Poisoning with narcotic drugs and psychotropic substances. Functional poisons Functional poisons forensic medicine

Each classification pursues specific goals for solving certain problems. For the purposes of forensic medical examination of poisonings, the forensic medical classification of poisons is used (Scheme 35), which is based on the clinical and morphological picture of poisoning, confirmed by the results of a forensic toxicological study, and reflects the capabilities of forensic medical diagnosis of poisoning.

Depending on the site of the primary action of the poison and the obvious or hidden manifestation of the toxic effect after its absorption, poisons are divided into caustic and resorptive.

Caustic, or corrosive, poisons attack tissue at the site of exposure to the poison. Such poisons include acids and alkalis, some salts of heavy metals, phenol and its derivatives, caustic gases (chlorine, ammonia), which, in contact with tissues, cause a chemical burn. Interacting with them, they not only affect them at the point of contact, but also have a pronounced general toxic effect on the body, mainly changing its acid-base balance, leading to alkalosis or acidosis.

Depending on the concentration and time of contact, these substances exhibit an irritating, cauterizing or necrotizing effect.

Resorptive poisons exhibit their selective effect on certain tissues, organs or systems from the injection sites. These include blood, destructive and functional poisons that act after absorption and entry into the blood.

Blood poisons- these are poisons that change the composition of the blood or cause hemolysis of red blood cells. Absorbed by tissues, these poisons enter the blood, destroy red blood cells, stick them together and disrupt the function of hemoglobin in the blood, depriving it of the ability to carry oxygen necessary for the life support of tissues and organs, as a result of which their function is disrupted. Typical representatives of these poisons are arsenic hydrogen, berthollet salt, carbon monoxide and lamp monoxide, nitrobenzene, aniline and its derivatives, poisonous mushrooms

Poisons that bind hemoglobin or change the composition of hemoglobin in the blood,deprives the blood of hemoglobin transport oxygen from the lungs to the tissues. Bound hemoglobin has a specific color. These poisons include: carbon monoxide, which forms carboxyhemoglobin with blood hemoglobin, nitric acid salts (nitrates and nitrites), which form methemoglobin with blood hemoglobin.

Destructive (destroying) poisons - poisons that cause dystrophic and necrotic changes in parenchymal organs. They are a transitional group from caustic to blood and functional poisons. Destructive poisons act mainly on the cells of internal organs (liver, kidneys, heart muscle), causing fatty or protein degeneration (dystrophy) in them, which in some cases can be determined macroscopically during autopsy and in more detail by histological examination. Representatives of these poisons are heavy metals and their salts (arsenic, lead, some pesticides), phosphorus.

Poisons that do not cause noticeable morphological changes at the site of their contact with the body, or poisons that primarily act on the central and peripheral nervous system without noticeable morphological changes, or neurofunctional poisons. Depending on the predominant damage to certain organs and systems, there are poisons that excite the central nervous system, depress the central nervous system, paralyze the central nervous system, and act primarily on the peripheral nervous system.

To the poisons exciting CNS, include atropine, phenamine, phenatine and convulsive poisons - strychnine, ergotamine.

To the group oppressive The central nervous system includes narcotic poisons - morphine, codeine, ethylene glycol, paralyzing ethyl and methyl alcohols and other hypnotic barbiturates.

group paralyzing The central nervous system consists of cyanide and organophosphorus compounds (OPCs).

To the poisons acting predominantly on the peripheral nervous system, include natural and synthetic muscle relaxants.

In subsequent sections of this chapter, only the poisons that are most often encountered in the practical work of an ATS investigator will be considered.

Forensic medical diagnosis of poisoning, especially with poisons that do not cause noticeable morphological changes, is very difficult. In this regard, the discovery of a corpse without significant visible injuries should raise suspicion of poisoning. In such cases, a thorough examination of the scene or discovery of the corpse is crucial.

Inspection of the scene of a poisoning incident

In case of suspected poisoning and rapid death with unknown circumstances, a timely and correct inspection of the scene of the incident becomes of great importance, both in cases of discovery of a corpse and in the absence of one. The main attention during the inspection of the crime scene should be directed to the search for poison or its residues.

A targeted search for poison or its residues at the scene of an incident allows you to detect them on surrounding objects, in leftover food, drink, empty dishes, vials, on glass fragments, in a syringe, ampoules, syringes, empty packages of medicines, chemicals, in vomit, feces, saliva, urine, garbage cans, on the floor, clothes, underwear and bed linen.

After recording general data about the inspected room in the inspection report of the scene of the incident, it is necessary to immediately note the smell felt at the moment of entering the room where the corpse was found. The peculiar smell in the room gives reason to suspect poisoning with a certain poison, which will allow for a targeted search for it in the inspected room and focus the investigation on certain investigative actions.

It is advisable to begin the inspection of the scene of the incident with an examination of the corpse. After tying the corpse to fixed landmarks, describing the position and position of the corpse, the position of the corpse among surrounding objects, paying attention to the posture (of a sitting person hanging from the bed), emphasizing the location at the door, record the location of vomit, traces of feces, urine, saliva, sputum, objects with which and in which poison could be injected in relation to the corpse and stationary objects (landmarks). Then they begin to examine the clothes on the corpse. When inspecting clothing, attention is focused on its position (buttoned, unbuttoned, waistband lowered), traces of crystalline, powdery and liquid, both dried and wet substances, impregnations found on clothing, indicate their shape, area, direction of drips, damage to clothing due to poisoning caustic poisons, location of damage and deposits of substances and saliva on the surfaces and sides of clothing. The ingress of caustic poisons, depending on the concentration, can cause melting or damage only to the supporting surface of the material, ruptures when touched, or variously shaped holes, the location and size of which make it possible to judge the sequence of their occurrence. Thus, the presence of significant stains on the front surface of clothing and sleeves indicates the spilling of poison taken through the mouth; many small round holes indicate coughing and splashing of poison taken through the mouth. By examining underwear, the presence of stool and urine soaking is established, indicating their smell, and the consistency and color of the stool is noted.

Pockets and hiding places in clothes, socks, and shoes must be inspected carefully so as not to lose the poison during the inspection, and carefully in order to identify it. Particular attention is paid to the seams, where there may be traces of poison. Sometimes packages with various substances, injection syringes, needles, items for administering liquid substances, recipes, notes with the names of chemical substances, labels, etc. may be found in the pockets, which must be seized and handed over to the investigator.

When thoroughly inspecting the shoes, pay attention to the top, where there may be deposits of toxic substances or traces of their action, as well as vomit.

The smell of poison

By examining the corpse in cases of poisoning, it is necessary to establish: the specific smell emanating from the corpse, the severity of rigor mortis, the special color of cadaveric spots, the color of the skin and mucous membranes, the presence of parchment spots, the size of the pupils, traces of injections on the body.

The smell emanating from the openings of the mouth and nose is determined by pressing the hand on the chest and abdomen of the corpse. By the smell, one can suspect poisoning with alcohols, acetic and carbolic acids, cyanide and organophosphorus compounds. If the odor is not detected, this is also noted in the inspection report, and therefore efforts must be directed to finding the source of this odor.

When examining a corpse, pay attention to the color of the skin, which sometimes indicates poisoning with certain poisons. So, in cases of poisoning with phosphorus and arsenic preparations, mushrooms, the skin becomes yellow in color, and with carbon monoxide - pink.

The severity of rigor mortis gives reason to suspect poisoning. Severe rigor mortis indicates poisoning with convulsive poisons: strychnine, hemlock, aconite, and weak rigor indicates the action of hemolytic poisons, narcotic substances, chloral hydrate, cocaine.

The unusual coloring of cadaveric spots makes it possible to diagnose poisoning with certain poisons that change the composition of the blood. Red or pink color of cadaveric spots indicates poisoning with carbon monoxide or cyanide compounds, brown - with methemoglobin-forming poisons

By examining the body by area, attention is focused on the circumference of the nose and mouth, where the remains of powdered poison in the form of deposits and caustic in the form of drips can be found - manifested by chemical burns.

Ingestion of caustic poisons through the mouth is accompanied by chemical burns of the transitional border of the lips, mucous membrane of the vestibule and oral cavity. Spraying these poisons from the mouth during coughing causes chemical burns on the face, neck, and chest. They are parchment spots of various shapes and sizes from light to dark brown.

During examination of the corpse, examination of the pupils is mandatory. Their sharp narrowing indicates poisoning with opium, morphine, pilocarpine, organophosphorus compounds, and their expansion indicates poisoning with atropine, belladonna, asthmatolomist, dope, henbane, plants of the nightshade family. The presence of pinpoint hemorrhages on the connective membrane of the eyes indicates asphyxial phenomena preceding death in cases of poisoning with ethyl alcohol and its surrogates, morphine, etc.

Examination of the oral cavity sometimes reveals particles of powders, tablets and other substances, the presence of a grayish border on the gums, indicating lead or mercury poisoning.

Examining the body by area, they look for traces of injections that indicate the parenteral administration of poisons. Such marks can be located in the folds of skin under the mammary glands, in the elbows and on all surfaces of the body. Injection sites may be of different ages. Therefore, the description of their features should reflect the color of the surface, the height of the crusts, their peeling off at the edges, retention in the center, if they are surrounded by an outpouring of blood, they will necessarily accentuate their color in the center and along the periphery.

The introduction of toxic substances is possible using an enema into the rectum or a douche into the vagina, and therefore examination is mandatory. At the same time, pay attention to the presence of discharge, changes in the mucous membrane, streaks around the anus or vagina.

Poisoning with many poisons is accompanied by disorders of the gastrointestinal tract, vomiting, salivation, involuntary excretion of feces and urine, in which poison can be detected

Having completed the examination of the corpse, the expert begins to search for poison in objects of biological origin, on household items and furnishings. First of all, traces of saliva, feces, and urine are subject to inspection. The distance between them is measured, the area, consistency, smell, the presence of crystals, powdery substances, and parts of tablets are described. Sometimes discharge can be on the bed linen under the corpse, the body's underwear and clothing, or separate items of linen and clothing. In these cases, their location and the presence of overlaps are recorded. A variety of containers that could contain poison, syringes, needles, garbage cans, toilet drains, sinks, bathtubs, toilet walls, packaging for loose and crumbly substances, food debris, dishes (even empty ones), and water after washing dishes are subject to careful inspection. Sometimes you can find particles or crystals stuck to the bags, or deposits on the bottom of the dishes left after the liquid evaporated. Vials with labels pasted on cannot always be trusted, as they can be used to store poison.

There may be bottles, glasses, plates, etc. near the corpse that are subject to careful inspection. Their contents, quantity, smell, consistency, color, and the presence of foreign inclusions are described. There may be a crystalline or other coating on the walls and bottom of the dish after the contents have dried.

Particular attention should be paid to searching for various correspondence, recipes, diaries, notes on poisons, special notes in textbooks, reference books, manuals, works of fiction, books about poisons and their effects on humans, suicide notes. Indicating a specific poison in them will to a certain extent help the search for it by toxicological experts. In addition to the location of discovery, the corridor, pantry, yard restroom, etc. are inspected.

Detected secretions and objects with substances similar to poison must be collected in clean glass jars, hermetically sealed, sealed and removed for subsequent forensic toxicological examination; clothing and linen soaked in saliva and urine are removed by the investigator, dried, dishes and other items with contents similar to poison, as well as empty dishes (glasses, bottles, etc.) are confiscated, since poison residues may be found on their walls. Remains of various medicines are seized and sealed (including in medical institutions, if death occurred after the administration of these medicines). Powdery substances on clothing and in pockets are collected by lightly tapping the clothing material over a sheet of clean paper or clean glassware. All objects are properly processed and sent for examination to the forensic toxicology department of the Bureau of Forensic Medicine. In this case, the investigator makes a decision to order an examination and sends it, along with the objects, to the experts of the forensic toxicology department of the laboratory.

Information necessary for an expert to carry out an examination in case of poisoning

In the materials of the investigation of cases related to poisoning, the investigator must reflect information about the lifestyle, profession and occupation of the victim, access to potent and toxic substances, pesticides, household chemicals, solvents, paints (indicating which ones). In cases of occupational poisoning, indicate in what form the substance used was (in the form of a solution, gas, dust, etc.), where and in what form it was stored. When asking about lifestyle, it is necessary to note what chemicals the victim used and for what purpose in everyday life and at work, the tendency to drink alcohol, its substitutes, drugs, and toxic substances in order to obtain euphoria. To assess the state of health, it is necessary to find out what diseases the victim suffered from, what medications he used for treatment, how often and for a long time, in what doses. When asking people who observed the picture of poisoning, it is necessary to clarify whether the victim had weakness, dizziness, abdominal pain, nausea, vomiting and what caused it, salivation, diarrhea, convulsions, agitation, delirium or depression, coma, involuntary urination, defecation, what types of assistance and by whom, what drugs and in what doses were administered during the provision of first aid.

When interviewing medical personnel, it is necessary to find out which drugs were administered and how during the provision of medical care, their doses and order of administration, and how the picture of poisoning developed.

It is advisable to conduct interrogations of witnesses with the participation of a forensic physician. During the interrogation, it is necessary to find out whether the victim suffered from chronic alcoholism, whether he used alcohol substitutes, what medications he took, the conditions and approximate time of taking the poison, the behavior of the victim, external manifestations of poisoning, the picture of dying, the nature of the first aid provided by those present and emergency doctors "

A description of the symptoms sometimes allows an expert to diagnose poisoning with a particular poison and direct the investigation towards its search.

By interrogating relatives, they find out what diseases the victim suffered from (oncological, neuropsychic, etc.), how he treated them, and find out whether there were any family quarrels or troubles.

To conduct an examination of living persons, the investigator must seize and submit the originals of all medical documents that recorded the procedure for providing medical care, administering medications and conducting detoxification therapy, as well as seize, properly register and send the wash water to the forensic toxicology laboratory in order to establish presence of poison and its quantity.

Sometimes valuable data can be obtained by studying medical documents, which are often the only sources of information about the route and method of acquiring poison, reported by the victim himself, which is of great importance not only for targeted forensic research, but also for determining the degree of guilt of persons, directly or indirectly contributed to what happened. Of no small importance, subject to appropriate expert assessment, belongs to the clinical picture and dynamics of poisoning with poisons that are quickly destroyed in the body, the results of toxicological tests, and information about the administered medicinal substances described in the medical history.

In contrast to the poisons of previous groups, they do not cause morphological changes, which is why they got their name - functional. Representatives of this group are cyanide compounds, sleeping pills, ethyl and methyl alcohols, alcohol surrogates. They enter the body through the gastrointestinal tract and are quickly absorbed into the blood.

The overall effect of cyanide depends on the dose of poison taken. At the same time they state:

At large doses - acute loss of consciousness, convulsions, shortness of breath, and rapid death from paralysis of the respiratory and vascular-motor centers;

At small doses - increasing headache, nausea, vomiting, general weakness, painful convulsions, loss of consciousness, respiratory arrest and death.

Acute poisoning with ethyl alcohol ranks first among fatal poisonings studied in forensic medicine.

Alcohol acts on the body as a narcotic substance, and the following phases of its action are distinguished:

a) excitement;

b) anesthesia;

c) paralysis.

Like any drug, alcohol acts primarily on the central nervous system, namely on the cerebral cortex, causing general inhibition of the cerebral hemispheres and release of the subcortex.

In the development of alcohol poisoning, three stages of intoxication are observed - mild, moderate, severe.

1) With a mild degree, at first there is an increase in breathing and pulse, expansion of peripheral capillaries (redness), and the temperature rises. There is motor excitement and a feeling of a surge of strength.

2) In a moderate degree of intoxication, reflexes fade, coordination of movement is impaired (ataxia). Speech becomes incoherent, signs of paralysis of the retention centers appear. The pupils narrow, the temperature drops due to increased heat transfer and reduced heat production. Vomiting is observed.

3) A severe form of intoxication is characterized by the development of diffuse cortical inhibition. Reflexes sharply decrease, breathing becomes rare, hoarse, the pupils do not respond, the temperature drops significantly, muscle and cardiac weakness progresses, vomiting continues (aspiration of vomit). Involuntary urination and defecation occur.

Quite often, so-called pathological intoxication occurs, which is characterized by an increased, pathological reaction to alcohol, that is, a very strong reaction occurs from small doses of alcohol. This condition can often occur in congenital epileptics and in people after a skull injury. Pathological intoxication is a qualitative change in the reaction to alcohol, i.e., illusory ideas, deception of feelings, motiveless anger and fear are observed without the usual signs of intoxication. This state can occur suddenly and end in sleep after a short time. In most cases, this is followed by amnesia (loss of memory of the past).

Fatal poisoning with hypnotics is caused by taking barbituric acid derivatives (luminal, veronal, phenobarbital, etc.). The mechanism of action of barbiturates is that when they enter the gastrointestinal tract, they are quickly absorbed into the blood. Within 1-2 hours, the central nervous system is deeply depressed and a coma develops, hypoxia and death occur.

Psychotropic drugs affect neuropsychic processes. These include: drugs, neuroleptics, antidepressants, tranquilizers, psychoanaleptics.

Drugs are used in medicine as painkillers.

Morphine is a plant alkaloid found in opium. At the initial stage of poisoning, euphoria occurs, which is then replaced by drowsiness, dizziness, dry mouth, nausea, often vomiting, slow breathing, and decreased blood pressure. Then a comatose state develops, the skin becomes pale, the skin feels damp and cold to the touch, and body temperature drops. Death occurs in a state of deep coma from respiratory paralysis.

Other drugs of plant origin, when introduced into the body, cause short-term psychosis with hallucinations. These substances (plan, anasha, marijuana, etc.) can cause short-term mental disorder even in small doses.

Neuroleptic drugs have a calming effect (reduce anxiety, agitation, excessive activity, etc.).

The first signs of poisoning appear a few hours after taking the drugs: pronounced inhibition of the function of the cerebral cortex with loss of consciousness, convulsions, acute respiratory and vascular failure develops.

Tranquilizers (meprobamate, elenium, etc.) are also classified as sedatives. They are low-toxic, but with a significant increase in dose, acute poisoning can occur. The clinical picture, autopsy data, and diagnostics resemble those of poisoning with antipsychotics.

These are poisons that primarily act in the area of ​​primary contact. These include: concentrated acids, concentrated alkalis, phenol, formaldehyde, hydrogen peroxide, alcohol solution of iodine, potassium permanganate, etc.

dissociated acid(sulfuric, hydrochloric, nitrogen) act with their hydrogen ions, which, when colliding with tissues, cause their dehydration, coagulation of proteins with the formation of acidic albumins

Unlike acids concentrated alkalis act with hydroxyl groups, causing the soaping of fats and the hydrolysis of proteins with the formation of alkaline albumins, which dissolve in water. The tissues swell and soften due to the fact that pron penetrates much deeper than acids. The affected tissues become grayish-white in color, and after the formation of alkaline hematin - brownish-brown. Resorption of alkalis causes profound metabolic disorders, leading to disruption of the functioning of organs and systems. First of all - cardiovascular.

When acids and alkalis are administered orally into the body, there are traces of “chemical burns” in the form of streaks around the mouth and chin. Significant changes are also observed along the esophagus, in the stomach, and in the intestine. There is almost always significant swelling of the laryngeal tissue, which can cause asphyxia or asphyxia.

The degree of tissue necrosis during poisoning with acids and alkalis depends on their concentration, level of dissociation and duration of contact. As these characteristics increase, the degree of necrosis also increases.

1 Poisoning with certain acids

For fatal poisoning you need 5-10 ml of hydrochloric acid, 2040 ml of acetic acid, about 10 ml of carbolic acid, 20-40 ml of Lysol. In everyday life, poisoning most often occurs with acetic acid in the form of an essence (40-8 80% acid solution), since it is very common, therefore it is used in the food industry and at home as a seasoning for dishes and an admixture in home canning.

Cases of death from the action of acids on the skin are not known in the literature, so poisoning occurs after they enter the gastrointestinal tract.

. Action of acetic acid characterized by severe swelling of the gastric mucosa, which has a dark red color. At the same time, the use of glacial acetic acid is accompanied by the formation of an almost black mucous membrane. Olonka of the stomach. In contrast to sulfuric and hydrochloric acids, which act in large quantities at once. H-ions, acetic acid acts in small portions. And although the action is simultaneous. H-ions are less pronounced and last much longer. Therefore, the severity of the defeat will be quite great.

For damage caused by fluorohydrofluoric acid lethal dose 10-15 ml. Damage to tooth enamel is characterized by a dull yellowish color with the formation of small defects

. Carbolic acid (phenol) like its derivatives (lysol, cresol), it acts as a whole molecule. It can enter the body either orally, through the respiratory tract, or even through intact skin. It has both highly irritating and generally toxic (nerve-paralytic) effects. The lethal dose when administered through the respiratory tract is 1-2 g, orally 10-30 m ml.

First aid :. If phenol gets into the stomach, you need to drink a large amount of water, induce vomiting, and then drink activated carbon. Then rinse the stomach with a 10% solution of ethyl alcohol, and then with warm water. It is also recommended to drink a glass of milk, a mixture of egg whites and water, or a decoction of rice or oatmeal.

In case of contact with skin, immediately rinse the affected area with water or wipe with olive oil, alcohol or glycerin until the dead layer of epithelium disappears. When eliminating an accident with the release of phenol, use respiratory and skin protection (gas masks, rubberized suit, rubber boots and gloves).

. Formalin(40% formaldehyde solution). Widely used in agriculture, industry and medicine. Poisoning occurs as an accident, or for the purpose of suicide. Has a sharp specific smell. Lethal dose is 10-30 ml of formalin. Formaldehyde leads to rapid coagulation of proteins with the formation of a scab. In addition to the pronounced local effect, it also has a general effect on the body, and, first of all, on the central nervous system, which causes shortness of breath, cyanosis, and heart failure.

. First aid

1). In case of contact with skin or eyes: rinse with water for 15 minutes.

2). If ingested: drink (drink) water or milk to dilute; emetics are contraindicated

3). Hospitalization

2 Poisoning with certain alkalis

Lethal dose for poisoning caustic sodium and caustic potassium -

10-20 ml, ammonia - 25-30 ml. Alkalies act predominantly. OH ions

Unlike acids, traces of the chemical action of alkalis on the skin around the mouth and along the digestive tract are not clearly demarcated from the surrounding tissues and are significantly swollen. The mucous membranes of the mouth, pharynx are grayish in color, swelling.

. Ammonia can penetrate the body in the form of gas or a saturated 33% aqueous solution (ammonia). It has a sharp, specific smell. Ammonia penetrates well through tissues into the blood and, reaching the brain, has an irritating effect on it. With an excess of ammonia in the body, paralysis of the nervous system and death from asphyxia can occur. Ammonia has a hemolyzing effect on the blood and leads to the formation of alkaline hematin. The lethal dose is 10-20 ml of a saturated solution (33%) or 25-50 ml of pharmaceutical (10%) ammonia to alcohol.

. First aid

In case of inhalation poisoning, remove the victim from the affected area. Breathe through a moistened napkin

In case of contact with skin, rinse with plenty of water or wipe with a well-moistened cloth or tissue.

In case of ingestion of a large amount of granular alkaline drugs, gastric lavage is recommended.

If chemicals get inside, never neutralize the acid with alkalis (baking soda) or alkalis with acid (citric or acetic). What is acceptable for burns is not suitable for burns! O.

3 Poisoning with some other corrosive poisons

. Hydrogen peroxide. In medicine, a 3% aqueous solution is used. A 33% solution (perhydrol) is also used. It is used for washing wounds in medicine, for bleaching fabrics in industry, and hair in everyday life. Etching. Anna seeds - in agriculture. The lethal dose of perhydrol is 100 ml. After ingestion, consciousness is lost very quickly, swelling of the larynx and pharynx appears, and the cardiovascular system increases. NOT enough and after a few hours or days mortality and death occurs.

. Potassium permanganate- a strong oxidizing agent with irritant properties. Aqueous solutions are widely used in medicine, agriculture, and laboratory practice. Poisoning occurs as suicides, accidents ((mainly in children) and when concentrated solutions are introduced into the uterus for the purpose of terminating pregnancy. The lethal dose is 15-20 g. After ingestion of the poison, swelling of the larynx and vocal cords develops, phenomena appear and grow rapidly cardiovascular failure, up to collapse.A similar picture of poisoning is given by the ingestion of an alcohol solution of iodine into the body.

. First aid

Gastric lavage, coating agents. Hospitalization

4 Poisons with a predominantly general effect (resorptive poisons)

41. Poisons acting primarily on the blood

When absorbed into the blood, some poisons lead to changes in its properties and functions. The interest of scientists in hemolytic poisons is increasing, since recently the number of poisonings has increased, in particular with mushrooms (see walruses and toadstools), and cases of snake bites have also become more frequent. A common characteristic of these poisons is massive intravascular hemolysis, accompanied by jaundice, hemolytic anemia, and liver degeneration.

. Carbon monoxide. Carbon monoxide poisoning occurs so frequently that it is second in number only to alcohol poisoning. Carbon monoxide is formed during incomplete combustion of organic substances containing carbon. Let carbon monoxide poisoning most often occur in the cold season, when using stove heating or when a person is in a closed garage with the car engine running. The gas is colorless and odorless, and poisoning occurs slowly; signs of intoxication appear when 30% of hemoglobin is converted into carboxyhemoglobin. Muscle acidity builds up very quickly in a poisoned person, and she often cannot leave the poisoned room on her own. A person has a pink color of skin and mucous membranes. Death occurs when more than 60% carboxyhemoglobin accumulates in the blood. There are cases of fulminant poisoning. CO. This rapid form occurs when the concentration of carbon monoxide in the ambient air exceeds 1%. A person in a room with a high concentration of carbon monoxide in the air instantly loses consciousness (similar to a stroke), begins to have convulsions, and within a few minutes death occurs from respiratory arrest. When a person, while intoxicated, enters a gas-polluted area, the effects of alcohol and carbon monoxide can be cumulative.

A number of substances (Berthollet salt, nitroglycerin, aniline, nitrobenzene, sodium nitrite, hydroquinone, dinitrobenzene), entering the blood, form a fairly stable compound methemoglobin with hemoglobin, which is why the blood is unable to transport oxygen to the tissues of the body and acute oxygen starvation occurs. When administered orally, the lethal dose of aniline is 10-20 g, sodium nitrite - 1-2 g, hydroquinone - 5-10 g, potassium chlorate - 10-15 g. In addition to the ability to bind hemoglobin, individual representatives of this group also have a selective effect on various body systems. Thus, poisoning with potassium chlorate causes damage to the kidneys with the development of nephritis, accompanied by uremia, sodium nitrite suppresses the vascular-motor center, hydroquinone and aniline affect the respiratory center of the brain.

The first signs of intoxication, as in case of poisoning. CO appear at a methemoglobin concentration of 30%, and death occurs when it reaches 70-80%. In high concentrations, methemoglobin reduces the resistance of the era of itrocytes and leads to hemolysis. Excess substances that form methemoglobin can accumulate in the liver and fatty tissue. Therefore, if a person remains alive after poisoning, after some time the appearance of methemoglobin may recur due to the release of substances into the blood from the depot.

. First aid: bring the victim into fresh air, provide him with peace, warm him up, let him inhale ammonia, rub his body, give him strong sweet tea

In addition, oxygen must be given

If there is no breathing - artificial ventilation, hospitalize

Carbon monoxide is lighter than air, so if you are in a smoky room during a fire, you need to move forward bending towards the floor

5 Poisoning with destructive substances

Most destructive substances have a dual effect; they partially cause a local irritant effect in the contact area and a general effect on the body after resorption

. Common to all destructive poisons is their ability, after absorption into the blood, to produce an effect on the body, causing dystrophic, atrophic or even necrotic changes, mainly in parenchymal organs.

Destructive poisons include salts of heavy metals (mercury, lead, copper, zinc, arsenic and phosphorus metalloids, etc.). The named poisons disrupt all types of metabolism, blocking the functions of enzymes. The central and peripheral nervous systems are also affected. Most of these substances can accumulate in the body, causing chronic poisoning.

All heavy metal salts can be divided into several groups:

Mercury compounds;

Arsenic group;

Lead salts;

Zinc group

TO mercury groups also include tungsten and molybdenum. Mercury is a liquid metal of a grayish-white color. Together with its compounds, it is widely used in industry, agriculture, and medicine. Metallic mercury. HE p dissolves in body fluids and is therefore not poisonous. Very toxic fumes of mercury and its salts - mercuric dichloride (sublimate), mercuric chloride (calomel), granosan and other compounds that dissolve well in water.

Once in the body, mercury vapor or salts act on tissue proteins. Due to inhibition of enzyme activity, the processes of intracellular electrolyte exchange and glucose consumption are disrupted. Hormonal and immunological activity also suffers.

Most often, mercury vapor poisoning occurs when metallic mercury is poured, which, when it gets on the floor, clothing or other objects, begins to evaporate, causing chronic poisoning, as well as poisoning with sublimate, mercuzal or granosan. Typically, these are accidents.

. Corrosive sublimate- white crystalline powder, to which pink or blue dyes are added to warn of toxicity. The lethal dose of mercuric chloride ranges from 0.1 to 0.5 g. When it enters the body, symptoms of poisoning appear very quickly. These are signs common to all poisonings: nausea, vomiting, diarrhea, weakness, headache, as well as those specific to heavy metal poisoning - a metallic taste in the mouth. Blew and diarrhea can be bloody. At first there is an increase in the amount of urine, but anuria quickly sets in. Blood appears in the urine. Death occurs within 2-3 days. Noteworthy is the dark gray border on the gums, at the border with the teeth, characteristic of mercury poisoning;

Mercury cyanide poisoning has significant features, since when introduced into the body through the stomach, hydrocyanic acid is formed under the influence of hydrochloric acid, which causes the clinical picture of poisoning. The lethal dose of cyano and mercury is 0.2-1.0 g.

If you see spilled mercury in an apartment or other premises, immediately notify the emergency response service or department. Emergency. If a mercury thermometer is broken in the room, collect small drops of mercury with an enamel scoop or a rubber bulb with a thin tip. You can collect mercury using it heated to 70-80 °. A soap-soda solution (4% soap and 5% aqueous soda solution), which is applied to the surface to be treated, is rubbed with a brush, and then washed off with water into the sewer network. Using a vacuum cleaner to collect mercury is prohibited.

. First aid: change clothes, take a shower, rinse your mouth with a 0.25% solution of potassium permanganate, brush your teeth, drink 2-3 egg whites, milk, mucous decoction. In severe cases - hospitalization

. Arsenic compounds. In its purest form arsenic- This is a gray metal that is completely poisonous. Yet its compounds, both inorganic and organic, are very toxic, especially compounds of trivalent arsenic (arsenic oxide). Arsenic compounds are used to treat grain in agriculture and in medicine as a means of deratization.

Arsenic poisoning is an accident. Although in the last century arsenic was also used for murder, as an odorless, tasteless and colorless substance. The lethal dose is 0.1-0.2 g

Arsenic compounds - arsenites of potassium, sodium, calcium, arsenous hydrogen when entering the body, they cause a local effect at the points of contact (from mild inflammation to necrosis of the mucous membranes)

Arsenic compounds affect the nervous and vascular systems of the body. Capillaries and small vessels dilate, blood is redistributed, as a result of which blood pressure drops and abscess develops.

Depending on the route of administration and dose of arsenic compounds, gastrointestinal and paralytic forms of poisoning are distinguished

. Gastrointestinal form occurs when poison is introduced into the digestive tract. 0.5-1 hour after taking arsenic, a taste in the mouth begins to be felt, a sensation of tickling and heartburn in the throat, abdominal pain, uncontrollable vomiting; after a few hours, diarrhea appears, and the discharge looks like rice water (cholera-like stool). Urine output decreases sharply, leading to anuria. Cramps appear in the muscles of the lower leg, then spread to other muscle groups due to the redistribution of blood, causing a bluish appearance of the face, nails and coldness of the extremities. Death usually occurs 1-2 days after ingesting poisonous tinder.

Paralytic or nervous form poisoning occurs when the poison is administered parenterally, or a large amount of arsenic enters the stomach at the same time. Accompanied by severe headache and dizziness, delirium, and convulsions. Quickly on. Asta becomes deaf, then collapses and falls into a comatose state. Death occurs quite quickly (from several hours to a day) from paralysis of the respiratory and vascular-motor centers.

Cases of chronic arsenic poisoning are rare, mainly due to occupational accidents due to violation of safety precautions. The clinical picture of such poisonings is very diverse. Their manifestations depend on pathological changes that occur in various systems and organs. These changes are due to:

1) damage to the vascular system (paresis and paralysis), small vessels and capillaries, primarily the gastrointestinal tract (loss of appetite, nausea, diarrhea or constipation), conjunctivitis, age spots, hyperkeratosis, lichen on the skin, nail damage in the form white stripes running across the nails (stripes. Mass)

2) damage to the central and peripheral nervous system (headache, decreased performance, paresthesia of the extremities, paralysis of muscles - often extensor muscles, muscle atrophy)

Death in chronic poisoning usually occurs from cardiovascular failure; through degenerative changes in the heart muscle, other organs (liver, kidneys) also undergo dystrophic changes.

. First aid

Emetics; gastric lavage, then coating agents. Hospitalization

. Lead salts:lead acetate, chloride, lead nitrate, lead oxide and others. This group also includes bismuth, tin, thallium, and barium. Cases of acute lead poisoning are rare. There are frequent cases of chronic occupational poisoning in industry and printing. Nevertheless, cases of lead poisoning sometimes occur, for example, when drinking an alcoholic solution of lead salts prepared for lotions instead of alcohol, as well as when using solutions of lead salts as an abortifacient. The lethal dose of salts is 20-50 g. Then there is vomiting, sometimes with blood, abdominal pain with tenesmus and diarrhea, a metallic taste in the mouth, and thirst. When a large amount of lead is used overnight, collapse and death from cardiac paralysis quickly occur. In slower cases of poisoning, signs of damage to the lead excretion systems appear - loosening of the gums, swelling, protein in the urine, disorders of the nervous system - convulsions, loss of sensitivity, stupor, delirium, loss of consciousness and death on the 2nd - 3rd day3 th day.

. Copper salts. The most common copper salts are copper vitriol, Bordeaux mixture(a mixture of copper sulfate with slaked lime) and chlorine copper oxide, used in agriculture to control pests in gardens, in construction, in everyday life, etc. The lethal dose of copper sulfate is 1.0-3.0 g.

Symptoms of poisoning with copper salts are the same as for poisoning with other salts of heavy metals discussed above. The vomit is green and the stool is dark gray, almost black.

. First aid. Emetics; gastric lavage. Hospitalization

. All considered poisons, salts of heavy metals and phosphorus, accumulate and are well preserved in bones, hair, nails, where they can appear after several years, decades and even centuries

6 Poisoning with poisons that cause disorders of the functions of systems and organs (functional poisons)

This is the largest group of poisons, which also includes almost all medications.

The effect of general functional poisons is characterized by a sharp disruption of redox processes in the body, resulting in rapid hypoxia and death. Generally functional poisons include cyanide (hydrocyanic acid, potassium cyanide, sodium or mercury), hydrogen sulfide, carbon dioxide, etc.

. Hydrocyanic acid poisoning occur rarely, mainly in children when eating large quantities of apricot, cherry, peaches, and almond seeds. Sometimes it happens in adults under the same circumstances or when consuming cherry, plum, and willow (with seeds) tinctures that have been stored for more than two years, the glycosides contained in the grains are hydrolyzed under the action of gastric juice to form hydrocyanic acid. Under the influence of hydrocyanic acid, the canine enzyme cytochrome oxidase is stabilized in the trivalent state of iron, due to which the absorption of blood oxygen by cells decreases by almost 80%. In addition, paralysis of the respiratory and vascular-motor centers occurs. Death occurs very quickly, from a few minutes to several tens of minutes. A lethal dose of hydrocyanic acid is 0.05-0.1 g, potassium or sodium cyanide is 0.15-0.25-0.25 g.

If a large amount of cyanide is taken, then within a minute shortness of breath appears, convulsions appear, the pupils dilate, the person loses consciousness and death occurs. Taking a smaller dose of cyanide causes clinical symptoms of poisoning within 5-10 minutes. There is a severe headache, pain in the heart, tachycardia, shortness of breath, redness of the face, dizziness, nausea, vomiting, and severe muscle weakness. Then - convulsions, loss of consciousness, and within 30-40 minutes death occurs from respiratory arrest and cardiac arrest.

. Help such patients must be provided very quickly with the use of antidotes: amyl nitrite and propyl nitrite. Give me a strong drink sweet tea

In case of inhalation damage, put on a gas mask, insert an ampoule with amyl nitrite under the gas mask helmet, then crush its head and inhale the vapors. Oxygen therapy and artificial ventilation are required. Be sure to have strong sweet tea, which helps neutralize and remove toxic substances from the body. Hospitalization.

. Hydrogen sulfide- a colorless, very poisonous gas that is heavier than air, therefore it accumulates in sewers, cesspools, mines, and ordinary wells. It is formed during the decomposition of organic residues and minerals containing sulfur. Has the smell of rotten eggs. Enters the body through the respiratory tract. Poisoning occurs if the concentration of hydrogen sulfide in the air exceeds 10 mg/mg/m3.

More often, poisoning occurs if safety precautions are violated. When hydrogen sulfide is inhaled, consciousness is lost very quickly, convulsions appear, reflexes are suppressed, impairment of cardiovascular and respiratory activity increases, and mortality quickly occurs.

. First aid. Remove the victim to fresh air if they are not breathing. mechanical ventilation

. Carbon dioxide (carbon dioxide). It is odorless and colorless, heavier than air. Poisoning by it also includes accidents due to violations of safety regulations, for example, when workers clean fermentation tanks for wine or after sauerkraut, when cleaning cesspools, wells, etc. When the concentration of carbon dioxide in the air exceeds the concentration, poisoning occurs. The clinical picture is similar to hydrogen sulfide poisoning. Death due to paralysis of the central leg.

7 Neurotropic poisons

Neurotropic poisons, in turn, can be divided into:

A) suppressing central nervous system;

b) such that cause agitation and convulsions;

To a large group suppressive poisons include sleeping pills, narcotic substances, alcohol and its surrogates . Poisoning with sleeping pills- or accidents due to drug overdose, or taking large quantities for the purpose of suicide, although accidental poisoning and murder in this way also cannot be ruled out. The most well-known sleeping pills are derivatives of barbituric acid (phenobarbital, barbital, barbamyl, etaminal), as well as derivatives of other substances (nitrozepam, noxiron), etc. Lethal doses vary widely - from 1 g for sodium etaminal to 5 -15 g for Noxiron. Tranquilizers - seduxen, trioxazine, elenium, etc. - also act as hypnotic substances. in.

Once in the body, hypnotic substances lead to a sharp depression of the central nervous system, as a result of which the person falls asleep, but this sleep quickly turns into a coma, accompanied by slowing of breathing, a drop in blood pressure and oliguria due to a drop in renal pressure within 2-3 days, death occurs due to asphyxia from paralysis of the respiratory center and severe swelling of the legs.

. First aid. Gastric lavage if 24 hours have passed after poisoning. For immediate intervention - an emetic (ipecac), at the stage of falling asleep - gastric lavage, activated charcoal. Constant monitoring and care. Call the speedster

8 Drug poisoning

Drug poisoning has become very common in recent years, most of them accidents due to a significant overdose when used in order to achieve a euphoric state, which is only possible if the therapeutic dose is exceeded. In medicine, the best known drugs are the alkaloid group: opium and its derivatives - morphine, codeine, as well as papaverine, heroin, cocaine, hashish (plan, anasha, marijuana) and others.

According to the symptoms of acute poisoning, three periods are distinguished. In the first period, your well-being improves, your mood rises and a euphoric state appears, your face turns red, your pulse and breathing quicken . In the second period apathy, drowsiness appears, the face turns pale, breathing and heartbeat slow down, the pupils narrow, nausea and vomiting are observed

If there is a significant amount of drugs in the body, then the third period may begin - the narcotic period. It is characterized by muscle relaxation, decreased reflexes, and significant constriction of the pupils, with the exception of cocaine poisoning, when the pupils dilate. Consciousness is lost and the person falls into a coma. Death due to paralysis of the respiratory center, depending on the dose, death can occur within a few hours or 1-2 days after taking the drug. The lethal dose of morphine with conventional (intramuscular) administration is 0.2-0.4 g, with intravenous administration it decreases to 0.1-0.2 g, but when the body gets used to it in some subjects it can increase to 5-10 g, that is grow 50 times. The lethal dose of opium taken orally is 2-5 g, cocaine - 1-1.5-1.5 g.

. First aid. Emetics are contraindicated. Gastric lavage, activated charcoal, ensuring adequate ventilation

9 Alcohol poisoning

Among all poisonings, ethyl alcohol poisoning undoubtedly ranks first. Therefore, it is considered separately, despite belonging to the suppressive poisons. CNS

. Ethyl alcohol-colorless, transparent, volatile liquid, burning to the taste. It is present in different concentrations as a component of alcoholic beverages. The effect of alcohol on the body is due to its influence on the central nervous system. First, the function of the cerebral cortex is inhibited, and later, as the concentration of ethanol in the body increases, the inhibitory processes spread to the subcortical nodes, the cerebellum, and the centers of the medulla oblongata and spinal cord. At the same time, the function of the autonomic nervous system and internal organs is impaired. In this case, coma and death may occur - either from the direct toxic effect of alcohol on the respiratory center, or from weakening of cardiac activity.

Once introduced into the body through the mouth, alcohol begins to be absorbed in the oral cavity, then in the kiss (about 20%) and in the duodenum and small intestine (80%). Absorbed into the blood, alcohol dissipates in all tissues, fluids and organs until diffuse equilibrium occurs (resorption phase). This happens in 1-1.5 hours, sometimes earlier. After reaching the highest concentration, the elimination of alcohol from the body begins. (elimination phase which occurs in 1.5-3 hours)

In the body, under the influence of the enzymes alcohol dehydrogenase and aldehyde dehydrogenase in the liver, and under the influence of catalase in the muscles, about 90-92% of ingested alcohol is inactivated due to oxidation into acetaldehyde, acetate, carbon dioxide and water; 8-10% are excreted in exhaled breath, urine, sweat, milk, tears, etc.

The effect of alcohol introduced into the body depends not only on the quantity and concentration of alcoholic beverages, but also on numerous points, features and circumstances, among which the following are important:

Individual tolerance of the body to alcohol;

Physical and mental state;

Age of the person;

The amount and nature of food contained in the stomach;

Ambient temperature, etc. The toxicity of ethyl alcohol is significantly increased by the presence of other alcohols (amyl, isobutyl and others) or fusel oils in moonshine

Usually a person does not take a large amount of alcohol at the same time, so the concentration in the body increases gradually, causing one or another degree of alcohol intoxication

It is believed that the blood alcohol content of up to 0.5 g/l (up to 0.5% o) (% o - ppm) does not produce a noticeable effect on the body and a person is in complete control of his behavior, just like a completely sober person. But it is also necessary to remember that in children even such a concentration causes significant intoxication, and in adults - under certain conditions - the so-called pathological intoxication.

Second stage - moderate intoxication which corresponds to a blood alcohol content of 1.5-2.5 g/l (1.5-2.5%), is characterized by emotional instability, depression, disturbances in gait, speech, orientation in space and the environment. Vegetative-vascular disorders become more common - the pulse weakens, the face turns pale, salivation and vomiting appear, and urination becomes more frequent.

If the blood alcohol content exceeds 3 g/l (3%), severe alcohol intoxication occurs, which is life-threatening. An intoxicated person falls into a coma with impaired respiratory function and cardiovascular activity. There is a rapid collapse and the onset of death. This alcohol content is especially dangerous in the body of people with diseases of the cardiovascular, respiratory and central nervous systems.

Blood alcohol concentration is believed to be 5-6% in is undeniably deadly. As a rule, this is the case, but sometimes there are cases when for other causes of death (fall from a height, transport injury, drowning in water, hanging, etc.) in the blood, a forensic toxicological study turns out to be 7-8% o and even 10% in alcohol.

. Severe alcohol intoxication is facilitated by impurities alcohol, for example tobacco, opium, barbiturates, leaves and roots of poisonous plants, etc.

The rate at which alcohol concentration decreases is determined by several factors. First of all, the state of metabolism in the body, physical fatigue, previous fasting, heavy physical labor, well-fed food and even the ambient temperature.

. First aid. Emetics, gastric lavage. Place on the side to prevent tongue injury, aspiration of vomit

10 Poisoning with pesticides

Among rural residents, and in recent years also in urban areas - when cultivating allocated plots of land (vegetable gardens, orchards), cases of poisoning with pesticides are relatively common, which are divided according to origin and purpose on several occasions.

. By purpose highlight:

Herbicides and defoliants - designed to control weeds;

Insecticides - to act on harmful insects;

Fungicides - to destroy fungi;

Zoocides - for rodent control

. By origin emit: organochlorine, organophosphorus and organomercury compounds, cyanides, copper preparations, arsenic and alkaloids

These substances are also used in everyday life to combat insects in domestic animals (fleas), indoors (cockroaches, moths, mosquitoes, etc.)

Most pesticides tend to be stored for a long time and accumulate in the environment (plants, soil, water bodies), from where they can enter the human body. Thus, organophosphorus compounds are the least stable, lasting up to 1 month, and organochlorine compounds - duets - up to 8-10 years. In addition, these substances tend to accumulate in adipose tissue, so when they enter the body gradually, in small quantities, they accumulate and cause chronic poisoning.

organochlorine compounds(hemptochlor, hexachlorane, aldrin, etc.) dissolve well in fats and organic solvents, but poorly in water. They enter the body through the respiratory or digestive tract, and drugs such as Aldrin and Dildrin can also be absorbed through intact skin. The liver, kidneys, heart muscle, brain, adrenal glands, thyroid gland, and mucous membranes of the digestive tract are affected. It is believed that in case of poisoning with organochlorine pesticides, tissue respiration is disrupted.

Acute poisoning is accompanied by headache, behind the sternum, under the chest, in the muscles of the limbs, dizziness, nausea, vomiting, tachycardia, shortness of breath, convulsions, and fever. Then the phenomena of toxic encephalitis, coma and death occur a few hours after poisoning.

. Organophosphorus compounds(karbofos, saifos, phosphamide, thiophos, chlorophos, mercaptophos, methylnitrophos, pyrophos and many others). Available in the form of liquids or crystalline powders. If included. FOSiv includes sulfur - the substance has a pungent odor of garlic. Chlorophosphamide and oxamethyl are soluble in water, all others are soluble only in fats and organic solvents. They are well absorbed through intact skin or enter the body through the mucous membranes of the respiratory tract and stomach. The least resistant pesticides in soil, water and plants are neutralized within a month and decompose when boiled.

By origin Poisonings are accidents caused by violation of safety regulations. According to the mechanism of action. FOS are classified as anticholinesterase substances. They block cholinesterase and other cellular enzymes, as a result of which the mediator acetylcholine accumulates in excess, which leads to disruption of the transmission of nerve impulses.

Poisoning with organophosphorus compounds is characterized by anxiety, a feeling of fear, dizziness, salivation and lacrimation, nausea, abdominal pain, and diarrhea. Then there is a constriction of the pupils and a spasm of comodation, as a result of which vision sharply deteriorates. There is respiratory distress due to bronchospasm coupled with the release of large amounts of mucus. Paresthesia, ataxia, tremors of the head and arms, speech disorders, and confusion appear. Finally, clonic-tonic convulsions appear and coma develops. Death often occurs from paralysis of the respiratory center during the first day. At a later date, bronchopneumonia develops.

. First aid should be provided immediately, because dichlorvos is quickly absorbed into the blood. If it enters the body, give the victim several glasses of water (with activated carbon or baking soda - 1 teaspoon per glass of water) and induce vomiting, irritating the root of the tongue or the back of the throat. This procedure is repeated 2-3 times. Then give half a glass of a 2% solution of baking soda and 1-2 tablespoons of activated carbon to drink. Anti-dot: atropine (drop into eyes).

After the procedures, intoxication decreases and after 2-5 days the person recovers

. Organomercury pesticidesethyl mercuric chloride found in granosan, mercuzal, mercuhexanium and other substances that are used as fungicides and bactericides. Very toxic, easily evaporates, stable in the environment, capable of accumulating food in the body. The mechanism of action is associated with blocking sulfhydryl groups of proteins and enzymes, grossly disrupting the body's metabolic processes. The lethal dose of ethylmercuric chloride is 0.2-0.44 g.

The clinical picture is typical for poisoning with mercury preparations. First aid is the same as for mercury damage

11 Food poisoning

. Food poisoning is understood as a health disorder- acute, chronic human disease or even death associated with the consumption of poor quality food products

1. Products poisonous by it's nature constantly and cause true poisoning. This:

a) products of plant origin:

Mushrooms (fly agaric, toadstool, stitches, etc.);

Seeds of stone fruits (apricots, peaches, almonds, cherries, plums, etc.);

Other poisonous plants (henbane, hemlock, aconite, hemlock and

b) products of animal origin:

Fish (marinka, barbel, moray eel, Kochak, lamprey, fugue, etc.);

Endocrine glands of slaughter cattle

2. Products poisonous temporarily and during such periods can cause health problems. These include products:

a) of plant origin - old edible mushrooms, green watermelons, potatoes with a green surface, etc.;

b) of animal origin - some fish during spawning

3. Products non-poisonous, in themselves, but they may contain toxic impurities - cockle, mustard, horns and others (in flour), pesticides (in vegetables)

4. Separately allocated foodborne infections and bacterial intoxications

Toxic infections occur due to the consumption of food containing pathogenic microorganisms (for example, bird eggs infected with salmonellosis)

intoxication is caused by consuming foods that contain toxins (botulism bacillus, staphylococcus, etc.)

There is also a health disorder that occurs when consuming food products contaminated with mushrooms (horns, bread)

All food poisoning is characterized by sudden onset. The latent period is quite short. More often than not, multiple people who consume these products are affected. Most food poisoning is bacterial in origin. They occur acutely and usually end in recovery. Exceptions include poisoning with mushrooms, botulinum toxin and some plants (for example, poisoning of children with henbane).

Ukraine is one of the countries where eating wild mushrooms is traditional, but this tradition is fraught with the danger of poisoning. More often, poisoning occurs due to the consumption of toadstool, although cases associated with the consumption of such species as tiger row, yellow-skinned champignon, stitches, brick-gray-red umbrella mushroom, and false honey fungus are recorded.

. Mushroom poisoning- a seasonal phenomenon, occurs in spring, summer and autumn as of 0509 2004, 497 cases of poisoning with inedible mushrooms were registered in Ukraine (82 of them were children); died - 75 (including 15 children)

The upward trend in the number of mushroom poisonings, unfortunately, is systematic and as of 050905 was registered: c. Kirovogradskaya and. Lugansk regions - 28 each. Sumskaya - 23,. Donetsk,. Khmelnitskaya,. June Rnigivsky - 15,. Zaporozhye - 13,. Zhytomyr - 110.

The peak of mushroom poisoning in Ukraine, as confirmed by long-term analysis, is systematically carried out. Ministry of Health, falls at the beginning of autumn. Most poisonings are caused, as a rule, by the consumption of lamellar poisonous mushrooms (pale toadstool, fly agarics, false honey mushrooms, puffballs, champignons), which are mistakenly perceived as edible, and conditionally edible mushrooms (when broken, ml of spectacled juice is released - puffballs, ink mushroom, morels, etc.) - as a result of their inept or incorrect culinary processing. And there are many cases of poisoning by edible mushrooms, which can be attributed to other factors (place of mushroom collection, age of mushrooms, etc.).

Mushroom poisoning is mostly accidental (the victims are sure that they consumed edible mushrooms) and for the most part have a “family” character. Symptoms of poisoning develop within a period of 30 minutes to 24 hours. Mushroom poisoning is much more severe than other food poisonings, and is often complicated by the consumption of alcoholic beverages.

Unfortunately, deaths due to mushroom poisoning are recorded annually in our country. Of particular concern is the consistently high mortality rate, including among children, because the use of mushrooms for children under 8 years of age is strictly contraindicated. Experts also do not recommend consuming mushrooms for pregnant and breastfeeding mothers. The main cause of deaths is, as a rule, late access to medical care in medical institutions.

Poisoning with spring mushrooms lines occurs through their external resemblance to edible zmorzhka mushrooms, and also due to improper culinary processing, since their toxic substance - gel-Velov acid - when cooked with the addition of table ots. Within 5 - 10 minutes, the CTU turns into a decoction, partially decomposes, and the lines become non-toxic. If processing is not carried out, 0.5-4 hours after eating mushrooms, nausea, vomiting, pain in the vomit, headache, and diarrhea appear. Then the pupils dilate, convulsions occur and coma sets in. On the second day, jaundice appears, the liver and spleen enlarge. Death occurs on the 2-6th day. The yellow color of the skin and mucous membranes, especially the sclera, is noteworthy. Mortality is 20-70-20-70%.

. Death cap from the outside it is somewhat similar to a champignon; there are three varieties: white, yellow and green. Several toxic substances have been isolated from this mushroom - amanitotoxin, amanithemolysin, phaloidin, a-and p-amanitin. The main role in poisoned. Yenny plays amanitotoxin because others are destroyed by heat treatment and under the influence of gastric juice.

The first signs of poisoning appear after 10-12 hours (sometimes later): nausea, diarrhea, oliguria, which is replaced by anuria, diplopia, liver enlargement, followed by loss of consciousness and coma. Death, calmer now, in 2-7 days. Mortality reaches 45-900%.

. fly agaric has a specific red color with white spots, due to which it is rarely poisoned. Toxic substances: muscarine, muscaridine, pilztoxin. Manifestations of poisoning appear after 1-6 hours. In addition to the symptoms usually associated with poisoning by other mushrooms, in case of poisoning with fly agaric, salivation and lacrimation, sweating, and shortness of breath are noted. The pulse is accelerated and the pupils are constricted (due to the action of muscarinine), or slow and the pupils are dilated (under the influence of muscaridine). Then convulsions appear, loss of consciousness, and death occurs within 24 hours. The percentage of fatal cases is relatively small (from 1% to 5% - according to various authors).

12 Poisoning by poisonous plants

This type of poisoning occurs in the warm season, mainly in children or people who do not understand plants. There are poisonings with aconite (the active substance is aconitine), spotted hemlock (contains the alkaloid coniine), henbane, datura (containing atropine, scopolamine, hyoscyamine), hemlock and other plants.

Poisoning begins acutely. 15-30 minutes after consuming the plants, salivation begins, "scratching" in the mouth and esophagus, abdominal pain, nausea, vomiting, diarrhea, convulsions, constriction or dilation of the pupils, tachycardia, which is replaced by bradycardia. Death occurs from respiratory arrest and cardiac activity.

. First aid

13 Food intoxication

Considered the most dangerous botulism. Intoxication is caused by botulism bacillus. There are six known types of these microbes. In our country, the causative agents of the disease can be types. A,. In and. E. They exist in the form of spores and vegetative forms, all types of anaerobes. Dry spores can persist for decades, and when exposed to a favorable environment, they can turn into vegetative forms that produce exotoxin - the formation of a protein nature. The exotoxin breaks down when heated to 80°. C for 15-30 minutes, and at 100 °. C - for 5-15 minutes.

The cause of botulism is considered to be products that have not been subjected to sufficient heat treatment; often these are products that are prepared and consumed without sufficient heat treatment: sausages, pates, ham, fish, canned meat, fish and vegetables. Homemade products are especially dangerous. Botulism bacilli multiply in certain areas of food products, so not all people who have consumed the same product are affected. Once in the intestines, vegetative forms penetrate the blood and spread to all organs. The exotoxin they produce affects the nuclei of the medulla oblongata and the cardiovascular vessels. NNU and muscular system.

After consuming foods contaminated with botulism, a latent period begins. Fluctuations in this period range from 2 hours to 10 days (on average 18-24 hours). With a short incubation period of years, the growth rate is higher. The first manifestations of intoxication: malaise, headache, weakness, anxiety, insomnia, nausea, vomiting, dry mouth, diarrhea. Then double vision (mesh, dilated pupils) and hearing loss occur. Later, there is a difficulty in swallowing, limited mobility of the tongue, impaired or loss of voice, and difficulty urinating. Blood pressure initially decreases slightly due to bradycardia, which is replaced by tachycardia and increased blood pressure. Breathing is rapid (up to 50 respiratory movements per minute), shallow, erratic. Consciousness persists until death. Death occurs within 1-2 days from asphyxia of central origin. Mortality reaches 40-70% and 40-70%.

. First aid. Gastric lavage. Immediate hospitalization

Staphylococcal intoxication

Staphylococci, unlike botulism bacilli, are aerobes. Their vital activity can occur in any products, especially milk, dairy products, as well as meat, fish products and confectionery products. Staphylococci die when heated to 80°. C in 10-60 minutes, and when boiling - immediately.

When multiplying in food, staphylococci secrete hemolysin, dermotoxin, and an enterotoxin complex of specific polypeptides. Currently, six types of enterotoxins are known. They vitrify at temperatures above 120°. C. Once in the digestive tract, enterotoxin causes poisoning. The latent period lasts from 0.5 to 4 hours, then nausea, vomiting, abdominal pain, and diarrhea appear. In severe cases, convulsions appear and collapse occurs. Recovery occurs in 1-2 days. Deaths are rare.

. First aid. Gastric lavage. Take activated carbon. Diet therapy, antibacterial therapy as prescribed by a doctor

Foodborne illnesses

More often called salmonella of which more than 140 varieties are known. More than 60 of them are pathogenic for humans. The source of microbes is livestock, birds and people who carry bacteria. Once on food products, salmonella release enterotoxin, which is destroyed during heat treatment at 70°. C for 10 - 50 minutes, and at 100 °. S - instantly. In case of insufficient heat treatment or failure to comply with personal hygiene rules, enterotoxin enters the body. Gastrointestinal tract and causes poisoning. The latent period lasts 12-24 hours. The onset is violent - nausea, vomiting, cold sweat, diarrhea, possible temperature rise up to 40 °. C. General intoxication may result in skin rashes, enlargement of the liver and spleen. Clinical forms of toxic co-infection are polymorphic. Intoxication lasts 3-7 days. Infection rarely ends in death.

. First aid. Rinse the stomach with plenty of water. Give an alkaline solution to drink and consult a doctor

Poisoning(spicy).

Poisoning is a disease that develops as a result of exogenous exposure to the human or animal body of chemical compounds in quantities that cause disturbances in physiological functions and pose a danger to life.

There are chemicals in the human environment that have toxic properties, poisonous plants And poisonous animals . Due to the production of a huge number of chemical compounds widely used for agricultural, industrial, household, medical and other purposes, a so-called toxic situation has developed. Every year several thousand are synthesized and several hundred new chemicals are introduced into practice. Many of them, as a result of violation of safety conditions during production, use and storage, can cause acute and chronic poisoning.

According to poison treatment centers, in the RSFSR for 1987-1988. among hospitalized patients, the largest number of cases are patients with acute O. caused by various drugs, mainly psychotropic (60-30.4%); alcohol and its surrogates (40-10.6%); organophosphate insecticides (6.3-1.8%); household chemicals - acids and alkalis, mainly vinegar essence (28.8-7.6%).

A significant proportion of victims of acute O. are children (see. Poisoning acute in children).

When characterizing O., existing classifications of poisons are used according to the principle of their action (irritating, cauterizing, hemolytic, etc.) and “selective toxicity” (nephrotoxic, hepatotoxic, cardiotoxic, etc.).

Depending on the route of entry of poisons into the body, inhalation (through the respiratory tract), oral (through the mouth), percutaneous (through the skin), injection (parenterally administered) and other poisonings are distinguished.

Clinical classification is based on assessing the severity of the patient’s condition (mild, moderate, severe, extremely severe O.), which, taking into account the conditions of occurrence (domestic, industrial) and the cause of this O. (accidental, suicidal, etc.), is of great importance in forensic -medically.

Etiology. The cause of acute poisoning is toxic substances of different structure, which, according to the purpose of their use, can be divided into the following groups: industrial poisons, used in an industrial environment as solvents, fuels, chemical reagents, etc.; agricultural pesticides , used to control pests and increase productivity (insecticides, herbicides, etc.); medicines; household chemicals; biological, plant and animal poisons; natural poisonous gases that are formed in areas of active volcanoes and during earthquakes; chemical warfare agents.

In the social and hygienic analysis of the etiology of acute O., it is important to determine the conditions of their occurrence. Industrial O. are associated with accidents or violations of safety regulations at work and are usually of a widespread nature. However, in the total amount of O. household ones make up more than 90%.

The reasons for the entry of poisons into the body are divided into two main categories: subjective, directly dependent on the behavior of the victim, and objective, related to the specific toxic situation created. However, in each case of O. it is usually possible to detect causes of both categories. Subjective reasons - O. is associated mainly with accidental (erroneous) or deliberate (suicidal) use of various chemicals. Accidents include O. as a result of an overdose of drugs during self-medication, alcohol intoxication, erroneous consumption of poisonous mushrooms and plants, bites of poisonous snakes and insects.

Criminal cases of O. arise as a result of the use of toxic substances for the purpose of murder or the development of a helpless state in the victim. In this case, toxic substances (for example, thallium compounds) are usually used for the purpose of murder, the symptoms of which appear after a certain asymptomatic period. In the most common cases of deliberate O., for the purpose of robbery, psychotropic drugs are used, which quickly cause in the victim a helpless state with a disorder of consciousness, similar in appearance to alcohol intoxication.

The objective reasons determining the increase in the number of acute O. include the tension of modern living conditions, which cause some people to need to constantly take sedatives. A special place is given to chronic alcoholism and m. Other causes of O. include self-medication, as well as the use of toxic doses of drugs or chemicals for out-of-hospital termination of pregnancy, especially in countries where abortion is prohibited.

Pathogenesis. In the pathogenetic aspect, it is advisable to consider O. as a chemical injury that develops as a result of the introduction into the body of a toxic dose of a foreign chemical substance with a specific effect that disrupts certain functions. The toxicogenic effect manifests itself in the earliest clinical stage of O. - toxicogenic, when the toxic agent is in the body in a toxic dose. At the same time, adaptive processes are activated and developed aimed at restoring homeostasis: activation of the pituitary-adrenal system (stress reaction), centralization of blood circulation, lysosomal reaction, hypocoagulation, etc. Compensatory reactions and recovery processes along with signs of disturbances in the structure and functions of various organs and systems The body consists of the contents of the second clinical stage of O. - somatogenic, lasting from the moment of removal or destruction of the toxic substance until the complete restoration of functions or death of the body.

The distribution of toxic substances in the body depends on three main factors: spatial, temporal and concentration. The spatial factor includes the routes of entry, excretion and distribution of poison, which is associated with the blood supply to organs and tissues. The amount of poison entering an organ depends on its volumetric blood flow per unit mass. Accordingly, it is possible to single out the organs whose tissues usually receive the largest amount of poison per unit time: lungs, kidneys, liver, heart, brain. In case of inhalation poisoning, the main part of the poison enters the kidneys, and in case of oral poisoning - into the liver, because The liver/kidney specific blood flow ratio is approximately 1:20. The activity of the toxic process is determined not only by the concentration of the poison in the tissues, but also by the degree of their sensitivity to it - selective toxicity. Particularly dangerous in this regard are toxic substances that cause irreversible damage to cellular structures (for example, during chemical treatment of tissues with acids or alkalis).

The time factor characterizes the speed of poison entering the body, its destruction and elimination, i.e. it reflects the relationship between the time of action of the poison and its toxic effect.

Concentration factor, i.e. the concentration of poison in biological media, in particular in the blood, is considered fundamental in clinical toxicology. Assessment of this factor makes it possible to distinguish the toxicogenic stage of poisoning from the somatogenic stage, and to prognostically characterize the threshold, critical or fatal level of poisons in the blood ( table. 1 ) and evaluate the effectiveness of detoxification measures.

Table 1

Threshold critical and fatal for some poisons in the blood

In clinical toxicology, the concept of a conditional lethal dose is traditionally used, which corresponds to the minimum dose that causes death in a person with a single exposure to a given toxic substance. Objective data on lethal concentrations of toxic substances in the blood are more accurate and informative (in µg/ml, mEq/L), obtained by chemical analytical studies.

Clinical manifestations of poisoning in the toxicogenic stage are determined mainly by the specific properties of poisons, and in the somatogenic stage - by the nature and degree of damage to various functional systems, depending on the intensity of the chemical injury, the duration of the toxicogenic stage and the selective toxicity of the poison.

Psychoneurological disorders develop as a result of a combination of the direct effect of poison on various structures of the central and peripheral nervous system in the toxicogenic stage of O. (exogenous) and under the influence of endogenous toxins in the somatogenic stage with damage to the excretory systems of the body, mainly the liver and kidneys (endogenous). O. by substances that disrupt the mediation of nervous processes as a result of inhibition or stimulation of adrenergic and cholinergic receptors, leads to severe disturbances of autonomic functions (heart activity, secretory activity of glands, smooth muscle tone). The convulsive syndrome observed in O. with various poisons may be the result of the direct toxic effect of some poisons (strychnine, isoniazid derivatives, etc.) on the function of the central nervous system, as well as a manifestation of hypoxia or cerebral edema. In acute O., vascular lesions and degenerative changes in brain tissue (disseminated areas of necrosis in the cortex and subcortical formations) are noted, indicating a combination of toxic and hypoxic damage with the phenomena of hemo- and liquorodynamic disorders.

Breathing disorders can develop due to disorders of gas exchange and oxygen transport with the development of various types hypoxia . Clinical signs of external respiration disorders with symptoms of hypoxemic hypoxia account for approximately 86%; in other cases, phenomena of hemic, circulatory and tissue hypoxia predominate. The most severe respiratory disorders are observed with a combination of the listed forms, which is noted in 45% of cases (mixed form of hypoxia). A common cause of respiratory disorders is mechanical asphyxia due to obstruction of the bronchi with secretions or aspirated masses from the oral cavity and disruption of the drainage function of the bronchi.

Circulatory disorders - cardiac arrhythmias , asystole, collapse , toxic - caused by damage to both the mechanisms of blood circulation regulation and the cardiovascular system itself (for example, in case of poisoning with cardiac glycosides, cardiotropic poisons). In the toxicogenic stage of O., the so-called primary toxicogenic collapse develops, observed in 1-5% of cases of fatal O. Acute anoxia of the brain and disturbances in conduction and heart rhythm such as atrioventricular block and ventricular fibrillation (cardiotoxic poisons) are important in its development. If, in response to a chemical injury, compensatory mechanisms of increasing peripheral vascular resistance and centralization of blood circulation manage to turn on, then another clinical syndrome develops - exotoxic shock . In e collapse, observed in approximately 1/3 of cases of fatal O. in the somatogenic stage, an important role is played by the hypokinetic state of hemodynamics and pronounced toxicity.

Poisonings vary by cause (accidental and intentional) and by the circumstances of their occurrence (industrial and domestic). In forensic medical practice there are poisons mainlywith local action (caustic poisons), which include concentrated acids and alkalis, which cause sharp morphological changes at the site of application in the form of chemical burns of varying degrees. When taking caustic substances through the mouth, burns occur in the form of streaks or spots on the skin in the mouth, chin, and cheeks.

Acids They exert their damaging effect with free hydrogen ions, which dehydrate tissues and coagulate proteins, leading to coagulation (dry) necrosis. The nature of the damaged surface (scab) often suggests the action of a certain acid. In case of poisoning with sulfuric acid, a dirty gray color and thickening of the mucous membrane of the esophagus and stomach are noted, and the scab becomes brown or almost black in color. In case of poisoning with nitric acid, a yellow or green-yellow color of the affected tissues is observed; the action of acetic acid is associated with its pronounced hemolyzing effect, as a result of which the scab acquires a pinkish-reddish tint.

Alkalis act with their hydroxyl ions, causing liquefaction and melting of proteins with the formation of colliquation (wet) tissue necrosis. The affected areas become soft, swollen, and slippery to the touch. A gray-greenish or dark brown scab forms on the mucous membrane.

Another group includes resorptive poisons, the toxic effect of which appears only after their absorption. This group contains the following toxic substances.

Destructive poisons, causing dystrophic, necrobiotic and necrotic changes in internal organs. These include mercury derivatives (sublimate, granosan, etc.) and arsenic compounds (arsenic acid anhydride).

Poisons that change the composition of the blood are blood poisons. These primarily include carbon monoxide (carbon monoxide), which, if it enters the body,

nism, hemoglobin binds and carboxyhemoglobin is formed, which gives the blood, muscles, and cadaveric spots a bright red color. Other representatives of this group are methemoglobin-forming substances (aniline, Bertholet salt, sodium nitrite, nitrobenzene, hydroquinone, etc.). Like carboxyhemoglobin, methemoglobin is a stable compound that is unable to attach oxygen and transfer it to tissues.

Functional poisons having a general cellular and neutrotropic effect without pronounced morphological changes. These include poisons: 1) paralyzing or depressing the central nervous system (organophosphorus compounds, hydrocyanic acid compounds (cyanides with the smell of bitter almonds), ethyl and methyl alcohols, ethylene glycol, drugs and hypnotics); 2) poisons with stimulating and convulsive effects (alkaloids in the form of atropine and strychnine); 3) poisons with a predominant effect on the peripheral nervous system (myo-relaxants, pachycarpine).

Also distinguished food poisoning bacterial origin (botulism) and food poisoning of non-bacterial origin (poisonous mushrooms, poisonous plants, poisonous animal products).

Forensic medical examination of poisoning is based on a detailed analysis of the circumstances of the incident, medical document data, autopsy results, forensic chemical examination of objects, results of other types of laboratory tests (histological, biological, botanical, bacteriological, etc.). It should be remembered that positive or negative results of a forensic chemical study in themselves do not in all cases prove the presence or absence of poisoning. False-positive results may be due to the post-mortem entry of various toxic substances from the environment into the corpse. Negative results of forensic chemical research are often associated with the complete removal of a toxic substance from the body before death or with its various transformations (decomposition, biotransformation).

Scrollquestions, permittedatexaminationpoisoning

1. Could death have occurred from poisoning?

2. What toxic substance caused the poisoning?

3. What could be the dose and concentration of the injected poison?

4. How the poison was introduced into the body, in what state of aggregation
yaniya?

5. Could the substance introduced into the body be destroyed and completely
stand out before death? What time is required for this?
Dimo?

6. Could a toxic substance enter the body posthumously (from
soil, water, etc.)?

7. What could be the origin of food poisoning (plant
nimal or animal, bacterial or non-bacterial)?

8. What conditions could contribute to the onset of poisoning (with
accompanying diseases, synergism, addiction, etc.)?

9. Could alcohol intoxication affect the course and outcome of
management?

10. Isn’t the death a consequence of individual relapse?
reactions (intolerance) of the body to the introduced chemical or
medicinal substance?

Note.

Any substances found at the scene of the incident or on the clothing and body of the victim that could presumably have caused poisoning, as well as vomit, urine, feces and other biological secretions should be sent for examination.

Testcontrol

In paragraphs 1-10 below there are two statements connected by the conjunction “because”. Determine whether each of these statements individually is true or false and whether the connection between them is true. Give the answer indicated by the letter according to the following code.

1. “Boxer pose” is a sign of intravital action of high
what temperature, because when exposed to high temperature
muscle shortening and thickening occurs.

2. Acids and alkalis are caustic poisons, because in their place
contact with the body causes chemical burns.

3. Skin moisture contributes to electric shock, That's why
What Skin resistance increases when moisturized.

4. In the initial period of alcoholic intoxication, there is a
a state of euphoria, because Alcohol is an initial stimulant
giving an effect on the central nervous system.

5. A sign of the intravital effect of low temperature is
curl up pose because at low temperatures people
It is possible to reduce the heat transfer surface.

6. The possibility of overheating of the body increases with increasing
air humidity, because with significant air humidity
ha decreases the evaporation of moisture from the surface of the skin.

7. Sunstroke is accompanied by a violation of thermoregulation of the neck
big brain because in this case there is a direct and long-term
exposure to sun rays on the head.

8. Violation of heat transfer processes leads to burns and frostbite
niyam, because disruption of these processes is associated with local
the effect of temperature on the body.

9. Chemical burns to the skin of the face when caustic substances enter through
mouth usually look like vertical streaks, because degree
chemical burns to the skin depends mainly on the concentration
tions and exposure to caustic substances.

10. Neurotropic poisons do not cause specific morphological
changes, because they belong to the group of functional
poisons, predominantly acting on the central nervous system
topic (CNS).

In paragraphs 11-20 of the answers indicated by letters below,You must choose one correct answer.

11. The signs of a typical electrotag are all of the following,
except:

A - roller-like elevation of the skin along the edges of the lesion;

B - round or oval shape;

C - crater-shaped depression in the center;

D - epidermal detachment;

E - wet surface with purulent overlay.

12. The limit of “safe” electric current voltage is:
A - 12-24 V;

V - 40-60 V; C - 100-110 V; D - 220-240 V; E - 3g0 V.

13. The damaging effect of electric current depends on:
A - current voltage]

V - current strength;

C - current frequency;

D - resistance;

E - all of the above.

14. Skin burns from hot liquid are characterized by:
A - significant depth of damage;

B - the presence of singed hair;

C - the shape of a burn wound, reminiscent of drip marks;

D - the presence of soot on certain parts of the body;

E - signs of burning clothes.

15. When examining poisonings, the expert must answer all questions
sy, except the following:

A - is the death associated with poisoning;

B - what toxic substance caused the poisoning;

C - for what purpose was the poisoning committed (murder, suicide or accident);

D - how the toxic substance entered the body;

E - what diseases the deceased suffered from and whether they contributed to the onset of death.

16. Factors contributing to the general effect of low temperature
ry, include all of the above, except;

A - low humidity;

B - strong wind;

C - state of clothing;

D - adynamia;

E - alcohol intoxication.

17. At what stage of alcoholic intoxication could the subject be at
life if 2.8% ethanol is found in his cadaveric blood:

A - slight intoxication;

B - moderate intoxication;

C - severe intoxication;

D - severe alcohol intoxication;

E - fatal poisoning.

18. Which of the following substances belongs to the group of destructive
poisons;

A - carbon monoxide;

B - chlorophos;

C - morphine;

D^-arsenic anhydride;

E - hydrogen sulfide.

19. In case of poisoning with what substance the blood turns bright scarlet?
color;

A - ethylene glycol;

B - arsenic anhydride;

C - carbon monoxide;

D - acetic acid; E - sublimate.

20. With a significant effect of radiant energy on the body, they can
arise:

A - acute radiation sickness; B - chronic radiation sickness; C - radiation burns; D - all answers are correct; E - the answers are incorrect.

In paragraphs 21-30 below, indicate the correct answer, indicated by a letter, according to the following code:A- if 1, 2, 3 are true;IN- if 1, 3 is true;WITH- if 2, 4 is true;D - if 4 is true;E - if everything is true.

21. What should be attributed to the main mechanism for the development of decompression?
onny disease:

1) nitrogen poisoning;

2) oxygen poisoning;

3) carbon dioxide poisoning;

4) blockage of blood vessels by gas bubbles (gas embo
lia).

22. The most typical signs of a sharp increase in barometry
ical pressure are:

1) pulmonary barotrauma;

2) barotrauma of the hearing organs;

3) barotrauma of the paranasal cavities;

4) barotrauma of the musculoskeletal system.

23. What is the basis for establishing carbon monoxide poisoning:

1) the circumstances of the case;

2) cadaveric spots of pinkish-red color;

3) detection of carboxyhemoglobin in the blood with spectral
research;

4) bright red (scarlet) blood.

24. Negative result of forensic chemical research
may indicate:

1) absence of poisoning;

2) destruction of poison in the body;

3) complete removal of poison from the body;

4) deposition of toxic substances by organs and tissues.

25. In accordance with the forensic classification of poisons under
are divided into:

2) destructive;

3) blood;

4) functional,

26. Signs of IV degree frostbite include:

1) local redness and swelling of the skin;

2) formation of blisters on the skin;

3) necrosis (death) of the entire thickness of the skin;

4) necrosis of the skin and underlying tissues.

27. Factors contributing to overheating of the body are:

1) high ambient temperature;

3) high air humidity;

4) human height,

28. The conditions for the action of poisons depend on:

1) the amount of substance administered;

2) concentration and state of aggregation;

3) routes of administration and elimination;

4) the nature of the transformation of poison in the body.

29. Diagnostic signs of intravital effects on humans
High temperatures in fire conditions are:

1) the presence of soot on the mucous membrane of the respiratory tract;

2) the absence of soot in the depths of the folds of the skin on the face;

3) a large amount of carboxyhemoglobin in the blood and skeletal
muscles;

4) “boxer” pose.

30. Signs of lifetime general effects of low temperature (human hypothermia) are:

1) the presence of frost at the openings of the mouth and nose;

2) “curl” pose;

3) icing of the corpse bed;

4) frostbite on open areas of the body.

For items 31-50 listed below, select the correct answers: the question (phrase) indicated by a number must correspond to one correct answer, indicated by a letter. Each answer can be used once, several times, or not at all.