rats serum GSH content significantly lower than that of the control group (P<0.05) . Treatment group rats 7 days time GSH content significantly lower than that of the control group (P<0.05) . Treatment group 21 days, 28 days GSH content was increased significantly than that of the paraquat group (P<0.05) . Each experimental time point paraquat group rats alveolar lavage SOD content was significantly lower than that of the control group (P<0.05) . Treatment group 7 days, 14 days time SOD content was significantly lower than that of the control group (P<0.05) , Treatment group 21 days, 28 days SOD content was increased significantly than that of the paraquat group (P<0.05) . Each experimental time point paraquat group and the treatment group rats alveolar lavage GSH content significantly were lower than that of the control group (P<0.05) . Treatment group days 14 and 21 days, 28 days GSH content was increased significantly than that of the paraquat group (P<0.05) . Each experimental time point paraquat group rats alveolar lavage TNF α levels was higher than that of the control group (P<0.05) . Treatment group 7 days, 14 days the rat alveolar lavage TNF α levels was higher than that of the control group (P<0.05) . Treatment group 21 days, 28 days TNF α content significantly was decreased than that of paraquat group (P<0.05) . Paraquat group days 14 and 21 days, 28 days HYP content was significantly higher than that of control group (P<0.05) . Treatment group 21 days HYP content was significantly higher than that of control group (P<0.05) . Treatment group 28 days time HYP content in lung tissue of rats was significantly decreased than that of the paraquat group (P<0.05) . Each experimental time point paraquat group rat lung tissue (tissue homogenate) TGF-β1 content was higher than that of the control group, the difference was statistically significant (P<0.05) . Under optical microscope, the tissue damage of lung was aggravated, and reduced after cordyceps-astragalus-salvia miltiorrhiza was administrated.@*Conclusion@#Cordyceps-astragalus-salvia miltiorrhiza can reduce inflammation factor releasing, and relieve lung injury. It has therapeutic effect on lung injury induced by paraquat poisoning.
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<p><b>OBJECTIVE</b>To observe the prevention effects of patients with lung exudation and pulmonary fibrosis induced by paraquat poisoning in sodium bicarbonate (SB) with gastric lavage, atomization inhalation and intravenous injection.</p><p><b>METHODS</b>To collect 38 patients with paraquat poisoning in hospital, after poison immediately with gastric lavage of 1.5% SB, and atomization inhalation of 5% SB 10~15 ml twice daily and intravenous injection of 5% SB twice a day, continuous application of 5~7 days. and the HRCT score and liver and kidney function was performed on patients with lung after treatment. And the extraction of 38 SB patients with previously untreated with SB for comparison.</p><p><b>RESULTS</b>Lung HRCT average score in 72 h, 7 d, 30 d on patients with paraquat poisoning untreated with SB reached 2.87, 3.12, 2.13, HRCT display shows that the appearance of the wear glass shadow, grid shadow, honeycomb shadow, and other signs of fibrosis. Average HRCT reached 1.95, 2.20, 1.67 on patients treated with SB,signs of lung exudation and fibrosis was significantly reduced,compare two groups,there was statistically significance (P<0.01). And compared to the control group, activity of serum alanine aminotransferase (ALT) and aspartic acid transaminase (AST) decreased significantly in group of paraquat poisoning with triple application of SB, the level of serum urea nitrogen (BUN) and creatinine (Cr) significantly decreased, the difference is statistically significant (P<0.01).</p><p><b>CONCLUSION</b>The triple application of SB can reduced the pulmonary fibrosis and effusion induced by paraquat poisoning,and protective effect on the function of liver and kidney is obvious, suggesting that the method for treatment of paraquat poisoning, prevention of paraquat lung and improve survival rate has the exact effect.</p>
Subject(s)
Humans , Blood Urea Nitrogen , Creatinine , Blood , Gastric Lavage , Injections, Intravenous , Lung , Pathology , Paraquat , Poisoning , Pulmonary Fibrosis , Therapeutics , Sodium Bicarbonate , Therapeutic Uses , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical efficacy of early application of sequential gastrointestinal lavage in patients with acute paraquat poisoning by analyzing the clinical data of 97 patients.</p><p><b>METHODS</b>A total of 97 eligible patients with acute paraquat poisoning were divided into conventional treatment group (n = 48) and sequential treatment group (n = 49). The conventional treatment group received routine gastric lavage with water. Then 30 g of montmorillonite powder, 30 g of activated charcoal, and mannitol were given to remove intestinal toxins once a day for five days. The sequential treatment group received 60 g of montmorillonite powder for oral administration, followed by small-volume low-pressure manual gastric lavage with 2.5%bicarbonate liquid. Then 30 g of activated charcoal, 30 g of montmorillonite powder, and polyethylene glycol electrolyte lavage solution were given one after another for gastrointestinal lavage once a day for five days. Both groups received large doses of corticosteroids, blood perfusion, and anti-oxidation treatment. The levels of serum potassium, serum amylase (AMY) alanine aminotransferase (ALT), total bilirubin (TBIL), blood urea nitrogen (BUN), creatinine (Cr), lactate (Lac), and PaO₂of patients were determined at 1, 3, 5, 7, and 10 days. Laxative time, mortality, and survival time of dead cases were evaluated in the two groups.</p><p><b>RESULTS</b>The incidence rates of hypokalemia (<3.5 mmol/L) and AMY (>110 U/L) were significantly lower in the sequential treatment group than in the conventional treatment group (P < 0.05). There were no significant differences in the incidence of ALT (>80 U/L), TBIL (>34.2 µmol/L), BUN (>7.2 mmol/L), and Cr (>177 µmol/L) between the two groups (P>0.05). However, the highest levels of ALT, TBIL, BUN, Cr, and Lac were significantly lower in the sequential treatment group than in the conventional treatment group (P < 0.05). Moreover, the sequential treatment group had significantly lower incidence of PaO₂(<60 mmHg), shorter average laxative time, lower mortality, and longer survival time of dead cases than the conventional treatment group (P < 0.05).</p><p><b>CONCLUSION</b>The early application of sequential gastrointestinal lavage can shorten laxative time, alleviate organ damage in the liver, kidney, lung, and pancreas, reduce mortality, and prolong the survival time of dead cases in patients with acute paraquat poisoning.</p>
Subject(s)
Humans , Acute Disease , Bentonite , Bilirubin , Blood Urea Nitrogen , Charcoal , Combined Modality Therapy , Creatinine , Gastric Lavage , Methods , Liver , Paraquat , Poisoning , Poisoning , Therapeutics , Treatment OutcomeABSTRACT
Objective To investigate the effect of extraction of radix isatidis on the expression of transforming growth factor(TGF-β)in lung tissues of rats with radioactive lung injury.Methods 72 female Wistar rats were randomly divided into 3 groups,blank control group(groupA,n=24),simple irradiation group(group B,n=24),irradiation with Chinese medicine group(group C,n=24).Rats in group A and group B were given distilled water 2 mL/200g by gavage for one week,the rats in group C were given extraction of radix isatidis 2 mL/200g(1.6 g/200 g)per day for one week,then the rats received irradiation,during irradiation,the rats' weight was measured once a week,to illuminate the end.After 10-time irradiation(the 30th day), and at 60 days and at 120 days after irradiation,the expression levels of TGF-βin lung tissue were detected;In addition each rat lung tissue morphology was observed.Results The expression levels of TGF-βprotein in group B reached peak at the 30 days after irradiation,which at different time points in group A and group C was significantly lower than that in group B(P<0.01).Rats of group A had no significant change in lung tissue.Rats of group B were observed inflammatory cells in interstitial pulmonary alveolar,alveolar structural damaging,interstitial pulmonary edema,interstitial hemorrhage and inflammatory pulmonary with alveolar cavity;Rats of group C pulmonary interstitial fewer inflammatory cells in alveolar damage were not obvious, with no-pulmonary interstitial edema, hemorrhage and no inflammatory symptoms, comparison between group B and C was not obvious. Conclusion Extraction of radix isatidis could reduce the expression levels of transforming growth factor(TGF-β)in lung tissues of rats with radioactive lung injury ,has better preventive effect on radioactive lung injury,could protect lungtissue from damaging,inhibite alveolar permeability,and present the effect of pulmonary edema.