Respiratory depression

Introduction Respiratory depression is more common in opioid poisoning: 1. The clinical manifestations of mild opioid poisoning are headache, dizziness, nausea, vomiting, excitement or inhibition. The patient has illusions, lost time and space. 2. In severe poisoning, there are three major signs of coma and dilated pupils such as needle tip size and severe respiratory depression. Patients may have convulsions, closed jaws, and angular arches. Breathing becomes shallower and slower, followed by sigh-like breathing or tidal breathing, often accompanied by pulmonary edema. Acute poisoning died of respiratory failure within 12 hours. 3. Chronic poisoning mainly manifests as loss of appetite, constipation, weight loss, aging and sexual dysfunction.

Cause

The main active ingredient of opioids is morphine (about 10%), most of which is metabolized in the liver, excreted in the kidneys within 24 hours, and only traces in the urine in 48 hours. Morphine is first excited by the central nervous system, and then inhibited, but mainly by inhibition. Morphine first inhibits the high-level center of the cerebral cortex, and later involves enlarging the brain, inhibiting the respiratory center and exciting the chemosensory area. Morphine enhances the excitability of the spinal cord, increases the gastrointestinal smooth muscle and its sphincter tone, reduces intestinal peristalsis, and has similar effects on the bronchial, bile duct, and ureteral smooth muscle.

Large doses of morphine can inhibit the medullary vasomotor center and release histamine, causing peripheral blood vessels to dilate resulting in hypotension and bradycardia. One time misuse of large or frequent application of morphine can cause poisoning. The morphine poisoning rate was 0.06 g in adults and the lethal dose was 0.25 g; the lethal dose of dry opioid was 10 times that of morphine, and the oral lethal dose was 2-5 g. The codeine toxicity is 1/4 of morphine, the toxic dose is 0.2 g, and the lethal dose is 0.8 g. Long-term use of morphine can cause euphoria and addiction. Patients with chronic diseases such as liver disease, emphysema, bronchial asthma, anemia, thyroid or chronic adrenal insufficiency are more likely to develop poisoning. With alcoholic drinks, even if the treatment dose of morphine, poisoning may occur. Barbiturates and other hypnotic drugs have synergistic effects with this class of drugs, and should be used with caution.

an examination

Related inspection

Maximum exhalation mid-flow flow breath test breath test

1. There is a history of applying excessive opioids.

2. Clinical manifestations: Mild poisoning is headache, dizziness, nausea, vomiting, excitement or inhibition. In severe poisoning, coma, dilated pupils such as needle tip size and difficulty breathing. Chronic poisoning is mainly characterized by loss of appetite, constipation, weight loss, aging and sexual dysfunction.

3. Urine and stomach contents are detected in the presence of opioids.

Differential diagnosis

It needs to be distinguished from the following symptoms: Respiratory failure: Respiratory failure is a serious disorder of respiratory function, which prevents normal breathing at rest, hypoxia or carbon dioxide retention, and causes a series of clinical and metabolic disorders. In the early stage of illness, only breathing is strong. When it is severe, it is not easy to breathe, sweating is dripping, nails and nails are prominent, mental function changes, directional dysfunction, headache, insomnia, sorrow, irritability, turmoil, and then lethargy, causing coma, convulsions , heart rate is accelerated, blood pressure is elevated, skin vasodilatation and the like. Some severe patients have oliguria, lower extremity edema or liver damage and gastrointestinal bleeding. Open mouth breathing: children with adenoid hypertrophy, rhinitis, severe nasal septum deviation, etc., because the nasal cavity or the nasal cavity is partially or completely blocked, the ventilation is not smooth, the child will breathe, and the mouth breathing will cause the child to have a jaw. Sudden deformity. Chest breathing: chest breathing is also called rib breathing, horizontal breathing. This breathing method relies on the lateral expansion of the ribs to inhale, and the ribs are lifted by the intercostal muscles to enlarge the thorax. In other words, when inhaling, the shoulders are lifted up, and the breath is absorbed shallowly, so it is also called shoulder breathing method, clavicle breathing method or high chest breathing method.

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