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🎣 | Carbon monoxide poisoning by fishing smelt Transported by two men and a XNUMX-year-old boy helicopter Minamifurano-cho, Hokkaido


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Carbon monoxide poisoning by smelt fishing Transport by helicopter for two men and a XNUMX-year-old boy

 
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At Lake Kanayama, four men fishing for smelt had just been transported by carbon monoxide poisoning on the 10th.
 

Around 12:11 am on the XNUMXth, at Lake Kanayama in Minamifurano-cho, Hokkaido, a man said, "My son got sick and vomited." → Continue reading

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Carbon monoxide poisoning

Carbon monoxide poisoning(Isansantansudoku, akaCO poisoning) IsCarbon monoxideIt is a poisoning symptom caused by.

Cause

Mechanism of pathogenesis is not fully understood[1]However, it is considered as follows. Carbon monoxide is about 200-250 times as much as oxygenRed blood cellInhemoglobinEasy to combine with[2]In addition, it modulates the relationship between the partial pressure of oxygen and the concentration of oxyhemoglobin. Hemoglobin has four oxygen-binding sites, and the larger the number of bonds, the more stable the bond becomes. That is, when the oxygen is transported to a tissue with low peripheral oxygen partial pressure, the bond of oxygen begins to dissociate, but as the amount of bonded oxygen decreases, the dissociation becomes easier, so that oxygen is efficiently released in the peripheral region. However,Hemoglobin (), in which one of the four binding sites is bound to carbon monoxide, stabilizes oxygen bound to other sites and makes it difficult to release it, reducing the oxygen carrying capacity of blood and reducing oxygen partial pressure in the periphery. Extremely low and causes symptoms of poisoning[Source required].

Carbon monoxide is generated with combustion even if it is not in an oxygen-deficient state,Coal mineAccumulates when there is an explosion accident in a room or when there is poor ventilation in an underground space.charcoalUse of stove,Gas water heater,Stove OfIncomplete combustionIt causes poisoning symptoms due to a rapid increase in the amount generated. For this reason,Air pollutionPertaining toEnvironmental standardsFor more information, see “The daily average of hourly values ​​is 1 ppm And the 8-hour average value is 20 ppm or less.''Industrial Safety and Health ActAccording to the Office Hygiene Standards Regulations based onAir conditioning equipmentOr in offices with mechanical ventilation, it is specified to be 10 ppm or less.

In addition, the formerCity GasContains carbon monoxideCoal gasWas used, a poisoning accident caused by a gas leak occurred, but on March 2010, 3Shikoku Gas Natural gasLastly, the city gas supplied in Japan did not contain carbon monoxide, and carbon monoxide poisoning due to gas leaks no longer occurred.[3]. Also,tobaccoIt is also contained in a large amount in the smoke, and it exerts a great burden on the circulatory system, but acute concentrations do not cause acute symptoms.[1].. However, apart from the above acute poisoning, if a small amount of carbon monoxide is inhaled continuously (repetitively) for a long period of time, chronic poisoning symptoms such as headache, dizziness, and deterioration of mental function.[4]May be present.

In addition, carbon monoxide poisoning due to fire is also known. In case of fire,ア ク リ ル,PolyurethaneUnder the influence of thermal decompositionHydrogen cyanideIn some cases, carbon monoxide poisoning is accompanied by hydrogen cyanide poisoning.

symptom

Acute symptoms
After 1 hour exposure, symptoms start to appear at 500ppm, significant symptoms at 1000ppm, and 1500ppm.DeathLeading to. It is impossible to be aware of carbon monoxide poisoning, and it is possible to die without being aware of the danger[5].
In mild cases,headache・Tinnitus・dizzy・Nausea etc. appears,coldBecause it resembles the symptoms of, the treatment of carbon monoxide is delayed. Then, although he was conscious, his body gradually lost his liberty, and by the time he suspected carbon monoxide poisoning (and when he inhaled a high concentration of carbon monoxide), he rapidly became conscious without feeling any symptoms.lethargyFall into. In this case, a vicious circle that continues to breathe high concentrations of carbon monoxide as it is, eventually breathing and cardiac functions are suppressed and 7% die, and even if they surviveMandibular mandibular syndromeorImmobilitySevere brain organ disorder called[6]And deafness[7]Remains.
Hemoglobin appears bright red when combined with carbon monoxide, so addicts appear to have a pink "good" complexion.[8].
Intermittent type (delayed neurological symptoms)
Acute carbon monoxide poisoning may develop and recover once with hyperbaric oxygen therapy, causing cognitive dysfunction (difficulty in communication, behavioral disorders, urinary incontinence, etc.) for several days to one month.[9]But,dementiaMay be mistaken for[6].

Diagnosis

Symptoms of poisoning include headache, tinnitus, dizziness,NauseaConfirm the diagnosis based on clinical symptoms such as the above and measurement of blood carbon monoxide-bound hemoglobin (COHb) concentration[1]However, this is due to the property that hemoglobin is more likely to bind to carbon monoxide than oxygen, as described above.

As mentioned above, due to the effect that the blood color of poisoned patients looks "good",AbsorbanceIn the bloodOxygen saturationMeasurePulse OximeterCannot give an exact value. Respiratory monitoring with pulse oximeter is not effective in this disease[1][8].

Arterial blood gas analysis shows that PaCO2 Values ​​decrease and vascular permeability increases as metabolism increasesacidosisBecame severe[10][Source invalid]bloodIs concentrated, so the Hct value rises. Modality tests show pulmonary edema, cerebral edema, and, in severe cases, a low absorption area of ​​the pallidum (due to decreased cytochrome C oxidase activity).[11].

EEGOn examination, slow waves and low potential appear.

治療

Since carbon monoxide binds to hemoglobin more strongly than oxygen, patients with carbon monoxide poisoning have systemic oxygen deficiency, and measures against oxygen deficiency are essential for initial treatment.[6]Therefore, treatment is oxygen inhalation, but even if pure oxygen is inhaledBreatheInsufficient oxygen inhales in high pressure tankHyperbaric oxygen therapyMay do[12].. However, it is not clear whether to prioritize normobaric oxygen therapy or hyperbaric oxygen therapy.[12].

However, brain cells (especiallyBasal ganglia) As a sequelaeParkinsonism(Due to damage to the basal ganglia)Numbness(Abnormal feeling) often occurs.

In addition,Pale sphereNecrosis ofDemyelinating diseaseThere is also a sequela that develops several days to several weeks after it seems to have recovered due to the gradual progression of the disease. This is called chronic poisoning (intermittent carbon monoxide poisoning), etc., as distinguished from immediately after poisoning (of acute poisoning).

EEG abnormalitiesSuch asHigher brain dysfunction,Consciousness disorder,Involuntary movement,Intellectual disability,Personality disorder,Euphoria,Parkinsonism, Symptoms such as neuropathy[6], As in the early stages of poisoningHyperbaric oxygen therapyCarry out. When the aftereffect of carbon monoxide poisoning appears, if it is mild, it may be gradually relieved over time in about one year together with hospitalization treatment for several months and the aftereffect may completely disappear, If the necrosis of the pallidum is severe, such as when it has progressed severely, complete healing is usually not expected[13][14].

(I.e.

Gas alarmIs used to detect the concentration of carbon monoxide in the air. When the concentration exceeds a certain level, an alarm sounds to indicate the danger.

Source

footnote

  1. ^ a b c d Carbon monoxide(CO) Addiction Merck Manual
  2. ^ Toru Takahashi, "Possibility of carbon monoxide (CO)/CO free molecule as therapeutic agent for acute lung injury“Endotoxins and Innate Immunity Research” 2018 Volume 21, p.62-65, two:10.24753 / jeiis.21.0_62, Japanese Society for Endotoxin and Innate Immunity
  3. ^ "Termination of supply of city gas containing carbon monoxide". Ministry of Economy, Trade and IndustryPress release, March 2010, 3. 2013/10/17Browse.
  4. ^ Son Fujun, Hiroshi Nitta, Kazuma Maeda and others,About personal exposure concentration of carbon monoxide and indoor concentration measurement result in Korea』Journal of Air Pollution Society, 1990, Vol. 25, No. 5, p.334-342, two:10.11298 / taiki1978.25.5_334Atmospheric Environment Society
  5. ^ Carbon monoxide poisoning Poisoning information center (PDF)
  6. ^ a b c d Masazumi Harada, Koichi Mimura, Motoaki Takagi, Eisuke Fujita, Shiro Sumiyoshi, Kohei Miyagawa, Nobuyuki Hotta, Tsubasa Fujino, Kenichi Okahara, Makiko Motooka "40 years from Miike Mikawa coal dust explosion Long-term prognosis of carbon monoxide poisoning (PDF) "Social Relations Research," Vol. 15, No. 2,Kumamoto Gakuen University, November 2010, pp. 3-1, ISSN 13410237, NOT 110007607493, 2014-5-17] Browse.
  7. ^ Kazumi Makishima, "Clinicopathology of inner ear and central conduction pathway disorders due to carbon monoxide poisoning”Journal of the Japan Society for Otolaryngology, 1972, Vol. 75, No. 11, p.1225-1228_2, two:10.3950 / jibinkoka.75.1225, Japan Society of Otolaryngology
  8. ^ a b Why you can't spot carbon monoxide poisoning with a pulse oximeter
  9. ^ Intermittent carbon monoxide poisoning must be suspected in rapidly advancing cognitive impairment Nikkei Medical Online Article: November 2013, 11, View: November 11, 2013
  10. ^ dandy_club et al (February 2004, 2). “● Burns and acidosis ●”. Yahoo! JAPAN. 2017/8/14Browse. “When the amount of oxygen decreases, it becomes anaerobically supplied and lactic acid synthesis itself increases. Also, as a result of the decrease in circulating blood volume, the metabolic capacity in the liver also decreases, so the blood that could not be processed together is blood. It overflows inside (and the amount of blood that serves as a saucer is small), which causes rapid acidosis. "
  11. ^ "Q & A related to carbon monoxide poisoning symptoms, causes, diagnosis, and treatment methods”. Goo. 2017/8/14Browse.
  12. ^ a b Kiyotaka Koshi, Takaaki Beppu, "Should hyperbaric oxygen therapy be prioritized for carbon monoxide poisoning?"Journal of the Japanese Society of Emergency Medicine" 2013 Volume 24, Issue 4, p.237-238, two:10.3893 / jjaam.24.237, Japanese Society of Emergency Medicine
  13. ^ Tachitsu MasajunIn addition, "Electroencephalographic study of carbon monoxide poisoning patients who were mass-produced by a coal dust explosion," "Psychiatry and Neurology Magazine," Vol. 69, No. 1,Japanese Psychiatry Society, November 1967, pp. 1-71, ISSN 00332658, NOT 40017965637.
  14. ^ Tachitsu MasajunIn addition, "Electroencephalographic study of carbon monoxide poisoning patients who were mass-produced by a coal dust explosion," "Psychiatry and Neurology Magazine," Vol. 69, No. 1,Japanese Psychiatry Society, November 1967, pp. 1-71, ISSN 00332658, NOT 40017965637.

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外部 リンク

Emergency services

Emergency services(Kyukyutai,English: Ambulance service or emergency medical service) is an appropriate treatment for an injured person who arrives at an emergency site.Emergency medical care) PromptlyambulancehospitalTransport toTroopsThat.

Japanese emergency services

Firefighters in JapanI am also in charge of emergency transportation, and ambulance teams throughout the countryFire Department,Fire departmentIt is installed in.FirefighterTrained in the first-aid course, and a captain/member and engineer (driverIt is a rule that three members form a group), but from April 3, one out of three members of a rescue team such as a remote island or a depopulated area will be a quasi-emergency team member (with local government staff, etc.). It has become possible to consist of persons who have completed the basic training regarding emergency services.

Until now, ambulance personnel were not allowed to carry out medical care merely by transporting the injured person to the hospital.Paramedic National ExaminationTake the examParamedicThe qualified and certified membersDoctorUnder the instructions ofCardiopulmonary arrestFor victims of the conditionSecure venous accessAnd used equipmentAirway security(Tracheal intubation・ ・Laryngeal maskEtc.) Further drug administration has become possible.2014ToshockIs suspected orCrash syndromeFor victims who are suspected to haveSecure venous accessblood sugarBy the fixedHypoglycemiaFor victims ofGlucoseSolution administration was added. These treatments are called specific acts.

Secured space for lifesaving in emergency departments nationwideHigh standard ambulanceIs deployed, and the goal is to have at least one paramedic on board. On the other hand, at the branch offices, branch offices, and detachment offices of the small-to-medium-sized fire department with limited personnel,Firefighter,rescue teamThere are also cases where they concurrently serve.

In the case of "emergency fire fighting" municipalities that do not have permanent fire fighters, local government staff only carry out emergency transportation,First aidHowever, medical care is not possible when performing emergency work by a local government employee who does not have a qualification as a paramedic.2015, An emergency paramedic belonging to a private company accompanies the “Yakusho Ambulance”, and the “Emergency Lifesaving Service Consignment”, which performs the same medical practice and lifesaving work as a normal rescue team, was carried out for the first time in Japan, the first company in Japan.Japan emergency system"ButMiyazakiMisato TownandTokushimaKatsuura TownIt is being carried out by commissioning from.

Thai emergency services

ThailandIn 2008Thai National Emergency Medical CenterUntil the establishment, there was no ambulance as a government agency. Therefore, even after the establishment of a public ambulance, the transportation of the injured to the hospital, disaster rescue activities, etc.ZendoIt is often done by a Buddhist volunteer group called. To a prominent groupOverseas Chinese report,Taikoku Yoshitokuzendo, There is a temple and a temple.

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