The last side of a paraquat victim

"some people with drug poisoning need emergency perfusion and go back to the hospital immediately."

in the early morning, a phone call from the hospital woke me up and I quickly got up to wash up. By the time we got to the hospital, the emergency room was busy before dawn.

the emergency room temporarily added a bed, the ECG monitoring equipment rattled, and two patients with acute poisoning lay flat on the hospital bed, with rubber tubes the size of their index fingers in their nostrils, all the way to the stomach. I took a look at the scale. Male patients showed 59, female patients showed 55, this number is the depth of the gastric tube, in centimeters. The gastric lavage machine is full of horsepower, pour 2000-6000ML of water into the stomach, and then extract the strong-smelling brown liquid from the stomach.

"what are you drinking?" I asked my colleague.

paraquat. "

at the end of the bed stood a white-haired old man, trembling and wiping away tears on crutches. I was afraid that she would stumble and fall to the ground, so I moved a chair to help her sit down.

the two patients were a middle-aged couple who began to fight because of a trivial quarrel. The wife was so angry that she picked up paraquat and poured it into her mouth. The husband grabbed the bottle and said, "you want to die, right? well, I'll die with you." He looked up and drank the rest.

it is said that the two kept quarreling on the way to the hospital. As soon as they entered the hospital, after a trip of infusion, blood draws, gastric lavage, and enema, the exhausted two people stopped and their emotions calmed down. Now they lay in a quiet white, with stomach contents spitting out at the corners of their mouths, on their clothes, and the edge of the bed and the irritating smell of poison was mixed with sour. They are like two fish that were accidentally washed ashore.

"how much did you drink?" I asked the first doctor.

"the woman drank a small half of the bottle, and the man drank more than half of the bottle, which far exceeded the lethal dose." The first doctor handed me a paraquat bottle brought by my family. I saw 200ML written under the mouth of the bottle.

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the adult lethal dose of paraquat is 20% aqueous solution 5 to 15ML. Once taken, it is absorbed through the digestive tract, skin, and respiratory tract, and the toxicity affects multiple organs of the whole body. In severe cases, it can lead to multiple organ dysfunction syndromes (MODS). The lung is the main target organ, which can lead to "paraquat lung".

it is often said that when paraquat comes out, no grass grows. In the past few years as a doctor, I have never seen anyone who can be saved by drinking more than 10 milliliters of paraquat in emergency and hemodialysis centers.

the only special case is a female patient who did not swallow paraquat in her mouth. Because of the demolition conditions of her old house, she did not agree with the government. She took a bottle of paraquat to the office, took a sip in front of the leading cadres, threatened to commit suicide, and was taken to the hospital by the police. A small mouthful of paraquat in the mouth did not swallow all the time, and finally, spit out. Their mouth was already rotten, but his life was saved.

so far, there is no effective detoxification drug for paraquat poisoning, and there is no unified diagnosis and treatment plan or guide for acute paraquat poisoning in China. On July 1, 2016, the sale and use of paraquat water agents were completely banned in China. despite this, paraquat has not disappeared among the people. I receive one case of paraquat poisoning almost every month in the San Hospital in this small city of Zhejiang Province.

I think the couple is hopeless.

two  

the old man who accompanied the patients who drank paraquat was the mother of the female patient.

I told her that her daughter and son-in-law drank far more paraquat than the lethal dose. Just now examined the blood of two people, the blood paraquat concentration is very high, and hemoglobin also decreased rapidly, although the paraquat concentration detected in urine has decreased compared with before, it can not change anything.

"now hemoperfusion is only temporary relief. Absorb some of the toxins and let them infiltrate slowly. You should be prepared psychologically."

"No way, it's impossible. They quarrel all the time, not once or twice." Both of them are short-tempered and impulsive, and every time they quarrel, they pass by. Doctor, I'm willing to pay for gastric lavage, blood exchange, and the best medicine. My wife went early, and she is the only daughter who has been spoiled since she was a child, but she has never done anything bad. Doctor, please do whatever you want to save. "

the first doctor shook his head and wrote on the critical notice: "Acute paraquat poisoning, critical condition, deterioration at any time, respiratory and heartbeat arrest at any time, please be informed. Please understand and hope that the family members will actively cooperate with the hospital's rescue and treatment."

the old man slumped into his chair. After a while, he said slowly, "is it hopeless?"

the first doctor did not speak, looked at me, and motioned for me to say something, but I tried to escape in a panic. The old man looked into my eyes, in which there were inquiries, anxieties, and faint expectations. The unclear eyeballs seemed to carry the weight of two lives. The weight weighed so much that I couldn't breathe. I bowed my head and didn't answer her.

the old man walked to the bedside of the patient step by step on crutches, saying something carefully and wiping away tears from time to time.

then, as if they had agreed, the couple sat up, ripped off the stomach tube and oxygen tube from their nasal cavity, and shouted, "Doctor, we're going home from the hospital and take the tube off our legs."

the male patient shouted, "We just drank some pesticides, and now the blood has been drawn, the stomach has been washed, and the blood has been changed." It's not all right. You're bluffing. "

"I warn you, my mother is old and in poor health, so don't scare the old people. Who can be held responsible if something goes wrong? " The female patient is in solidarity with her husband, and it seems that the two have made up.

then she turned to comfort the old lady: "do you think we are all right now?" Don't listen to them. The doctor is the best at making things serious. Our money. Come on, let's go home. Xiao Bao is still at home. "

when I encountered this situation in the past, I would go up and explain to them that the pathological changes of chest CT, abnormal blood gas analysis and hemogram data, and ECG showed that there had been arrhythmias. I will take these data to show that they are in poor health and must be hospitalized.

but now I am silent. I have no confidence. I know that there is no way back. Hospitalization can only delay their death and make them less painful on the way there, but it is inevitable. The reference book clearly states that patients with acute paraquat poisoning (taking> 40ML) will soon develop multiple organ failures with a fatality rate of 100%.

this is an inevitable 100%. I know exactly what they will face next. At first, most patients with paraquat poisoning are speechless. Paraquat infiltrates into the oral mucosa and begins to fester in the mouth, often accompanied by bloody exudation, swollen pharynx, enlarged tonsils, unbearable pain, and then difficulty breathing, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), followed by systemic multiple organ dysfunction syndromes (MODS). Alveolar and pulmonary interstitial fibrosis, and eventually death.

the progress of paraquat poisoning is so fast that even if blood perfusion is done every day and large doses of antivenom are used, it will not last a week. I watched the couple write on the death notice: "ask for discharge at your own risk." Then watch them leave.

three

the scene in front of me reminds me of one night in my first year of work when I first came into contact with patients who drank paraquat, the same bed, the same night, the same couple.

the boy broke up with his girlfriend of five years to get engaged to another girl. The girlfriend can not accept, the night before the boy's engagement, drank the whole bottle of paraquat with a high concentration of alcohol and called the boy before drinking. When the boy knew about it, he rushed her to the hospital for emergency treatment.

the girl was beautiful, with long straight black hair, big eyes, and fair skin. she was taken to the hospital with tears on her face and smelling of alcohol, crying with the boy in her arms and saying, "Don't leave me." but she couldn't speak. Seven tubes were inserted from the stomach tube into the body.

ethanol is a fat-soluble cosolvent, which can accelerate the rapid entry of paraquat into the blood and aggravate the corrosion of paraquat to the gastrointestinal tract by stimulating gastric acid secretion. A large number of gastrointestinal inflammatory factors were absorbed, which aggravated the damage of paraquat to the whole body system, and the metabolites of ethanol, acetaldehyde, and paraquat, formed superimposed damage to the liver cells.

death is coming soon, and when I got the girl's death certificate, there was a striking "25" written in the age column. In the days after

, I saw the last side of many paraquat patients, either intubated or ventilated or with all kinds of tubes hanging all over their bodies. More than 90% of them regretted it. Some wrote "I want to live, I regret it" on a piece of paper. Someone grabbed the doctor's hand, dragged the bleeding, shouted "help me", and some held their loved ones until they stopped breathing.

without exception, before they died, they all had sunken eyes, excessive protuberance of cheekbones, and open mouths to breathe. In the end, the breath didn't come up.

it was two days later that I saw the couple again. This time, they were carried to the hospital, followed by a group of family members. The mother of the female patient walked at the end, expressionless, but the wrinkle gully deepened. She was holding a five-or six-year-old child tightly in her hand, looking around, with still-dry tears on her face.

"ECG monitoring is in place, call emergency endotracheal intubation and ventilator. Bring out the blood and open the venous access. Call the hemodialysis and ask for an emergency consultation. "

"the patient lost vital signs and immediately received cardiopulmonary resuscitation. Adrenaline injection. "

"Cardiopulmonary resuscitation is invalid for half an hour and is declared dead."

the shouts, machines, and cries in the emergency room merged into one. The child clung to Grandma's hand and involuntarily hid in the corner. He did not know what had happened or what was about to happen. There was only fear in his eyes.

the female patient was lying on the hospital bed, breathing painstakingly on a ventilator, quietly watching the husband's bed next door drawn to the bed curtain, where the medical staff rescued the husband until he was opened again, and all the rescue workers and equipment were evacuated, and the husband took the lead and declared dead.

she couldn't speak-the ventilator was plugged into the trachea, and I could only see her facial expression twisted, tears wreaking havoc, and the pillow wet. On the ECG monitor, 129 heartbeats per minute seemed to be the only evidence that she had witnessed her husband's death. From her point of view, she could see her husband's head covered with a white cloth.

suddenly, the alarm of the ventilator and ECG monitoring sounded at the same time.

female patients try their best to unplug the ventilator tube from their mouths, which is tantamount to a second suicide. After my colleagues reconnected her ventilator tube, they fastened her shoulders and arms with restraints.

she looked at me and shook her head desperately, tears streaming down her cheeks. I knew she couldn't stand it, not only because of the physical pain but also because her husband drank the poison for her. In short, she can not bear it, she wants to go to another world to accompany him.

the old man tugged at the child and freed up a hand to wipe away his daughter's tears. The child stood by and asked, "Grandma, is Dad asleep?" Why is mom wearing this Transformers machine? "

the old man held back his tears and choked up and said, "Don't be capricious. What about Xiao Bao?" The female patient seemed to understand, glanced at the child, shook her head, closed her eyes, and burst into tears.

after her husband's death, the female patient lost her eyes and lost her soul. Like a dead believer in self-confession.

she was pronounced dead late the next night.

her relatives and friends seem to be ready, with no crying, no excessive emotion. The old man pinned a small hemp rope to his chest, and so did each of the relatives and friends present.

I stood at the door of the duty room and watched the old man stumble away with the little boy. I thought to myself that the couple had lost to impulse and ignorance, and it was a five-or six-year-old child and an old man who bore the consequences.

with the sound of "whoo", the funeral home car arrived and took away the patient's death certificate.