Help with botulism
Botulism is known to be one of the most dangerous neurotropic infections affecting the nervous system. Therefore, the first thing to do when signs of botulism appear is to call an ambulance!
All emergency methods for botulism poisoning are based on the correction of cardiovascular and nervous disorders.
In parallel, a general detoxification of the body, the restoration of motor disorders and the elimination of paresis and paralysis are carried out.
The standards of first aid for botulism poisoning at the prehospital stage include the release of the digestive organs from toxin residues: gastric lavage and cleansing enema.
For washing use:
- 5% soda solution;
- a weak solution of potassium permanganate.
The procedure is performed with a thick probe inserted directly into the stomach. After inside appoint sorbents: coal, Enterosgel to bind botulinum toxin.
In no case should you flush the stomach of an unconscious patient!
At this stage, you can choose from two options:
- give the patient a saline laxative and wait for an independent stool (for example, 30 g of magnesium sulfate);
- make a high siphon enema with boiled water.
The above procedures for cleansing the stomach and intestines should never be neglected. This is the first aid for botulism and very effective. These activities will significantly improve the patient's well-being and stop the entry of botulinum toxin into the blood.
Cardiopulmonary resuscitation (CPR)
When the patient's condition deteriorates, paralysis of the respiratory muscles and apnea, it is necessary immediately (prior to the arrival of the ambulance crew) to start artificial respiration and an indirect heart massage . This is an emergency aid for botulism.
If there is a pulse in the carotid artery and there is no breathing, only the mouth-to-mouth or mouth-to-nose ventilation is performed, blowing the patient's air into the lungs approximately 1 time in 5 seconds. First you need to prepare and clean the airways from saliva, vomit, foreign objects (if any).
If there is a cessation of breathing and heartbeat, resort to cardiopulmonary resuscitation. Sometimes it is possible to restore the work of the heart by carrying out the technique of precordial stroke on the chest. The disadvantage of this method is the likely fracture of the ribs.
The CPR procedure is performed 1: 5 (one injection every 5 pressure on the chest), with the assistance of two people and 2:15 - if one. The effectiveness of resuscitation can be judged by the appearance of spontaneous breathing and pulse.
There are three types of anti-botulism serum: A, B, and E. There is also a polyvalent serum containing the immunoglobulins of all bacterial serotypes.
As a rule, when signs of botulism appear, the last or simultaneously 3 drugs (A, B and E) are administered, and when specifying the type of infection, the treatment is continued with a certain type of monovalent serum.
Antibotulinic 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 test for sensitivity.
Diluted 1: 100 serum in an amount of 0.1 milliliter is injected subcutaneously into the area of the elbow bend and monitor the reaction. When swelling and redness more than 1 centimeter occur after 20 minutes, the sample is considered positive. However, this result is not a contraindication to intravenous administration of the drug. A vial of whole serum is diluted in 200 ml of sodium chloride solution and injected into a vein drip. In case of a positive skin test, before treatment, the hormone prednisone 60–90 mg intravenously is prescribed, injected to reduce the risk of allergy.
The only contraindication to the appointment of antibotulinic serum is a severe allergic reaction to an intradermal test in the form of anaphylaxis!
It is important to note that the earlier treatment with serum is started, the more effective its action will be. All therapeutic measures are carried out in a medical office equipped with an anti-shock kit. During the procedure, the doctor carefully monitors the patient's condition.
By this term is meant the intravenous and intramuscular administration of drugs, the action of which is aimed at binding, neutralizing and excreting toxin, as well as at correcting the resulting disorders of organs and systems.
Detoxification can also be carried out at the prehospital stage - by ambulance doctors with the necessary equipment of the brigade with all medicines, and in the hospital.
- Hemodez H, Reopoliglyukin, Gelatinol, Neocompensan and other solutions are indicated as indicated. 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. These solutions improve microcirculation, saturate tissues and cells with oxygen and glucose, normalize water and electrolyte balance, improve metabolism and blood flow, neutralize and remove poisons and slags.
- To provide cells with energy and normalize the work of the cardiovascular system, glucose-potassium-magnesium mixtures, Riboxin, Mildronate are prescribed.
- In case of hypotension, Cordiamine 1 ml is injected subcutaneously, to stimulate respiration (especially with the developed paresis of the 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), isotonic sodium chloride solution and glucose are infused intravenously.
It is one of the ways to quickly rid the body of toxins by removing them through the kidneys. To stimulate diuresis, use:
- hypertonic 40% glucose solution;
Summing up. Botulism is a rare but very dangerous disease. Sometimes the development of complications occurs rapidly, therefore, until the patient is admitted to the infectious disease ward, one should not get lost and apply all possible methods to provide him with first aid.