Cyanide Burns and Combined Poisoning

Introduction Cyanide can be divided into inorganic cyanide and organic cyanide according to its chemical structure, and the latter is called nitrile compound. Cyanide burns and combined poisoning can reduce the arteriovenous blood oxygenation of acute poisoning patients from 4% to 5% of normal to 1% to 1.5%, which may cause paralysis of the respiratory center and cause death. The main clinical manifestations of cyanide poisoning are fatigue, chest pain, chest tightness, dizziness, tinnitus, dyspnea, arrhythmia, dilated or enlarged pupil, aging or tonic convulsions, coma, and finally death, heartbeat and death. Diagnosis can be based on the patient's medical history and the clinical manifestations of the poisoning.

Cause

When cyanide enters the body, cyanide ions rapidly combine with the ferric oxidase of oxidized cytochrome oxidase, hindering the reduction of cytochrome to a cytochrome oxidase with ferrous iron, so that the cells cannot get enough oxygen, resulting in "Intracellular suffocation."

an examination

Related inspection

Blood routine lesion

The main clinical manifestations of cyanide poisoning are fatigue, chest pain, chest tightness, dizziness, tinnitus, dyspnea, arrhythmia, dilated or enlarged pupil, aging or tonic convulsions, coma, and finally death, heartbeat and death. Diagnosis can be based on the patient's medical history and the clinical manifestations of the poisoning.

Differential diagnosis

Differential diagnosis of cyanide burns and combined poisoning:

1, acid burn

Commonly used are sulfuric acid, hydrochloric acid, and nitric acid burns. In addition, there are hydrofluoric acid, carbolic acid, oxalic acid and the like. They are characterized by the precipitation and coagulation of tissue dehydrated proteins, so that the wounds become rapidly formed and the boundaries are clear after burns, thus limiting the continued erosion to the deep.

1 sulfuric acid, hydrochloric acid, nitric acid burns: sulfuric acid, hydrochloric acid, nitric acid burns a higher incidence of acid burns accounted for 80.6%. The burnt surface of sulfuric acid was black or brownish black; the one with hydrochloric acid was yellow; the one with nitric acid was yellowish brown. In addition, the color change is also related to the depth of the wound, the tide is the lightest, gray, brown or black. After the acid burn, due to the cover of the suede, the early judgment of the depth is more difficult than the general burn, and it cannot be judged as the concentration burn due to the waterless bubble.

Sulfuric acid, hydrochloric acid, and nitric acid can cause skin burns in a liquid state, and inhalation can cause inhalation damage in a gaseous state. Compared with the three acids, at the same concentration, the sulfuric acid is the strongest in the liquid state, and the nitric acid is the strongest in the gaseous state. Pulmonary edema can occur several hours after the inhalation of gaseous nitric acid. They can cause upper gastrointestinal tract edema and dyspnea and even ulcer perforation after oral administration.

2 Hydrofluoric acid burn: Hydrofluoric acid is an aqueous solution of hydrogen fluoride which is colorless and transparent, has strong corrosiveness, and has the functions of dissolving fat and decalcifying. After hydrofluoric acid burns, the wound may initially have only erythema or leather-like eschar and subsequent necrosis, and erosion to the surrounding and deep tissues may damage the bones and cause necrosis, forming ulcers that are difficult to heal, and the wounded are heavier. 10% hydrofluoric acid has a greater traumatic effect, while 40% has a slower infiltration of the skin.

3 Carbolic acid burns: After the absorption of carbolic acid, it mainly causes damage to the kidneys. It has strong corrosion and penetrability, and has progressive infiltration damage to the tissue.

4 oxalic acid burns: skin and mucous membranes are easy to form powdery white refractory ulcer after contact with oxalic acid. The combination of oxalic acid and calcium reduces blood calcium. Therefore, when using a large amount of cold water to wash, local and systemic should be applied in time.

2, alkali burns

Alkali burns commonly found in clinical practice include caustic soda, lime and ammonia, and their incidence is higher than that of acid burns. Alkali burn is characterized by binding to tissue proteins to form a basic protein compound, which is easy to dissolve, further deepens the wound; saponifies the adipose tissue; dehydrates the cells to death, and produces heat and damage. Therefore it causes damage more severe than acid burns.

1 caustic burn: caustic refers to the strong corrosive and irritating effects of sodium hydroxide and potassium hydroxide. After the burn, the wound surface is sticky bone or soapy eschar, the color is red, generally deep, usually above the deep II degree, the pain is severe, the wound blank is painful after the tissue is detached, the wound is sunken, the edge sneak, often unhealed

2 lime burn: quicklime (calcium oxide) and water form calcium hydroxide (slaked lime) and release a lot of heat. When the lime burns, the wound surface is brown and dark. Note that the lime powder should be wiped clean before washing with water to avoid heat and increase the wound surface.

3 ammonia water burn: ammonia is extremely volatile and releases ammonia. It can cause inhalation injury such as throat laryngeal edema and pulmonary edema after irritating inhalation. Those with shallow contact with ammonia water have a deep blisters of blistering. Its wound treatment is similar to general alkali burns. For those with inhalation injury, it should be treated according to the principle of inhalation injury.

3, phosphorus burn combined poisoning

Phosphorus burns ranks third in chemical burns, second only to acid and alkali burns. Phosphorus removal in the presence of air can cause injury, but also due to the oxidation of phosphorus to produce phosphorus pentoxide, which has dehydration and oxygen scavenging effects on cells. Phosphorus pentoxide forms phosphoric acid in the presence of water and produces heat during the reaction process to further deepen the wound surface. Inhalation of phosphorus vapor can cause inhalation damage, and phosphorus and phosphide can cause phosphorus poisoning through inhalation of wounds and mucous membranes.

Phosphorus protoplasts can inhibit the oxidation process of cells. Phosphorus absorption is more abundant in liver and kidney tissues, which may cause extensive damage to organs such as liver and kidney. After phosphorus burns, the main symptoms are headache, dizziness, fatigue, nausea, severe liver and kidney dysfunction, hepatomegaly, liver pain, jaundice, oliguria or anuria, and protein and cast in urine. Inhalation injury and phosphorus poisoning can cause shortness of breath, irritating cough, lungs and dry and wet rales, severe pulmonary insufficiency and ARDS chest radiographs suggest interstitial pulmonary edema, bronchial pneumonia. Some patients may have low calcium hyperphosphatemia, heart rhythm disorders, mental symptoms and cerebral edema. Phosphorus burn wounds are deeper, can damage the bones, the wound surface is brown, and the III degree wound can be bronze or black when exposed.

4, asphalt burns

Asphalt is called tar, which has a high degree of adhesive health search and is widely used in house construction, engineering anti-corrosion and moisture-proof, paving and so on. Liquid asphalt causes skin burns to be purely thermal and has no chemical damage. Its characteristics are not easy to remove, high heat, slow heat dissipation, so the wounds are often deep, and occur in exposed parts of the skin, such as hands, feet, face, etc., asphalt burns should not be scrubbed with gasoline, so as not to cause acute lead poisoning. The bitumen evaporates to produce a small amount of light-sensitive substances such as acridine, hydrazine, and phenanthrene, which increase the pain after light irradiation. Therefore, patients should avoid sun exposure, avoid the use of light-sensitive drugs, such as sulfonamide, chlorpromazine, promethazine, etc., disable red mercury, gentian violet on the wound.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.