Urgent! ! ! ! pesticide poisoning

Pesticide poisoning is one of the main causes of poisoning and accidental death, most of which are acute life poisoning, mainly caused by accidental ingestion or suicide and pesticide abuse. Pesticide poisoning caused by environmental pollution in production mainly occurs in packers produced in pesticide plant and pesticide users in rural areas. When spraying pesticides or dispensing drugs in the field, and overhauling the application tools, the skin is easily polluted by pesticides, and it is easy to cause acute poisoning through absorption through the skin and respiratory tract. In the process of contact with pesticides, if the amount of pesticides entering the human body exceeds the maximum tolerance of normal people, the normal physiological functions of people will be affected, and a series of clinical manifestations of poisoning such as physiological disorders and pathological changes will appear, which is the phenomenon of pesticide poisoning.

[Edit this paragraph] What is a pesticide?

Chinese pinyin: nóngyào pesticide [pesticide; Agricultural chemicals; Pesticide] refers to a class of drugs used to kill insects, bacteria and harmful animals (or weeds) in agricultural production to ensure and promote the growth of plants and crops. In particular, it is used to control pests and diseases, regulate plant growth, control weeds and other chemicals in agriculture. According to the source of raw materials, it can be divided into organic pesticides, inorganic pesticides, plant pesticides and microbial pesticides. In addition, there are insect hormones. According to the processing dosage forms, it can be divided into powder, wettable powder, soluble powder, emulsion, missible oil, concentrated emulsion, cream, paste, colloid, fumigant, fumigant, aerosol, oil agent, granule, microparticle and so on. Most of them are liquids or solids, and a few are gases.

[Edit this paragraph] Organochlorine pesticide poisoning

symptom

(1) Acute poisoning. Mouth numbness, tingling, anorexia, salivation, grinding teeth, nausea, vomiting, diarrhea, muscle tremor, convulsions, paralysis, confusion and even death. (2) chronic poisoning. Loss of appetite, headache, general discomfort, sometimes conjunctival inflammation, tears, purple skin, rash, especially when the skin is wet and sweaty.

type

The types of pesticide poisoning vary according to the variety, dosage and entry route of pesticides. Some only cause local injuries, some may affect the whole body, and even endanger life in serious cases. Generally, it can be divided into light, medium and heavy levels. The speed of poisoning is mainly divided into acute (including subacute) and chronic poisoning.

Ways of pesticide poisoning

1. Skin contact with pesticides is the most common and important way of poisoning. 2. Poisoning caused by inhaling pesticides through respiratory tract is also the fastest and most common way of poisoning. 3. Intake through the middle (digestive tract).

Poisoning symptoms and first aid measures

Because of the different poisoning mechanisms of different pesticides, their poisoning symptoms are also different, mainly manifested as headache, dizziness, general malaise, nausea and vomiting, respiratory disorders, cardiac arrest, shock coma, spasm, excitement, irritability, pain, pulmonary edema, brain edema and so on. In order to minimize symptoms and death, first aid measures must be taken as soon as possible, as soon as possible and in time. 1. Reducing pesticide pollution sources and preventing pesticides from continuing to enter the human body are the first measures taken in first aid. (1) The person with skin poisoning should immediately take off the contaminated clothes and trousers, and wash the contaminated skin with warm water, soapy water (except trichlorfon) or 4% sodium bicarbonate solution; If the liquid medicine spills into eyes, immediately rinse it with normal saline for more than 20 times, and then drop 2% cortisone and 0.25% chloramphenicol eye drops. If the pain gets worse, drip 1%-2% procaine solution and immediately send it to hospital for treatment. (2) In case of inhalation poisoning, the poisoned person should be immediately taken away from the application site, moved to fresh air, unbuttoned collar and belt, protected from breathing, removed false teeth, and kept warm. In severe cases, they should be sent to hospital immediately for treatment. (3) People with oral poisoning should not induce vomiting when they are unconscious. If you are conscious, you should induce vomiting, gastric lavage, catharsis or symptomatic use of antidote as soon as possible. (1) emesis is an important method to eliminate poisons. The method is as follows:-Give the poisoned person 200-400 ml of water first, then stimulate the throat with clean fingers or chopsticks to induce vomiting; -Take one spoonful 1% copper sulfate solution every 5 minutes, three times in total; —— Use strong brine and soap to induce vomiting (but it should be noted that patients with trichlorfon poisoning should not use soapy water or alkaline water or soda water to induce vomiting or gastric lavage). -3 grams of traditional Chinese medicine, 3 grams of gallstones and 3 grams of melon seeds, ground into fine powder and taken once; -Arsenic poisoning patients use fresh sheep blood to induce vomiting. It should be noted that emesis must be used when the patient is conscious, and it must never be used when the poisoned person is unconscious, so as to avoid the danger of vomiting entering the trachea. Vomiting must be checked. ② Gastric lavage should be done early, quickly and thoroughly after vomiting, which is an effective measure to reduce the residue of poisons in human body. Remove dentures before gastric lavage, and choose different gastric lavage fluids according to different pesticides (Table 7-3). Attention should be paid to:-If you are still conscious, take the stomach-clearing agent yourself; If you are unconscious, you should first insert an endotracheal tube to keep breathing smoothly and prevent gastric juice from flowing back into the trachea. When breathing stops, artificial respiration can be used for rescue. -Convulsions should be controlled before gastric lavage; -due to the corrosiveness of eating by mistake, it is not advisable to lavage the stomach if pesticide poisoning is not spilled. After vomiting, you can take egg white, aluminum hydroxide glue and milk orally to protect the gastric mucosa; -the most serious patient can't insert a gastric tube, so he can only use surgical laparotomy to lavage his stomach. This is a last resort.

List of commonly used gastric lavage fluids after pesticide poisoning

The name of pesticide is commonly used as 2% sodium bicarbonate solution of organophosphorus pesticide in gastric juice (trichlorfon is prohibited) * 1:5000 potassium permanganate solution (thiophosphate such as 1605, 1059, 39 1 1, Su Hua 203, etc. 5% sodium thiosulfate solution, please do not use physiological saline and then add 1% sodium bicarbonate solution to organic nitrogen pesticide 5% sodium thiosulfate solution 2% sodium bicarbonate solution carbamate pesticide 2% sodium bicarbonate solution organic fluorine pesticide 1: 5000 potassium permanganate solution 2% sodium bicarbonate solution 2% calcium chloride solution organic sulfur pesticide1 : 5000 potassium permanganate solution organotin pesticide 1: 5000 potassium permanganate solution sodium pentachlorophenol 2% sodium bicarbonate solution zinc sulfide 1: 5000 copper sulfate 0. 1% ferrocyanide solution,1:5000 potassium permanganate solution, nicotine1%. : 5000 potassium permanganate solution, 0.2%-0.5% activated carbon aqueous suspension, pyrethroid pesticide, isotonic saline containing activated carbon, 0. 1%-0.5% copper sulfate solution, 1∶5000 potassium permanganate solution, zinc phosphide 0.2%-0.5% activated carbon aqueous suspension chlormequat/. * * Potassium permanganate is an oxidant, which can transform 1605, 1059, 39 1 1, marathon, dimethoate, etc. It is transformed into the corresponding oxide with higher toxicity (direct inhibitor of cholinesterase), such as 1605. (3) The cathartic poison has entered the intestine, and only catharsis can remove the poison. Oil laxatives are generally not used as drainage agents, especially pesticides with benzene as solvent. 30g of sodium sulfate or magnesium sulfate can be used for drainage, and 200ml of water can be added. Take it once and drink water many times to speed up drainage. When severe organophosphorus pesticide poisoning leads to respiratory depression, magnesium sulfate should not be used for drainage, so as to avoid a large number of magnesium ions absorbed and aggravate respiratory depression. Magnesium sulfate cannot be used for zinc sulfate poisoning. 2. The absorbed pesticides and their metabolites can be discharged as soon as possible through oxygen inhalation, infusion and dialysis. (1) Oxygen inhalation. Poisoning caused by gaseous or vaporous pesticides can be eliminated from the respiratory tract after oxygen inhalation; (2) In the absence of pulmonary edema, brain edema and heart failure, 10% or 5% glucose saline can be infused to promote the excretion of pesticides and their metabolites from the kidney; (3) Colon peritoneum and kidney dialysis were used for dialysis.

Treatment measures of pesticide poisoning

1. Taking detoxification drugs in time can alleviate or eliminate the symptoms of poisons on human body, but other treatment measures are needed. Several commonly used release agents are introduced as follows: (1) cholinesterase reactivating agents The cholinesterase reactivating agents used in China include pralidoxime, chlorophosphate, bisphosphonate and so on. This kind of antidote can quickly revive cholinesterase inhibited by organophosphorus pesticides, and has a strong control effect on muscle tremor, convulsion and respiratory paralysis. They are only effective for acute organophosphorus poisoning, but not for chronic organophosphorus poisoning and carbamate pesticide poisoning. Carbamate pesticides have side effects, but for some pesticides, it will enhance the activity of inhibiting cholinesterase. For example, carbaryl pesticide poisoning should be banned. (2) Atropine sulfate is used as a detoxification drug for acute organophosphorus pesticide poisoning and carbamate pesticide poisoning. (3) The sulfhydryl complexing agent is effective for detoxification of arsenic preparation and organochlorine preparation, and can also be used for detoxification of pesticide poisoning such as organotin and bromomethane. Commonly used drugs are sodium dimercaptopropate, sodium dimercaptosuccinate, dimercaprol and mercaptoethylamine. (4) Acetamide can prolong the incubation period after organofluorine pesticide poisoning, relieve symptoms or stop the attack, and the effect is good. 2. Symptomatic treatment (1) Treatment of patients with respiratory diseases: Atropine and cholinesterase can be used for dyspnea, intermittent breathing or dyspnea caused by organophosphorus pesticide poisoning. You can also use the respiratory stimulant Lobelin 3 mg intramuscular injection, Nicodemus 1.5 ml intramuscular injection or 9 mg intravenous drip with 5% glucose saline 100 ml. It should be noted that when doping is used, it must be used when the ventilation function is improved and the respiratory resistance is reduced, otherwise the oxygen consumption will increase due to the increase of respiratory power. If the victim's breathing stops, oxygen infusion and mouth-to-mouth artificial respiration should be performed immediately, and the victim's upper respiratory tract should be cleaned and kept unobstructed. At first, the pressure is higher and the frequency is faster, and then the pressure is gradually reduced. Excessive blowing will cause alveoli to rupture, or make alveoli extremely expand, which will cause gas to stay in alveoli and increase functional residual gas, which is unfavorable to gas exchange. It is not advisable to blow too long or too short. (2) Treatment of cardiac arrest This symptom is very dangerous and directly endangers the patient's life. After respiratory arrest or the direct toxic effect of pesticides on the heart, it needs to be rescued in time. The method is: beat the precordial area, and beat the precordial area with your fist for 3-5 times continuously, with moderate strength, at this time, heartbeat recovery and pulse beating can occur. If this method is ineffective, you should immediately switch to chest massage, 60-80 times per minute, and artificial respiration must be carried out at the same time when doing chest massage, otherwise it will be difficult to revive or not last. When doing chest massage, you should pay attention to putting the poisoned person on a hard board or on the ground, and don't use too much force to avoid rib fracture and visceral injury. You can also use strong tea to strengthen the heart needle, and inject sodium benzoate and caffeine if necessary. (3) Treatment of shock Acute pesticide poisoning or severe headache can cause shock. Symptoms include acute fatigue, listlessness, weakness, cold limbs, pallor, cyanosis, rapid pulse and decreased blood pressure. When giving first aid to people in shock, patients should keep their feet high and bow their heads, keep warm, and give blood transfusion, oxygen delivery and artificial respiration when necessary. (4) When treating coma, put the patient flat, slightly lower his head, give oxygen, and give symptomatic treatment. Acupuncture can be used for treatment, such as Renzhong, Neiguan, Zusanli, Baihe and Yongquan. Supplementing water and nutrition, intravenous administration of resuscitation agents such as Knofane and Chloroester and 5%- 10% glucose water. (5) Spasm caused by hypoxia should be treated with oxygen inhalation. Spasm caused by other poisoning can be treated by chloral hydrate enema, intramuscular injection of phenobarbital sodium or drugs such as ether and chloroform. (6) For the treatment of exciters, chloral hydrate enema and ether valerian drops can reduce the restlessness of poisoned people. (7) Treatment of pain. Pain in the head, abdomen, joints, etc. It can be relieved by taking painkillers. (8) Pulmonary edema is treated with oxygen, high dose of adrenocortical hormone, diuretic, calcium agent, antibacterial agent and a small amount of sedative. (9) The treatment of brain edema should be given oxygen, cold compress on the head, and drugs such as energy management mixture, hypertonic glucose, dehydrating agent, corticosteroids and multivitamins should be used.

[Edit this paragraph] Prevention

Pesticides help to kill pests and increase production, but improper use can also cause poisoning. In order to prevent pesticide poisoning, we should do the following: weak, sick, old, pregnant and lactating women and minors, do not engage in the management and use of pesticides. Pesticides must be stored in a safe (special warehouse or cabinet), locked place, and kept by a special person. Every pesticide container should be clearly labeled. The purchase, storage and use of pesticides should be strictly regulated. Not in the living room or barn. The preparation of pesticide solution, seed soaking and seed dressing with pesticide should be handled by special personnel. The working place should be far away from houses, barns, vegetable gardens and drinking water sources. According to the regulations, wear long-sleeved clothes and trousers, hats, latex gloves and masks to avoid splashing liquid medicine or inhaling pesticide gas. Tools and containers should be dedicated and cannot be used for other purposes. Pesticide solutions sent to the field for application should be kept in special containers and locked. When applying pesticides in the field, we should strictly abide by the operating rules. Wear long-sleeved clothes and trousers, a hat and latex gloves. When spraying, stand in the wind and spray backwards. Do not smoke, eat, drink or wipe your face and eyes with contaminated hands during operation. Take a bath and change clothes with soap after work. Contaminated clothes should be soaked in 5% alkaline water for an hour or two before washing. The remaining small amount of potions and sewage from washing utensils should be buried deep underground. You can't spray pesticides one month before the harvest of grain and fruit. If pesticides have been used in orchards and vegetable gardens, it is best to soak fruits and vegetables in water for an hour or two before eating. Once pesticide poisoning occurs, if it is oral poisoning, gastric lavage should be done immediately, and vomiting should be induced at the same time, and drugs should be used to detoxify. If you are poisoned by inhalation when spraying pesticides, you should leave the poisoned environment immediately, take off the contaminated coat quickly, and wash the contaminated part with soapy water and flowing clean water. If the symptoms are serious, they should be sent to the hospital immediately after the initial treatment.

[Edit this paragraph] Pesticide poisoning-glyphosate

toxicology

Acute poisoning is basically caused by a slip of the tongue, and it rarely causes systemic acute poisoning in production and use. There are many reports of oral poisoning abroad and in Taiwan Province Province of China. Venous diluent poisoning 1 case, died after being rescued. At present, there are few reports in Chinese mainland, but there are some cases of oral acute poisoning. Oral intake, absorption and excretion are faster. There are high concentrations of poisons in blood and urine 1/2 ~ 10 hours after ingestion, and the concentration will drop to be difficult to detect after 1 ~ 3 days. Although the product has organic substitution of phosphoric acid, there is only one hydroxyl substitution in its structure, so it has little or no inhibition on cholinesterase. Many scholars speculate that nonionic surfactants in the preparation may be an important factor of toxicity. In addition, its preparation has strong acidity, which can stimulate acid to corrode skin and mucosa, and even cause mild burns. If ingested in large quantities through the mouth, it will cause chemical corrosive inflammation of the gastrointestinal tract.

clinical picture

1. Skin and mucous membrane irritation symptoms After oral intake, the oral mucosa and throat are stimulated, causing pain, mild burns and ulceration, forming oral ulcers; The root of the eye is polluted and there are signs of conjunctivitis; Undiluted preparations pollute the skin, causing itching and erythema when stimulated locally, and a few patients have skin allergies. 2. Digestive tract reaction is often the main symptom of acute oral poisoning. In addition to swelling and swelling of oral mucosa, nausea, vomiting and epigastric pain often occur, and in severe cases, gastrointestinal bleeding and diarrhea occur. 3. Respiratory system damage Inhalation can cause cough, asthma and lung rales. Severe oral poisoning is prone to aspiration pneumonia and/or pulmonary edema, cough, chest tightness and dyspnea, and severe cases can die of respiratory failure. 4. In addition to tachycardia or bradycardia, cardiovascular injury often leads to a drop in blood pressure. In the early stage, the decrease of blood pressure may be the influence of the decrease of blood volume, but in the later stage, it is the effect of the poison itself. Dogs were injected with pure glyphosate and surfactant respectively, and it was found that the blood pressure of those injected with surfactant decreased. Creatine kinase (CK) increased in some cases. 5. Nervous system symptoms are generally not seriously damaged except dizziness, fatigue and sweating; However, when high-dose oral poisoning is serious, abnormal consciousness, convulsion and coma may also occur. 6. Liver and kidney damage is generally mild, which can often be recovered automatically, but individual patients may cause serious kidney damage or even acute renal failure due to hemolysis. Diagnosing glyphosate poisoning

Emergency treatment

1. Rinse with soapy water and clean water to detoxify skin pollution, and rinse with 2% sodium bicarbonate solution for eye pollution; In order to reduce the chance of aspiration pneumonia, oral intake should not induce vomiting. It is recommended to suck out the stomach tube manually for gastric lavage, and the action should be gentle. Sodium bicarbonate solution should not be used for gastric lavage to avoid gas generation. 2% ~ 30% magnesium oxide emulsion or 0.3% ~ 0.5% medicinal carbon suspension can be used, the former is better. After gastric lavage, 50 ml suspension can be made of aluminum hydroxide gel, egg white or 6 grams of octahedral montmorillonite (Smecta). After gastric tube injection, 50 grams of medicinal carbon suspension can be injected to absorb residual poisons. If there is no diarrhea, laxatives can be given to induce diarrhea. Patients with severe poisoning can be treated with hemodialysis, hemoperfusion or plasma exchange at an early stage to remove poisons from the blood. 2. At present, there are no satisfactory special detoxification drugs. Atropine can only be used in a small amount (0.5 ~ 1 mg) for symptomatic treatment, and it is not suitable for repeated use, let alone atropinization; There is no need to use oxime regenerator. 3. Symptomatic support treatment should focus on controlling life-threatening toxic reactions, such as aspiration pneumonia, pulmonary edema, intractable hypotension, shock and convulsion, coma, etc. Respiratory failure and shock are important causes of death, so early prevention and treatment should be paid attention to, and antibiotics should be used appropriately to prevent and treat secondary infections, especially lung infections. 4. rehydration and diuresis can not only replenish blood volume, but also promote the excretion of poisons. At the same time, we should pay attention to correct the imbalance between electrolyte and acid-base metabolism. 5. Patients with moderate or above poisoning should adopt oxygen therapy. Although herbicide poisoning has a certain mortality, early and correct treatment can obviously improve its prognosis. According to a group of 9 cases of suicide by taking poison in Taipei Veterans General Hospital, 8 cases took 4 1% isopropylamine saline at a dose of 25-500ml (average 1 3015/ml) and1case was given intravenous diluent/kloc-0. 2 ~ 80 hours before first aid, the poisoning degree was mild in 4 cases, moderate in 3 cases and severe in 2 cases. Pneumonia occurred in 5 cases, mild disturbance of consciousness 1 case, coma convulsion 1 case. After gastric lavage, tracheal intubation 1 case, hemodialysis and plasma exchange 1 case, and symptomatic support treatment, all patients were rescued and cured.

[edit this paragraph] organophosphorus pesticide poisoning

Organophosphorus pesticides belong to organic phosphate or thiophosphate compounds, most of which are yellow or brown oily fat-soluble liquids, and a few are crystalline solids, which are volatile, easy to decompose in case of alkali and have garlic smell. At present, there are many kinds of phorate, such as phorate (39 1 1), phosphorus absorbed internally (1059, E 1059), parathion (1605, E605) and dichlorvos (DDV). Organophosphorus pesticides are toxic to people and livestock, and can invade the human body through the skin, mucosa, respiratory tract and digestive tract, causing poisoning.

1, etiology and poisoning mechanism

Improper management, careless use, poor protection, suicide or homicide may all lead to poisoning. Poisons enter the human body and are distributed in the liver, kidney, lung, spleen, muscle and brain. It is mainly oxidized and decomposed in the liver, and most of it is excreted by the kidney. After organophosphorus enters the body, its phosphate closely combines with the active part of cholinesterase to form phosphorylated cholinesterase, which makes it lose the ability to hydrolyze acetylcholine, leading to acetylcholine accumulation and linear poisoning symptoms.

2. Clinical manifestations

(1) Muscarinic symptoms: smooth muscle spasm, excessive gland secretion, pupil contraction, blurred vision, loss of light reaction, pallor, sweating, salivation, nausea, vomiting, diarrhea, bronchospasm, chest tightness, dyspnea and pulmonary edema. (2) Symptoms of nicotine-like poisoning: Muscle twitching often starts from small muscle groups, accompanied by muscle twitching of eyelids, face and tongue, and gradually spreads to the whole body, such as clenching teeth, gastrocnemius spasm, muscle twitching, muscle weakness in severe cases, and even paralysis. (3) Central nervous system symptoms: headache, dizziness, irritability, lethargy, delirium, ataxia, convulsion, coma, etc. (4) Others: Some patients have toxic myocardial damage, arrhythmia, heart failure, local contact dermatitis, skin redness, blisters, etc. Symptoms of chronic poisoning are mild, such as dizziness, fatigue, memory loss, anorexia and nausea. After treatment, organophosphorus pesticide poisoning generally has no sequelae, and individual patients may have lower limb paralysis and peripheral neuritis.

Step 3 diagnose

(1) Exposure history of organophosphorus pesticides. (2) The clothes, breath, skin and vomit of patients have special garlic smell, which can be used as a preliminary diagnosis of organophosphorus pesticide poisoning. (3) Special clinical manifestations: especially dilated pupils, salivation, hyperhidrosis, muscle tremor, etc. (4) Determination of blood cholinesterase activity: In patients with mild poisoning, the blood cholinesterase activity decreased to 70-50%; Moderate poisoning decreased to 50 ~ 30%; Severe poisoning fell below 30%.

4. Treatment and care

Critical patients with acute organophosphorus pesticide poisoning are in a dangerous condition, with many changes and rapid development. It should be rescued and treated accurately and timely, and at the same time, it should be closely observed and properly cared to prevent complications and make patients turn the corner. (1) Remove the poison quickly, stay away from the scene, take off the contaminated clothes, and thoroughly clean the contaminated hair and skin. Except for trichlorfon poisoning, all contaminated skin can be thoroughly cleaned with cold soapy water or 2% sodium bicarbonate solution. Trichlorfon poisoning can be cleaned with clean water to prevent residual poisons from being absorbed. Gastric lavage should be done immediately when oral poisoning occurs, and repeated gastric lavage should be required as soon as possible to ensure thoroughness. Conscious patients, after drinking warm water, stimulate the throat to induce vomiting. If the author disagrees, immediately insert a gastric tube and wash the stomach with 2% sodium bicarbonate solution or warm water. Trichlorfon poisoning should not be washed with sodium bicarbonate. Because trichlorfon can be quickly transformed into more toxic dichlorvos when it meets alkaline solution, warm water is chosen for gastric lavage (see general introduction to poisoning). For patients with mild to moderate poisoning, the total amount of gastric juice that needs gastric lavage is 10000 ~ 30000 ml, and for patients with severe poisoning, it needs more than 30000~40000ml. Until the eluate has no smell of pesticide garlic. After gastric lavage, inject 50% magnesium sulfate or sodium sulfate for 40 ~ 50ml for catharsis. If intubation fails due to heart spasm and gastrostomy and gastric lavage are feasible, the poison in the stomach can be removed in time. (2) Detoxification treatment: Use anticholinergic drugs and cholinesterase reactivating agents as soon as possible. ① Atropine. Has the effect of antagonizing acetylcholine, and can eliminate or alleviate muscarinic symptoms. Administration principle: early enough until atropinization, and pay attention to prevent the prognosis from being affected by insufficient dose and repeated illness. The tolerance of patients to atropine and the dosage required for atropinization vary from person to person. We should closely observe the changes of the disease, increase or decrease the dose at will, and pay attention to observe and judge the clinical manifestations of atropinization and poisoning. Atropine: Pupils gradually expand, but do not shrink, but respond to light, salivation and runny nose stop or decrease obviously, cheeks flush, skin is dry and irritable, heart rate is accelerated and powerful, and lung rales decrease or disappear obviously. After atropinization, pay attention to gradually reducing the dose or extending the interval of medication to prevent atropine poisoning or repeated illness. Atropine poisoning symptoms: fidgety, even hallucination, mania and other mental symptoms, dilated pupils, delayed or disappeared response to light, anhidrotic high fever above 40℃, tachycardia, 65438 060 beats/min, urinary retention. Patients with severe atropine overdose can turn to inhibition, leading to coma and respiratory center failure. Antagonists such as cholinergic drugs, pilocarpine, physostigmine and neostigmine can be used in atropine poisoning, which can increase the infusion volume and promote excretion. ② Choline ester energy restorer. Chlorpromazine and pralidoxime are oxime compounds, which can restore the activity of inhibited acetylcholinesterase and relieve nicotine-like toxicity, but only have an effect on newly formed phosphorylcholinesterase. After a few days, phosphorylcholinesterase "aged" and its activity was difficult to recover. Therefore, early use of such drugs has a good poisoning effect, but it is ineffective for chronic poisoning. Pholidoxime has a good effect on 1605, 1059, Tepp and ethion, but it has a poor or ineffective effect on dichlorvos, dimethoate, trichlorfon and malathion. The effect of chlorophosphonamide on trichlorfon and dichlorvos is poor, but it is suspicious or ineffective on dimethoate and malathion. This medicine must be mixed with atropine to improve its curative effect. (3) Symptomatic treatment and nursing: ① Closely cooperate with the treatment, ensure timely and accurate intravenous administration, and observe the drug action and reaction. ② Closely observe the patient's consciousness, pupil, complexion, skin, urine volume, body temperature, pulse, respiration, blood pressure, respiratory secretions and lung rales, be familiar with the signs of atropinization, be alert and prevent atropine overdose at any time, and reduce the dosage of atropine in time when poisoning is found. (3) Record the nursing records and the quantity in and out in detail to ensure the liquid supply and prevent dehydration and electrolyte disorder. ④ Keep the respiratory tract unobstructed, because organophosphorus poisoning can cause increased secretion of bronchial mucosa, congestion and edema, and severe cases are often accompanied by pulmonary edema, respiratory muscle paralysis or respiratory center depression, so it is extremely important to keep the respiratory tract unobstructed and maintain respiratory function. In case of cardiac insufficiency, the infusion speed should be strictly controlled, and cardiotonic, diuretic, rational use of oxygen, respiratory stimulants and antibiotics should be given in time according to the doctor's advice to treat pulmonary edema and prevent infection. For patients with respiratory failure, tracheotomy and mechanical ventilation are necessary means to save lives. ⑤ When coma and convulsion are caused by moderate or severe poisoning, routine nursing should be carried out according to coma, and the head should be tilted to one side to prevent suffocation when vomiting. Strengthen safety protection measures to prevent self-injury or bed fall. Toxic substances and heat dissipation obstacles often cause high fever after a large amount of atropine is used, and physical cooling or antipyretic agents can be used. Patients with urinary retention can be treated by bladder compression, acupuncture and catheterization. Catheterization should be strictly sterile, and the catheter should be removed in time to prevent urinary tract infection. In case of brain edema, in addition to the treatment of head ice pack or ice cap, oxygen inhalation and dehydration, move slowly when changing positions to prevent encephalopathy. ⑥ Observe whether there is gastrointestinal bleeding after poison stimulation and repeated gastric lavage. If there is hematemesis or bloody stool, report it to the doctor as soon as possible. ⑦ Strictly implement the shift change system, and pay attention to the rebound phenomenon caused by organophosphorus pesticide poisoning. The reasons are: incomplete gastric lavage, reabsorption of gastrointestinal residual poisons, or rapid reduction of atropine. Causes the original symptoms to reappear or worsen, and its premonitory symptoms are: chest tightness, loss of appetite and obvious increase in saliva secretion, which should be treated in time. Today, those who commit suicide by taking poison should do psychological care and strengthen protection to prevent suicide again.

5. Prevention

(1) Implement safety production and labor protection, and strengthen health education. (2) Strict sales and management of organophosphorus pesticides.