First aid treatment
1. On-site rescue is extremely important, because the extremely high concentration of hydrogen sulfide in the air often causes many people to die in shock at the scene. The patient should be removed from the scene immediately to fresh air. Give oxygen immediately if possible. On-site rescue personnel should have knowledge of self-rescue and mutual rescue to prevent rescuers from being poisoned after entering the scene.
2. Maintain vital signs. Cardiopulmonary resuscitation should be performed immediately for those who are breathing or cardiac arrest. If artificial respiration can be performed in time for those who suffer respiratory arrest at the accident site, cardiac arrest can be avoided. When performing mouth-to-mouth artificial respiration, the practitioner should prevent inhalation of hydrogen sulfide escaping from the patient's exhaled breath or clothing to avoid secondary poisoning.
3. Symptomatic and supportive treatment is the main focus. Hyperbaric oxygen therapy plays an important role in accelerating the resuscitation of coma and preventing hydrocephalus, and all coma patients, regardless of whether they have resuscitated or not, should be given hyperbaric oxygen therapy as soon as possible, but it needs to be combined with comprehensive treatment. Those with obvious symptoms of poisoning need to be given adrenal glucocorticoids early, sufficiently, and short-term, which is conducive to the prevention and treatment of cerebral edema, pulmonary edema and myocardial damage. For the control of convulsions and the prevention of cerebral and pulmonary edema, see < Treatment of Acute Chemical-Toxic Encephalopathy > and < Treatment of Acute Irritant Gas-induced Toxic Pulmonary Edema>. More severe patients need to undergo electrocardiogram monitoring and myocardial enzyme spectrum measurement to detect changes in the condition in time and deal with them in time. For those with eye irritation symptoms, rinse immediately with water and treat them symptomatically.
4. There is no unified opinion on the indications and methods of the application of methemoglobin-forming agents. In theory, methemoglobin formers are suitable for the treatment of intracellular asphyxia caused by hydrogen sulfide, but are ineffective against reflex inhibitory respiration of the nervous system. Appropriate application of isoamyl nitrite, sodium nitrite or 4-dimethylaminophenol (4-DMAP) to oxidize hemoglobin in the blood to methemoglobin, which can combine with the free hydrosulfur group to form sulfmethemoglobin (SMHb) and detoxify; It can also deprive the hydrogen sulfur group bound to cytochrome oxidase to reactivate the enzyme and improve hypoxia. However, there is no simple and feasible indicator to judge intracellular asphyxia, and sulfides are quickly oxidized and inactivated in the body, and the use of the above drugs aggravates tissue hypoxia. Methylene blue (Meilan) should not be used, because methemoglobin can only be formed in large doses, and excessive doses can have serious side effects. Currently, the use of such drugs can only be determined by the clinical experience of the physician.