GB 16391-1996 Diagnostic criteria and treatment principles for combined radiation and impact injuries
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of managementfor combined radiation-blast injuryGB16391---1996
Combined radiation-blast injury refers to a type of combined injury in which radiation damage occurs simultaneously or successively in the human body as the main combined impact injury. Among them, indirect impact injury is similar to many traumas. The injuries of combined radiation-blast injury can be divided into four levels: mild, moderate, severe and extremely severe. The course of the disease generally goes through four stages: shock stage, local infection stage, critical stage and recovery stage. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles for combined radiation-blast injury. This standard is applicable to the diagnosis and treatment of combined radiation-blast casualties under the conditions of nuclear accidents or nuclear weapons wars in peacetime. 2 Reference standards
GB8280 Diagnostic criteria and treatment principles for acute radiation sickness caused by external irradiation GB16392 Diagnostic criteria and treatment principles for combined radiation and burn injuries 3 Diagnostic principles
Based on the injury history and the estimated radiation dose, find out the location and severity of the impact injury, combine clinical manifestations and laboratory test results, refer to the health records, conduct a comprehensive analysis, and make a correct judgment. The focus of diagnosis is the radiation dose and visceral impact injury. 4 Diagnosis and grading standards
4.1 Diagnosis
Radiation injury and its severity can be diagnosed with reference to GB8280. Patients with one or more of the following injuries can be diagnosed as radiation-impact combined injury.
4.1.1 In case of combined hearing injury, tinnitus, ear pain, hearing impairment, serous or bloody fluid flows out of the external auditory canal, and otoscope examination can show perforation and bleeding of the tympanic membrane.
4.1.2 In case of combined chest injury, if there is lung injury, chest pain, cough, hemoptysis of foamy sputum and dyspnea will occur. X-ray examination: When there is pulmonary hemorrhage, there is a flake shadow in the lung field. When there is pleural hemorrhage, an arc-shaped shadow can be seen on the lower part of the lung field. When there is pneumothorax, it shows that the chest cavity on the injured side accumulates air, the lung is compressed, and the mediastinum is biased to the healthy side. When there is heart damage, there will be precordial pain, chest tightness, a sense of nausea and cold sweats, and electrocardiogram examinations will show myocardial damage.
4.1.3 In case of complex abdominal injury, abdominal pain, tenderness, abdominal muscle tension, weakened or disappeared bowel sounds, and pneumoperitoneum occur. In severe cases, there may be symptoms of hemorrhagic shock such as irritability, thirst, dry tongue, pale face, tachycardia, and decreased blood pressure. Abdominal puncture, peritoneal lavage, X-ray examination, B-type ultrasound examination, etc. are all of significance for confirming the diagnosis.
4.1.4 In case of complex fracture, there is pain, bleeding, swelling and movement disorder in the injured area, and X-ray examination can obtain a clear diagnosis. 4.1.5 In case of combined closed craniocerebral injury, there are clinical manifestations such as brain atrophy, brain contusion, brain injury (intracranial plaque, etc.) 4.1.6 In case of combined limb crush injury, the injured limb is significantly swollen, becomes solid and less elastic, numb or paralyzed, the distal arterial pulsation is weakened or disappeared, and hypovolemic shock and myoglobinuria may occur. GB 16391-1996
4.1.7 In case of combined soft tissue injury, there may be clinical manifestations such as contusion, laceration, and injury caused by flying objects or broken glass. 4.1.8 In case of combined eye injury, there may be corresponding eye clinical manifestations. 4.2 Injury classification standards
4.2.1 Mild radiation injury combined with mild impact injury is a mild radiation-impact combined injury. 4.2.2 Moderate radiation injury combined with mild blast injury is moderate radiation-blast combined injury. 4.2.3 Severe radiation injury combined with mild blast injury, or moderate radiation injury combined with moderate blast injury is generally severe radiation-blast combined injury. 4.2.4 Extremely severe radiation injury combined with various degrees of blast injury, or severe radiation injury combined with moderate and severe blast injury is extremely severe radiation-blast combined injury. 5 Principles of first aid and treatment
Comprehensive treatment should be adopted according to the overall injury and different injured parts. For those with more serious visceral injuries, they should rest in bed and avoid overload to prevent aggravation of pulmonary hemorrhage, pulmonary edema, rupture of visceral hematoma and heart failure. 5.1 On-site first aid includes hemostasis, fixation, bandaging, analgesia, prevention of shock, and prevention of ventricular asphyxia. 5.2 Systemic treatment
5.2.1 Preventive injection of tetanus toxoid.
5.2.2 Blood transfusion and fluid replacement to prevent shock. If there is lung injury, the amount and speed of transfusion should be controlled to prevent or aggravate pulmonary edema. 5.2.3 Use radiation prevention and treatment drugs, infection prevention and treatment, bleeding prevention and treatment, platelet transfusion, fetal liver cell and bone marrow transplantation, etc., refer to GB16392.
5.3 Local treatment
5.3.1 In case of complex hearing injury, the external auditory canal should be plugged with sterile cotton balls to prevent infection. If it is infected, it should be cleaned with 4% warm boric acid water and gauze strips should be placed for drainage. Tympanic membrane perforation can be repaired during the recovery period. 5.3.2 In case of combined chest injuries, patients with lung injuries should keep their airways open, inhale 95% alcohol atomized oxygen, and be given drugs to promote the absorption of edema; patients with hemothorax should undergo thoracentesis to drain the accumulated blood, and closed drainage should be performed for hemothorax that is difficult to aspirate cleanly; for open pneumothorax, the wound should be immediately tightly sealed and bandaged; for tension pneumothorax, closed drainage should be performed to exhaust the air. Patients with heart injuries should rest appropriately, avoid activities, and receive symptomatic treatment. In case of heart failure, patients should use digoxin or Convolvulus toxicus II K. 5.3.3 In case of combined abdominal injuries, such as hematoma of the liver and spleen, and gastrointestinal contusion, patients should absolutely rest in bed and receive symptomatic treatment; in case of liver and spleen rupture, and gastrointestinal perforation, emergency surgery should be performed to stop bleeding and repair. 5.3.4 In case of combined fractures, fracture reduction and fixation surgery should be performed as soon as possible. The fracture fixation time is longer than that of general fractures. The specific time depends on the clinical manifestations and X-ray examination results.
5.3.5 In case of complex craniocerebral injury, the mild case (brain congestion) should be given sedation, analgesia, and bed rest; the severe case should undergo surgery as soon as possible, such as repair of scalp laceration, repair of skull fracture, and removal of intracranial hematoma. 5.3.6 In case of complex soft tissue injury and radionuclide contamination, the contamination should be eliminated as soon as possible; when excessive radionuclide enters the body, radionuclide accelerated excretion treatment should be performed; after early expansion of soft tissue injury, initial suture or delayed suture should be performed. 5.3.7 In case of complex limb compression injury, the injured limb should be fixed to avoid unnecessary movement, and deep fascia incision and decompression should be performed along the longitudinal axis of the injured limb. After surgery, it should be fixed with a thick layer of material. Pay attention to the prevention and treatment of acute renal failure. 5.3.8 In case of complex eye injury, it should be treated by an ophthalmologist after first aid. 5.3.9 Local anesthesia should be used for surgical anesthesia. Ketamine and sodium hydroxybutyrate, ketamine and meperidine or procaine combined anesthesia are relatively safe. Inhalation anesthesia and intravenous anesthesia can be used as appropriate during the shock period, local infection period and recovery period, but ether anesthesia is prohibited in the case of combined lung blast injury and respiratory tract burns.
6 Principles of treatment after treatment of combined blast injury
Those who have been confirmed to be clinically cured after treatment should undergo strict medical follow-up observation and regular health examinations, pay attention to possible disability and long-term effects, and give corresponding treatment. According to the recovery situation, they can recuperate, rest or arrange appropriate work. 370
GB16391-1996
Appendix A
Diagnosis and treatment of combined blast-radiation injurybZxz.net
(Supplement)
A1 Combined blast-radiation injury Combined blast-radiation injury refers to a type of combined injury in which the human body suffers blast injury as the main injury and radiation injury simultaneously or successively. A2 Diagnosis and management for combined blast-rabiation injury The diagnosis and management of combined blast-rabiation injury can refer to this standard. The focus of diagnosis is to clarify the blast injury (pay special attention to visceral blast injury) while finding out the ionizing radiation dose received. During treatment, the focus is on treating blast injuries and paying full attention to the impact of radiation injury. Appendix B
Explanation of terms
(Supplement)
B1 Blast injury
The injury caused by the shock wave generated by a nuclear explosion, explosive explosion or other explosion acting on the human body is called a blast injury. B2 Direct blast injurydirect blast injuryThe injury caused by the blast wave directly acting on the human body is called a direct blast injury. B3 Indirect blast injuryindirect blast injuryThe injury caused by the blast wave acting on the human body through objects, buildings, etc. is called an indirect blast injury. Appendix C
Grade of injury of impact injury
(Supplement)
C1 Mild: Mild brain concussion, hearing damage, visceral hemorrhage or skin abrasion may occur. Clinically, there may be transient loss of consciousness, headache, dizziness, tinnitus, hearing loss, congestion or rupture of the tympanic membrane, and generally no obvious systemic symptoms. C2 Moderate: Concussion, severe hearing damage, multiple visceral hemorrhages, mild pulmonary hemorrhage, edema, soft tissue contusion and simple debridement may occur. Clinically, there may be temporary loss of consciousness, headache, dizziness, ear pain, tinnitus, hearing loss, tympanic membrane rupture, chest pain, chest tightness, cough, blood in sputum, occasional rales, swelling and pain in the injured area, and movement disorders. C3 Severe: Obvious pulmonary hemorrhage, edema, rupture of abdominal organs, and fracture of important bones may occur. Clinically, it may manifest as chest pain, dyspnea, hemoptysis, dullness and bubbling sound in chest examination, abdominal pain, tension and tenderness of abdominal wall, decreased blood pressure, diffuse peritonitis signs, shock or coma of varying degrees, and corresponding symptoms and signs of local fracture. C4 Extremely severe: Severe pulmonary hemorrhage, pulmonary edema, severe rupture of liver and spleen, and severe craniocerebral injury may occur. Clinically, it may manifest as extreme dyspnea, convulsions, restlessness, convulsions, dullness in chest examination, dry and wet rales, bloody foamy liquid spraying, signs of critical acute abdomen, and severe shock or coma.
GB16391-1996
Appendix D
Recommendation on the use of drugs
(reference)
D1 The method of intravenous combined anesthesia of ketamine and sodium β-hydroxybutyrate is to first drip 0.3~0.6 mg of dapoxetine with a dropper, then slowly drip 2mL of non-mixture (100mg of meperidine + 50mg of phenergan, a total of 4mL) and 50~100mg of ketamine, and maintain anesthesia for about 30 minutes. After that, add 1/2 of the first dose of ketamine (no more than 3 times), and anesthesia can continue for another 30 minutes. If 2.0~5.0 g of sodium γ-hydroxybutyrate is slowly dripped on the basis of the first use of ketamine, anesthesia can be maintained for about 2 hours. Ketamine can increase intracerebral pressure and is not suitable for use in cranial surgery. Diazepam should be used instead.
Additional Notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Industrial Hygiene Laboratory of the Ministry of Health. The main drafters of this standard are He Qingjia, Cheng Tianmin, Chen Zongrong, and Tan Shaozhi. This standard is interpreted by the Industrial Hygiene Laboratory of the Ministry of Health, the technical unit entrusted by the Ministry of Health. 372
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