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DOI: 10.1055/s-0030-1248448
© Georg Thieme Verlag KG Stuttgart · New York
Rauchgasinhalations-Intoxikation
Ursachen, Primärversorgung und HandlungsempfehlungIntoxication through Smoke InhalationCauses, Primary Management and Recommendations for TreatmentPublikationsverlauf
Publikationsdatum:
10. Juni 2010 (online)
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Zusammenfassung
Rauch besteht aus einer Mischung von Erstickungs-, Reiz- und Giftgasen sowie aus Ruß. Die Erstickungsgase erniedrigen den Sauerstoffpartialdruck in der Umgebungsluft. Die Reizgase führen zum Bronchospasmus. Die Giftgase im Rauch sind die „giftigen Zwillinge” Kohlenmonoxid und Blausäure, die zu einer Sauerstofftransport- bzw. Sauerstoffutilisationstörung führen. Ruß reizt und verlegt die Atemwege und transportiert Chemikalien in den Bronchialbaum. Die Behandlung besteht aus den üblichen Basismaßnahmen. Der Einsatz von 100 % O2 ist in diesem Zusammenhang eine gezielte Antidottherapie. Patienten, die bewusstlos aufgefunden werden (GCS ≤ 9), müssen eine Therapie mit dem Zyanidantidot Hydroxocobalamin vor Ort erhalten und in eine Klinik zur weiteren Beurteilung verbracht werden. Innerhalb von 6 Stunden sollten sie einer HBO-Behandlung in einer Druckkammer zugeführt werden. Patienten mit einer Bewusstseinstrübung (GCS = 10–13) oder nach einer Synkope sollten ebenfalls mit HBO behandelt werden, wenn sie eine Kleinhirnsymptomatik oder ein COHB > 25 % aufweisen. Patienten mit Bronchialspastik müssen im Krankenhaus behandelt werden bis die Spastik beseitigt und der „peak flow” normalisiert ist. β2-Adrenorezeptor-Agonisten, aber keine Glukokortikoide, können Anwendung finden. Bewusstseinsklare Patienten ohne pulmonale Symptome benötigen keine stationäre Behandlung.
Abstract
Smoke is a mixture of asphyxiants, irritant and toxic (chemical asphyxiants) gases as well as soot. The asphyxiants decrease the partial pressure of oxygen in the environment. The irritants lead to bronchospasm. Chemical asphyxiants, the so called „toxic twins” are carbon monoxide and cyanide which lead to a disturbance of oxygen transport and utilisation. Soot may create mechanical obstruction and is transporting chemicals intra-bronchially. Treatment consists of the usual basic measures. The application of 100 % oxygen via mask or mechanical ventilation is an antidotal treatment under such circumstances. The patients who are unconscious (GCS ≤ 9) must be treated with the cyanide antidote hydroxocobalamin and be brought to a clinic for further assessment. Within 6 hours after the incidence they have to undergo HBO-treatment. Patients with clouding of consciousness (GCS 10–13) or following a syncope should also receive HBO treatment if they are showing cerebellar symptoms or a COHb > 25 %. Patients who exhibit bronchial spasm have to be admitted to hospital till symptoms disappear and peak-flow is normal. β2 adrenoreceptor-agonists but no glucocorticoids can be used. Patients with a clear consciousness without pulmonary symptoms do not require hospital admission.
Schlüsselwörter
Rauchgase - Kohlenmonoxid - Blausäure - Hydroxocobalamin - HBO
Keywords
smoke - carbon monoxide - cyanide - hydroxocobalamin - HBO
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