one. Etiology and pathogenesis
   Ammonia poisoning is a systemic disease characterized by acute respiratory damage after inhalation of high concentrations of ammonia in a short period of time, often accompanied by eye and skin burns. In severe cases, adult respiratory distress syndrome and/or other complications may be associated.
   The contact of ammonia with water in the tissue produces NH4OH, which is alkaline, has a solubility effect on the tissue protein, and can react with the adipose tissue. After direct contact with the skin and mucous membranes, local corrosive damage can result. Causes serious chemical burns, causing chemical inflammatory reactions in the nasal cavity, mouth, throat, throat, and trachea, as well as toxic pneumonia and pulmonary edema. When inhaled at a high concentration, it can cause excitability in the central nervous system to cause paralysis, and then into inhibition, drowsiness, and can enter coma, suffocation and death.
   two. Clinical manifestation
   1. Ammonia stimulation only transient eye and upper respiratory tract irritation, no obvious positive signs in the lungs.
   2. mild poisoning, tears, sore throat, hoarseness, cough, cough and may be accompanied by mild dizziness, headache, fatigue, etc.; conjunctival, pharyngeal congestion, edema; dry voice in the lungs; one to two Throat edema.
   3. Moderate poisoning, hoarseness, difficulty breathing, severe cough, sometimes bloodshot sputum; chest tightness, rapid breathing, mild cyanosis, and often dizziness, headache, nausea, vomiting and fatigue; dry and wet phlegm in the lungs Sound; third degree laryngeal edema.
   4. Severe poisoning, severe cough, a lot of pink foam sputum, chest tightness, shortness of breath, palpitations; difficulty breathing, obvious cyanosis, dull lungs with dry and wet voice; consistent with alveolar pulmonary edema; acute respiratory distress syndrome (ARDS) ); fourth degree laryngeal edema; complicated with severe pneumothorax or mediastinal emphysema; asphyxia.
   5. Eye, skin burns, mild to moderate, severe acute poisoning can be accompanied by eye or skin burns.
   three. first-aid
   1. Quickly and safely move the patient to fresh air, maintain breathing and circulation function; thoroughly wash contaminated eyes and skin, give reasonable oxygen therapy, and do on-site rescue.
   2. Keep the airway open: bronchial spasmolytic agent, defoaming agent (such as 10% dimethicone), aerosol inhalation therapy; if necessary, tracheotomy, clear airway obstruction to prevent suffocation.
   3. Early prevention and treatment of pulmonary edema: The main focus of early rescue is to prevent and treat pulmonary edema, so that vital signs can be stabilized as soon as possible; early, adequate, short-term application of glucocorticoids, sputum drugs, etc., especially pay attention to strictly limit the amount of fluid replacement, Maintain water, electrolyte and acid-base balance.
   4. Due to the strong corrosiveness of ammonia, the mucous membrane of the respiratory tract is seriously damaged, and the condition is easy to repeat. During the course of the disease, it should be closely observed, pay attention to the occurrence of asphyxia or pneumothorax, strengthen various measures to prevent secondary infection, and monitor the critically ill patients.
   Ammonia poisoning is a systemic disease characterized by acute respiratory damage after inhalation of high concentrations of ammonia in a short period of time, often accompanied by eye and skin burns. In severe cases, adult respiratory distress syndrome and/or other complications may be associated.
   The contact of ammonia with water in the tissue produces NH4OH, which is alkaline, has a solubility effect on the tissue protein, and can react with the adipose tissue. After direct contact with the skin and mucous membranes, local corrosive damage can result. Causes serious chemical burns, causing chemical inflammatory reactions in the nasal cavity, mouth, throat, throat, and trachea, as well as toxic pneumonia and pulmonary edema. When inhaled at a high concentration, it can cause excitability in the central nervous system to cause paralysis, and then into inhibition, drowsiness, and can enter coma, suffocation and death.
   two. Clinical manifestation
   1. Ammonia stimulation only transient eye and upper respiratory tract irritation, no obvious positive signs in the lungs.
   2. mild poisoning, tears, sore throat, hoarseness, cough, cough and may be accompanied by mild dizziness, headache, fatigue, etc.; conjunctival, pharyngeal congestion, edema; dry voice in the lungs; one to two Throat edema.
   3. Moderate poisoning, hoarseness, difficulty breathing, severe cough, sometimes bloodshot sputum; chest tightness, rapid breathing, mild cyanosis, and often dizziness, headache, nausea, vomiting and fatigue; dry and wet phlegm in the lungs Sound; third degree laryngeal edema.
   4. Severe poisoning, severe cough, a lot of pink foam sputum, chest tightness, shortness of breath, palpitations; difficulty breathing, obvious cyanosis, dull lungs with dry and wet voice; consistent with alveolar pulmonary edema; acute respiratory distress syndrome (ARDS) ); fourth degree laryngeal edema; complicated with severe pneumothorax or mediastinal emphysema; asphyxia.
   5. Eye, skin burns, mild to moderate, severe acute poisoning can be accompanied by eye or skin burns.
   three. first-aid
   1. Quickly and safely move the patient to fresh air, maintain breathing and circulation function; thoroughly wash contaminated eyes and skin, give reasonable oxygen therapy, and do on-site rescue.
   2. Keep the airway open: bronchial spasmolytic agent, defoaming agent (such as 10% dimethicone), aerosol inhalation therapy; if necessary, tracheotomy, clear airway obstruction to prevent suffocation.
   3. Early prevention and treatment of pulmonary edema: The main focus of early rescue is to prevent and treat pulmonary edema, so that vital signs can be stabilized as soon as possible; early, adequate, short-term application of glucocorticoids, sputum drugs, etc., especially pay attention to strictly limit the amount of fluid replacement, Maintain water, electrolyte and acid-base balance.
   4. Due to the strong corrosiveness of ammonia, the mucous membrane of the respiratory tract is seriously damaged, and the condition is easy to repeat. During the course of the disease, it should be closely observed, pay attention to the occurrence of asphyxia or pneumothorax, strengthen various measures to prevent secondary infection, and monitor the critically ill patients.
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