From Big Medical Encyclopedia

ALL-TOXIC TOXIC AGENTS — toxic agents, toxic action to-rykh it is characterized by oppression of process of tissue respiration or respiratory function of blood and development of a hypoxia that leads to disturbance of activity nervous, cardiovascular, respiratory and other vital systems. Carry to OV of all-poisonous action cyanhydric acid (see) and cyanogen chloride. Hydrocianic to - that in turn is an ancestor of big group of the chemical substances combined under the general name cyanic connections (see), a part from to-rykh along with cyanogen chloride can render not only all-toxic, but also irritant action (see. the Irritating toxic agents ). In this group carry also carbon monoxide (see), edges, without being fighting toxic agent, can be a source of poisoning not only in peace time, but also in combat conditions.

During World War II of 1939 — 1945 ethers cyanoformic to - you were applied by fascist Germany under the code cyclones A and B to mass extermination of people in gas chambers. According to Franke (S. Franke, 1973), power sovr, systems of chemical arms of imperialistic armies allows to create the striking concentration hydrocianic to - you in a ground layer of the atmosphere to 1 mg/l for 2 min. in summer and up to 10 min. in winter time. Stay of people in such conditions without gas masks can lead to crushing and lethal inhalation defeats. Poisonings with salts hydrocianic to - you (cyanides) are possible at the use of the food stuffs infected with them and waters.

Cyanhydric acid (HCN) represents a colorless liquid with a smell of bitter almonds, t of piles 25,7, t froze-14, density of vapors by air 0,93. It is well dissolved in water, organic solvents, phosgene, yperite and other OV. Treats unstable OV (see. Toxic agents ). Toxicity hydrocianic to - you, according to WHO data, is characterized by the following data: at inhalation of the air containing couples hydrocianic to - you in concentration of 2 mg/l, within 1 min. there are defeats leading to loss of fighting capacity and working capacity; influence of 5 mg/l within 1 min. is srednesmertelny concentration; at receipt through a mouth in number of 1 mg/kg lethal injuries can develop.

The variety a wedge, symptoms and rapidity of the damages caused hydrocianic to - that, is explained by its ability to influence more than 20 fermental systems of an organism. The most important link of a pathogeny of defeats hydrocianic to - that blockade of fabric respiratory enzyme — cytochrome oxydase is considered owing to what even in the conditions of full oxygenation of blood and fabrics in the last oxidation-reduction processes are broken. At acute poisonings of easy degree struck note a smell of bitter almonds, smack of bitterness, numbness of mucous membranes of a mouth, the general weakness, dizziness, nausea, pains in heart, an asthma. At defeats of average degree the listed symptoms are expressed more sharply. Pains in heart gain ste-nokardichesky character; at electrocardiographic inspection signs of coronary insufficiency and focal changes of a myocardium come to light. An asthma amplifies, consciousness is periodically darkened. Integuments and mucous membranes get pink coloring because of «arterialization» of a venous blood. Heavy degree of poisoning is characterized by further deterioration in the general state, loss of consciousness, emergence kloniko - nicheskikh spasms, disturbances of a cordial rhythm, development of a collapse with terminal paralysis of breath and a cardiac standstill. At high toxic doses defeat develops within several minutes (fulminant, or «syncopal», a form). At defeat of OV in smaller doses intoxication can last till 12 — 36 o'clock.

Cyanogen chloride (ClCCN) — a colorless liquid with the pungent irritating smell, t°kip 12,6 t°zamerz — 6,5 °, density of vapors on air 2,1. It is badly dissolved in water (7%) and it is good — in organic solvents. Toxicity of cyanogen chloride, according to WHO data: concentration of 0,06 mg/l causes dacryagogue, irritation of a mucous membrane of a throat and trachea; influence of 11 mg/l within 1 min. is srednesmertelny concentration. The mechanism of toxic resorptive effect of cyanogen chloride and clinic of intoxication same, as at poisonings hydrocianic to - that.

Carbon monoxide (CO, carbon monoxide gas) — a product of incomplete combustion of carbon-containing substances, a component of exhaust and powder (explosive) gases (see. Blasting , Exhaust gases ). Carbon monoxide — colorless gas, inodorous; t°kip — 193 °, density of vapors in relation to air 0,97, a usual gas mask is not late. Toxicity of carbon monoxide: at influence in concentration of 0,23 — 0,34 mg/l during 5 — 6 hours there is easy degree of poisoning, in concentration of 1,1 — 2,5 mg/l within 0,5 — 1 hours — moderately severe poisonings, 2,5 — 4 mg/l within 0,5 — 1 hours — severe defeats. Srednesmertelny concentration of 14 mg/l within 1 — 3 min.

Carbon monoxide can cause acute poisonings in the industry, on transport and in life. Their frequency sharply increases at extensive wildfires, in zones of use of nuclear weapon and incendiary mixes (see).

Along with the description of nature of poisonings with powder (explosive) gases (see. Powder disease ), the blindages arising during the firing in not gates-ruyemykh, tanks, ship towers, in foreign literature the possibility of fighting use of carbon monoxide in the form of so-called carbonyls of metals is discussed. Very toxic connection such is, e.g., nickel tetracarbonyl. At receipt through skin in drop liquid state and inhalation of its vapors in concentration of an order of the 100-th shares of mg/l it is capable to cause severe damages of airways and a toxic fluid lungs. During the heating to 150 ° nickel tetracarbonyl decays with formation of carbon monoxide.

Primary mechanisms of poisoning with carbon monoxide are that it, getting to an organism, contacts hemoglobin, forming carboxyhaemoglobin and carboxymyoglobin, to-rye do not participate in transport of oxygen from lungs to fabrics. Thereof acute oxygen insufficiency of gemichesky type develops. Degree and duration of the coming hypoxia of a brain, muscular and other fabrics generally also define weight of poisonings.

At poisonings of easy degree patients complain of a headache, dizziness, the general weakness, heartbeat, an asthma. Unsteadiness of gait, euphoria is observed. With the termination of influence of poison at this stage recovery occurs on 1 — the 2nd days. Poisonings of average degree are characterized by disturbance of consciousness, the expressed muscular weakness, because of a cut victims, even realizing threat of the life which is not able to rise, leave the room, to open a door of a pla a window. Breath and pulse become frequent, the kollaptoidny state develops. Twitching of face muscles, the general kloniko-tonic spasms, fervescence is observed. Serious poisoning with a loss of consciousness, an areflexia and a coma during the next few hours can come to an end with a lethal outcome.

Medical care at poisoning

Medical care at O.'s poisoning with the lake of century is based on the uniform principles, but has essential features at poisonings hydrocianic to - that and cyanogen chloride because concerning these OV there are antidotes (see. Antidotes of OV ).

First aid (see) it has to appear immediately. It consists in putting on gas mask (see) (at poisoning with carbon monoxide the gas mask with the gogshalitovy boss), use of an antidote is used at poisoning hydrocianic to - that and cyanogen chloride (amyle nitrite, etc.), bystry removal of the victim from the poisoned atmosphere. If necessary the artificial respiration is carried out. Except the listed measures, during the rendering pre-medical help (see) enter the symptomatic means improving a condition of cardiovascular and respiratory systems.

First medical assistance (see) it is directed to O.'s binding by the lake of century, acceleration of its conclusion from an organism, recovery of breath and cordial activity. For this purpose carry out broad symptomatic therapy, and if necessary an artificial respiration. At a hydrocyanism and cyanogen chloride enter antidotes — amyle nitrite, hromosmon, glucose, sodium thiosulphate.

the Qualified medical care (see) and specialized medical care (see) can include repeated introduction of antidotes (taking into account their introduction at the previous stages of medical evacuation), and also depending on the state struck use of symptomatic means. Are shown ok-sigeno-and an oxygenobarotherapy. Rest and heat is recommended. After removal from a condition of acute intoxication apply the antibacterial and strengthening means.

Protection of troops and the population against all-toxic toxic agents is provided with a complex of the organizational and technical and special events held chemical, medical and other services of Armed Forces and Civil protection in the general system protection against means of war of defeat (see).

Bibliography: Harmful substances in the industry, under the editorship of N. V. Lazarev and I. D. Gadaskina, t. 3, L., 1977; Luzhniki E. A., Dagayev V. N. and Firsov H. H. Fundamentals of resuscitation at acute poisonings, M., 1977; Acute management at acute poisonings, under the editorship of G. N. Golikova, M., 1977; The Guide to toxicology of toxic agents, under the editorship of S. N. Golikov, M., 1972, bibliogr.; The reference book on rendering fast and acute management, under the editorship of E. I. Chazov, M., 1975; Franc 3. Chemistry of toxic agents, the lane with it., t. 1, M., 1973.

V. I. Artamonov, N. V. Savateev.