   Chlorine is a yellow-green strong irritating gas with a suffocating odor. Soluble in water and soluble in lye. In the case of water, hypochlorous acid and hydrochloric acid are formed, and hypochlorous acid is decomposed into new ecological chlorine, oxygen and chloric acid. It mainly invades the upper respiratory tract through the respiratory tract; it also invades the lower respiratory tract when the concentration of chlorine in the air is high.
   I. poisoning mechanism
   After inhalation of chlorine, it interacts with water in the mucous membranes and respiratory tract to form hydrogen chloride and new ecological oxygen. Hydrogen chloride can cause inflammatory edema, congestion and necrosis of the upper respiratory tract mucosa. The new ecological oxygen has a strong oxidizing effect on tissues and can form ozone with cytoplasmic action. If the concentration of chlorine is too high or the contact time is long, it can often cause deep respiratory diseases, damage the bronchioles and alveoli, and cause bronchiolitis, pneumonia and toxic pulmonary edema. As a result of the stimulation, the local smooth muscle tendon exacerbates the ventilatory disorder and aggravates the hypoxic state. High concentrations of chlorine can also stimulate the vagus nerve to cause a reflexed heartbeat.
   II. Clinical manifestations
   Acute poisoning is mainly the performance of respiratory damage:
   1. Onset and changes in the condition are generally faster.
   2. may occur pharyngitis, bronchitis, pneumonia or pulmonary edema, manifested as sore throat, cough, a small amount of sputum, shortness of breath, chest tightness or pink foam sputum, difficulty breathing, etc., the lungs may have no obvious positive signs or There are dry and wet rales. Sometimes accompanied by nausea, vomiting and other symptoms.
   3. Severe cases may still have adult respiratory distress syndrome, which is progressive respiratory acceleration and distress, tachycardia, refractory hypoxemia, and is ineffective with general oxygen therapy.
   4. A small number of patients have asthma-like episodes, wheezing, and wheezing in the lungs.
   5. Very high concentration can cause glottic sputum or edema, bronchospasm or reflex respiratory center inhibition leading to suffocation and death.
   6. Eye damage: Chlorine can cause acute conjunctivitis, high concentration of chlorine or liquid chlorine can cause eye burns.
   7. Skin damage: Liquid chlorine or high concentrations of chlorine can cause acute dermatitis or burns on exposed parts of the skin.
   8. Complications mainly include secondary infection of the lungs, myocardial damage, and pneumothorax and mediastinal emphysema.
   9. Electrocardiogram examination: myocardial damage and arrhythmia can be caused by hypoxia, pulmonary hypertension and autonomic dysfunction after poisoning.
   10. X-ray examination: no abnormalities, or enhanced lung texture on both sides, blurred shadows on dotted or flaky borders or cloud-like, butterfly-wing shadows.
   Blood gas analysis: The arterial oxygen partial pressure of the patients with severe disease is significantly reduced.
   III. First aid measures
   1. Inhaled gas immediately removed from the scene and moved to a well-ventilated place. Take off the clothes and socks when poisoning, keep quiet and keep warm.
   2. Immediately rinse the eye or skin with liquid water.
   3. Those who have symptoms after inhalation should observe at least 12 hours for symptomatic treatment. Those who have more inhalation should rest in bed, take oxygen, and inhale with salbutamol aerosol, asthma or 5% sodium bicarbonate plus dexamethasone.
   4. Acute oxygenation requires reasonable oxygen therapy, early, moderate, short-term application of adrenal glucocorticoids, maintain airway patency, prevent pulmonary edema and secondary infection.
5. When rescue patients with dyspnea with chlorine poisoning, artificial cardiopulmonary resuscitation methods such as free chest compressions should not be used. This is because chlorine has a strong stimulation to the upper respiratory tract mucosa, causing bronchial pneumonia and even pulmonary edema. This type of artificial respiration can make inflammation and pulmonary edema worse, which is harmful.
   I. poisoning mechanism
   After inhalation of chlorine, it interacts with water in the mucous membranes and respiratory tract to form hydrogen chloride and new ecological oxygen. Hydrogen chloride can cause inflammatory edema, congestion and necrosis of the upper respiratory tract mucosa. The new ecological oxygen has a strong oxidizing effect on tissues and can form ozone with cytoplasmic action. If the concentration of chlorine is too high or the contact time is long, it can often cause deep respiratory diseases, damage the bronchioles and alveoli, and cause bronchiolitis, pneumonia and toxic pulmonary edema. As a result of the stimulation, the local smooth muscle tendon exacerbates the ventilatory disorder and aggravates the hypoxic state. High concentrations of chlorine can also stimulate the vagus nerve to cause a reflexed heartbeat.
   II. Clinical manifestations
   Acute poisoning is mainly the performance of respiratory damage:
   1. Onset and changes in the condition are generally faster.
   2. may occur pharyngitis, bronchitis, pneumonia or pulmonary edema, manifested as sore throat, cough, a small amount of sputum, shortness of breath, chest tightness or pink foam sputum, difficulty breathing, etc., the lungs may have no obvious positive signs or There are dry and wet rales. Sometimes accompanied by nausea, vomiting and other symptoms.
   3. Severe cases may still have adult respiratory distress syndrome, which is progressive respiratory acceleration and distress, tachycardia, refractory hypoxemia, and is ineffective with general oxygen therapy.
   4. A small number of patients have asthma-like episodes, wheezing, and wheezing in the lungs.
   5. Very high concentration can cause glottic sputum or edema, bronchospasm or reflex respiratory center inhibition leading to suffocation and death.
   6. Eye damage: Chlorine can cause acute conjunctivitis, high concentration of chlorine or liquid chlorine can cause eye burns.
   7. Skin damage: Liquid chlorine or high concentrations of chlorine can cause acute dermatitis or burns on exposed parts of the skin.
   8. Complications mainly include secondary infection of the lungs, myocardial damage, and pneumothorax and mediastinal emphysema.
   9. Electrocardiogram examination: myocardial damage and arrhythmia can be caused by hypoxia, pulmonary hypertension and autonomic dysfunction after poisoning.
   10. X-ray examination: no abnormalities, or enhanced lung texture on both sides, blurred shadows on dotted or flaky borders or cloud-like, butterfly-wing shadows.
   Blood gas analysis: The arterial oxygen partial pressure of the patients with severe disease is significantly reduced.
   III. First aid measures
   1. Inhaled gas immediately removed from the scene and moved to a well-ventilated place. Take off the clothes and socks when poisoning, keep quiet and keep warm.
   2. Immediately rinse the eye or skin with liquid water.
   3. Those who have symptoms after inhalation should observe at least 12 hours for symptomatic treatment. Those who have more inhalation should rest in bed, take oxygen, and inhale with salbutamol aerosol, asthma or 5% sodium bicarbonate plus dexamethasone.
   4. Acute oxygenation requires reasonable oxygen therapy, early, moderate, short-term application of adrenal glucocorticoids, maintain airway patency, prevent pulmonary edema and secondary infection.
5. When rescue patients with dyspnea with chlorine poisoning, artificial cardiopulmonary resuscitation methods such as free chest compressions should not be used. This is because chlorine has a strong stimulation to the upper respiratory tract mucosa, causing bronchial pneumonia and even pulmonary edema. This type of artificial respiration can make inflammation and pulmonary edema worse, which is harmful.
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