Help with botulism
As is known, botulism is one of the most dangerous neurotropic infections affecting the nervous system. Therefore, the first thing to do when there are signs of botulism is to call an ambulance!
All emergency methods for poisoning with botulism are based on the correction of cardiovascular and nervous disorders.
In parallel, they carry out a general detoxification of the body, restore motor disorders and eliminate paresis and paralysis.
The standards for first aid in poisoning with botulism at the prehospital stage include the release of digestive organs from toxin residues: gastric lavage and cleansing enema.
For washing use:
- 5% solution of soda;
- weak solution of potassium permanganate.
A procedure is performed with a thick probe inserted directly into the stomach. Afterwards, sorbents are assigned: coal, Enterosgel for binding of botulinum toxin.
In no case should the stomach be washed to a patient who is unconscious!
At this stage, you can choose from two options:
- give the patient a salt laxative and wait for an independent stool (for example, 30 g of magnesium sulfate);
- make a high siphon enema with boiled water.
The listed procedures for cleansing the stomach and intestines should never be neglected. This is the very first aid in botulism and very effective. These measures will significantly improve the patient's well-being and stop the flow of botulinum toxin into the bloodstream.
Cardiopulmonary resuscitation (CPR)
With worsening of the patient's condition, paralysis of the respiratory muscles and stopping breathing, it is necessary immediately (before the arrival of the ambulance team) to begin artificial ventilation of the lungs and indirect heart massage . This is an emergency aid in botulism.
If there is a pulse on the carotid artery and there is no breathing, only mouth-to-mouth or mouth-to-nose ventilation is performed, blowing the patient air to the lung approximately once every 5 seconds. Preliminary it is necessary to prepare and clean the respiratory tract from saliva, vomit, foreign objects (if any).
If there was a stop of breathing and palpitations, resort to cardiopulmonary resuscitation. Sometimes it is possible to restore the work of the heart by performing the technique of a precordial stroke on the chest. The minus of this method is a probable fracture of the edges.
The CPR procedure is performed 1: 5 (one blowing through every 5 pressure on the chest), with the help of two people and 2:15 - if one. The effectiveness of resuscitation can be judged by the appearance of independent breathing and pulse.
Serum against botulism is of three types: A, B and E. There is also a polyvalent serum containing immunoglobulins of all bacterial serotypes.
As a rule, when signs of botulism appear, the last or simultaneously 3 drugs (A, B and E) are introduced, and when the type of infection is clarified, treatment is continued with a certain type of monovalent serum.
Anti-butulinic serum is a solution of specific protective immunoglobulins (Jg) of horse blood infected with botulinum toxin. The drug is extremely allergic, so it is necessary to sample for sensitivity.
The diluted 1: 100 serum in an amount of 0.1 milliliters is injected subcutaneously into the ulnar flexure area and the reaction is observed. When the swelling and redness of more than 1 centimeter appear after 20 minutes, the sample is considered positive. Nevertheless, such a result is not a contraindication to intravenous administration of the drug. Ampoule whole whey is bred in 200 ml of sodium chloride solution and injected into the vein drip. With a positive skin test before treatment, a hormone prednisolone 60-90 mg intravenously, jetly is prescribed to reduce the risk of allergy.
The only contraindication to the appointment of antibotulinum serum is a severe allergic reaction to the intradermal test in the form of anaphylaxis!
It is important to note that the sooner the serum treatment begins, the more effective its action will be. All medical measures are carried out in a medical room equipped with anti-shock kit. During the procedure, the doctor closely monitors the patient's condition.
This term is understood as intravenous and intramuscular administration of medications, the action of which is aimed at binding, neutralization and elimination of toxin, as well as correction of arising disorders of organs and systems.
Detoxification can also be carried out at the pre-hospital stage - emergency doctors, with the necessary equipment of the brigade with all medicines, and in the hospital.
- Drip Hemodez H, Reopoliglyukin, Gelatinol, Neocomensane, and other solutions are added drip according to the indications. The choice of the drug and the dose is determined by the attending physician based on the severity of the condition of the particular patient. The listed solutions improve microcirculation, saturate tissues and cells with oxygen and glucose, normalize the water-electrolyte balance, improve blood exchange and fluidity, neutralize and excrete poisons and toxins.
- To provide cells with energy and normalize the work of the cardiovascular system, glucose-potassium-magnesium mixtures, Riboxin, Mildronate are prescribed.
- When hypotension is administered subcutaneously, Kordiamin 1 ml, for stimulation of respiration (especially with developed paresis of intercostal and diaphragmatic muscles), Strychnine, Corazol 1 ml of 10% solution or Lobelin.
- To replenish the water balance (loss of fluid with vomiting, urine and intestinal contents) intravenously pour isotonic sodium chloride solution and glucose.
It is one of the ways to quickly release the body from toxins, by removing them through the kidneys. To stimulate diuresis apply:
- hypertonic 40% glucose solution;
Summing up. Botulism is a rare disease, but very dangerous. Sometimes the development of complications occurs rapidly, so before hospitalization of the patient in the infectious disease department, one should not get confused and apply all possible ways to provide him with first aid.