GBZ 78-2002 Diagnostic criteria for occupational acute chemical sudden death
Some standard content:
ICs13.100
National Occupational Health Standard of the People's Republic of China GBZ 78—2002
Diagnostic Criteria of Occupational Chemicals-Related Sudden Death2002-04-08 Issued
2002-06-01 Implementation
Ministry of Health of the People's Republic of China
3 Issued
Article 6.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". In various occupational activities, people may be exposed to some high-concentration and highly toxic chemicals in a short period of time, causing acute poisoning. These chemicals may be known species, or the exact pathogenic chemical species may not be known for a while after the poisoning has occurred: some chemical species are listed in the list of occupational diseases, while others have not yet developed separate diagnostic standards. However, all acute poisoning diseases have common patterns of onset, and it is possible and necessary to formulate common rules to be followed when diagnosing acute poisoning.
The various rules specified in this series of standards involve the diagnosis of occupational acute chemical poisoning. These rules are used to ensure the unification of the diagnostic system of occupational chemical poisoning. Regardless of whether the cause is known or hidden, and regardless of which target organ is damaged after poisoning, the diagnosis can be made according to the rules specified in this standard. Under the general title of "Diagnosis of Occupational Acute Chemical Poisoning", the following 10 parts are included: The scope defined in each part will be explained in the foreword and introduction of each part.
Part 1 Diagnostic criteria for occupational acute chemical poisoning (general principles); Part 2
Diagnostic rules for occupational acute hidden chemical poisoning: Diagnostic criteria for multiple organ dysfunction syndrome caused by occupational acute chemical poisoning; Part 3
Part 4
Part 5
Diagnostic criteria for occupational acute chemical sudden death: Diagnostic criteria for occupational acute chemical poisoning nervous system diseases; Part 6
Diagnostic criteria for occupational acute chemical poisoning respiratory system diseases: Part 7
Diagnostic criteria for occupational acute toxic liver diseases; Part 8
Diagnostic criteria for occupational acute toxic kidney diseases; Part 9
Diagnostic criteria for occupational acute chemical poisoning heart diseases: Part 10 Diagnostic criteria for occupational acute chemical poisoning blood system diseases; In the practice of treating acute chemical poisoning, we have accumulated rich rescue experience. In the case of exposure to occupational hazards such as high concentrations of cyanide compounds, hydrogen sulfide, carbon monoxide, nitrogen oxides, etc.; pure nitrogen, pure carbon dioxide, etc. can cause suffocation and hypoxia; acute organophosphorus pesticides, carbonate lock, hydrogen sulfide, etc., delayed heart damage, or nitroglycerin, etc., workers, potential heart damage, etc., often sudden death (i.e. chemical sudden death) may occur. This kind of sudden chemical sudden death is generally subject to the inevitable law of the operation of occupational hazard environment, so it can be prevented and completely avoided. In order to prevent chemical sudden death and improve the success rate of rescue after acute chemical sudden death, this standard is specially formulated. Appendix A of this standard is an informative appendix, and Appendix B, C, and D are normative appendices. This standard was proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Yangpu District Central Hospital of Shanghai and the Occupational Disease Prevention and Control Institute of Shantou City, Guangdong Province. The drafting units included Shanghai Sixth People's Hospital, Shanghai Changning District Health Bureau, Shanghai Zhabei District Central Hospital, Shandong Provincial People's Hospital and the Safety and Health Department of the former Ministry of Chemical Industry.
This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational acute chemical sudden death diagnosis standard GBZ78-2002
Occupational acute chemical sudden death refers to respiratory arrest or cardiac arrest caused by direct toxic effects of occupational chemicals or hypoxia in occupational activities. 1 Scope
This standard specifies the diagnostic basis of occupational chemical sudden death, the management and prevention principles of high-risk environments and high-risk operations that may cause this disease, the first aid principles of occupational chemical sudden death and the key points of monitoring high-risk groups. This standard applies to sudden death caused by exposure to chemical substances in occupational activities. Chemical sudden death occurring in non-occupational activities can be implemented by reference.
2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For all dated referenced documents, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties to an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For any undated referenced document, the latest version shall apply to this standard.
3 Diagnostic principleswww.bzxz.net
Diagnostic criteria for occupational acute chemical poisoning (general principles) Diagnostic rules for occupational acute latent chemical poisoning Diagnostic criteria for respiratory diseases of occupational acute chemical poisoning Diagnostic criteria for heart disease of occupational acute chemical poisoning Based on the data of clinical and various auxiliary examinations, combined with on-site labor hygiene investigation, the deadly chemical species shall be identified and sudden death caused by other causes shall be excluded before diagnosis can be made. 4 Diagnostic criteria
One of the following conditions exists:
a) Sudden respiratory arrest or cardiac arrest occurs in workers in high-risk environments; b) Unexpected respiratory arrest or cardiac arrest occurs during the course of acute chemical poisoning or when the condition has been basically stabilized.
5 Rescue principles
5.1 Rescue the scene quickly and safely, and at the same time, perform necessary cleaning of the contaminated parts. Immediately perform "cardiopulmonary cerebral resuscitation"
5.2 According to the type of chemical causing the disease and the condition, targeted special drugs can be used; 5.3 Provide other necessary emergency treatment;
5.4 While the above treatment is being carried out, continue to perform rescue on the way to the hospital and keep records. 6 Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
7 The management and prevention principles of high-risk environments and high-risk operations are shown in Appendix B (Normative Appendix).
The key points of monitoring high-risk groups
See Appendix C (Normative Appendix).
Cardiopulmonary cerebral resuscitation for occupational acute chemical-induced sudden death is shown in Appendix D (Normative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 There is no unified opinion on the definition of sudden death. Most medical organizations or academic groups advocate that sudden death is an unexpected non-violent sudden death. The causes, clinical manifestations, diagnosis, treatment and prevention of sudden death caused by exogenous chemicals are different from those caused by other reasons. What is particularly important is that chemical sudden death can be completely avoided as long as various preventive measures are strictly implemented. According to its clinical characteristics, the definition of chemical sudden death in this standard is: "Respiratory arrest or cardiac arrest caused by the toxic effects of occupational chemicals or environmental hypoxia caused by entering chemicals". This definition is in line with objective conditions and reflects the need to formulate this standard for prevention, diagnosis and rescue. A.2 Sudden death caused by exogenous chemicals can be divided into two situations according to its cause: A.2.1 Due to the toxic effects of chemicals:
a) Acute toxic effects include extremely high concentrations of certain chemicals, which cause reflex cardiac arrest or cardiac arrest in the contactor; b) Delayed toxic effects: unexpected cardiac arrest occurs during the course of acute poisoning or during the recovery period. A.2.2 Hypoxia caused by chemicals is often caused by rashly entering the hypoxic environment caused by chemicals. Asphyxia caused by simple hypoxia is the main cause of sudden death. The pathogenesis, clinical manifestations, rescue and prevention measures of the sudden death caused by the above two situations are not the same, so the diagnostic standards are also listed separately. Sudden death caused by heart disease is named cardiac sudden death, and sudden death caused by exogenous chemicals is named chemical sudden death. A.3 The purpose of formulating this standard:
A.3.1 Implement the principle of prevention first, and formulate the management and monitoring principles of high-risk environments and high-risk operations: A.3.2 Improve the accuracy of early diagnosis and the success rate of rescue; A.3.3 In the medical community, especially in the occupational medicine profession, reach a preliminary consensus on the academic issues of chemical sudden death, and lay the foundation for further research. A.4 Chemical sudden death must have an etiological diagnosis, which is the main basis for chemical sudden death and also provides a basis for targeted treatment. However, in an emergency, necessary rescue and treatment should be carried out first, and personnel should be organized to investigate the cause of the disease. Emergency rescue should not be delayed due to unclear diagnosis of the cause of the disease. A.5 The concept of death listed in this standard is clinical death, that is, cardiac arrest or respiratory arrest. Since sudden death occurs suddenly, cardiac arrest or respiratory arrest is used as a diagnostic indicator. This concept conforms to the objective situation and is easy to grasp. Once these situations occur, heart, lung, and brain resuscitation must be performed immediately. A.6 Before chemical-induced sudden death occurs, there may be short-term premonitory symptoms such as dizziness, syncope, chest tightness, palpitations, and confusion. Respiratory or cardiac arrest may also occur immediately without premonitory symptoms. Appendix C of this standard lists the key points for monitoring high-risk groups to facilitate early vigilance and timely treatment to prevent further development of the disease. A.7 The most prominent manifestation of cardiac arrest is deep coma and inability to palpate the pulsation of the large arteries; respiratory arrest refers to the cessation of spontaneous breathing. In these cases, cardiopulmonary cerebral resuscitation should be performed immediately. There is no need to repeatedly use a stethoscope to hear no heart sounds or breathing sounds, and there is no need to determine based on electrocardiogram examinations. Resuscitation should be started as soon as possible to strive for successful resuscitation. A.8 Another indicator of clinical death is pupil dilation. Since pupil dilation often occurs later than respiratory and cardiac arrest, in chemical poisoning, pupil size is affected by various factors. Acute organophosphorus pesticide and carbamate pesticide poisoning can cause pupil constriction; and atropine-type drugs can dilate pupils. Therefore, pupil dilation is not used as a diagnostic indicator of clinical death in this standard.
9 On-site rescue is the key to rescue chemical-induced sudden death, which can provide a good foundation for future treatment. A.9
A.10 Cardiopulmonary cerebral resuscitation has been correctly mastered by the majority of medical workers and formally trained personnel. This standard includes specific operating methods in Appendix D. Since there have been new progress in the theoretical research on cardiopulmonary resuscitation, rescue measures and monitoring indicators in recent years, it is necessary to continuously update knowledge and strengthen clinical practice to keep up with the advanced level and improve the quality of rescue. A.11 In rescue, the types and methods of using special antidotes vary due to different causes. There is no unified opinion on the indicators, methods and exact efficacy of the application of special detoxification in the case of poisoning by some compounds. A.12 Since chemical poisoning patients generally no longer continue to absorb poisons after leaving the scene, and patients often have no primary diseases, if chemical-induced sudden death can be rescued in time, the success rate of resuscitation may be higher than that of cardiac sudden death, and rescuers should strengthen their confidence. Appendix B
(Normative Appendix)
Principles of management and prevention of high-risk environments and operations B.1 High-risk environments refer to sites where high concentrations of chemicals exist, which may cause sudden death in contact. High-risk operations refer to operations that enter high-risk environments or other operations that may cause sudden death in chemicals. High-risk groups refer to workers who enter high-risk environments: or patients with acute chemical poisoning, who may suffer sudden death during the course of the disease, B.2 Relevant industrial and mining enterprises or departments should conduct a comprehensive investigation of chemical hazardous sources that may cause sudden death in their systems and units. High-risk environmental places such as certain workshops, closed containers, warehouses, cellars, sewage pools, oil pools, sewers, septic tank sampling ports, venting ports, and vehicles carrying chemical hazardous substances are all listed as key areas for preventing chemical-induced sudden death accidents. The types, physical and chemical properties, toxic effects, quantities, hazardous characteristics, different accident natures caused by different accident causes, and the scope of harm of chemicals that may cause chemical-induced sudden death when used, produced or stored should be fully understood, recorded in detail, and included in the archives.
B.3 On the basis of fully understanding the high-risk environment and high-risk operations of the enterprise, formulate practical and feasible preventive measures, including emergency rescue plans for chemical accidents, strictly implement safety production rules and regulations, and put an end to illegal commands and illegal operations. B.4 For harmful substances in key places, according to safety production regulations, regular and fixed-point monitoring is carried out to grasp the changes in the concentration of chemicals in the air on site under normal production conditions or different production conditions, as a basis for improving the site, and to accumulate data. If an accident occurs, it can provide necessary data for judging the situation. B.5 During the transportation of dangerous chemicals, the regulations on the transportation of dangerous goods should be strictly observed to maintain safety. B.6 For high-risk operators, pre-job physical examinations must be carried out, and those with occupational contraindications are not allowed to engage in this work. Before taking up the job, they should be given training on safe operation, self-rescue and mutual rescue, and obtain a job qualification certificate. And implement health monitoring, as well as regular safety operation training, and continuously strengthen the awareness and technology of preventing poisoning. B.7 Before entering a high-risk environment for work, you must first check according to the system and only allow work to be carried out if it meets the safety production conditions. In special circumstances, those entering must have protective measures to ensure safety and can only enter under strict supervision. B.8 During the work in a high-risk environment, there must be a dedicated person to monitor the entire process. Once an abnormal situation is found in the operator, emergency treatment should be carried out immediately.
B.9 Those who enter a high-risk environment to rescue patients must have the knowledge of self-rescue and rescue others, and do a good job of self-protection, such as wearing an air-supplied gas mask and fastening a safety belt. In the event of an emergency, if there is a lack of suitable personal protection equipment on site, all conditions at the time and place can be used, such as sending fresh air to the closed site, to ensure the safety of the rescuer and rescue the patient. B.10 Develop a rescue work plan for high-risk environments, high-risk operations and people. B.11 To do a good job in rescue work, routine training and preparation are very important, such as the implementation of rescue organization, popularization of self-rescue knowledge and cardiopulmonary resuscitation for workshop workers, and the provision of necessary rescue equipment. Once a situation occurs, the rescue work can be carried out in an orderly manner and can be operated according to the specifications.
B.12 Combine on-site rescue with rescue in the hospital, insist on rescue work on the way to the hospital, keep records, and cooperate with hospital doctors after arriving at the hospital. Introduce the on-site situation and the condition of the patient, so that the rescue work is closely connected and better results are achieved. B.13 If an acute chemical poisoning accident may occur in this enterprise, information should be provided to the relevant departments and departments of the affiliated hospital so that clinical physicians can be prepared for rescue work, which is conducive to carrying out treatment and rescue work in the event of an accident. C.1 Main chemicals causing sudden death
Appendix C
(Normative Appendix)
Key points for high-risk occupational groups and their monitoring
C.1.1 Chemicals that cause electric shock death immediately after contact: Cyanide and cyanide compounds
b) Hydrogen sulfide
Volatile organic solvents
Carbon monoxide
Extremely high concentrations of irritating gases
Extremely high concentrations of other chemical substances
Main chemicals that can cause sudden death during the course of acute poisoning or in the recovery period; a) Organophosphorus pesticides;
b) Barium carbonate, barium chloride:
c) Sodium pentachlorophenol;
d) Hydrogen sulfide;
e) Chemicals that can cause severe heart damage. 3Main chemicals causing environmental hypoxia;
a) Nitrogen;
Carbon dioxide;
c) Nitrogen oxides (barn gas);
d) Methane;
e) Propane;
f) Other inert gases, etc.
2Clinical features
It belongs to poisoning by C.1.1 compounds, which is characterized by death by electric shock after contact, and may also have symptoms before sudden death such as dizziness, headache, chest tightness, C.2.1
difficulty breathing, etc. If continued contact or not handled in time. Impaired consciousness, convulsions, cardiac or respiratory arrest may occur quickly.
C.2.2 It belongs to C.1.2 chemical poisoning. Sudden death caused by different mechanisms. It causes respiratory and cardiac arrest, so each has its own clinical characteristics.
C.2.3 belongs to C.1.3 compounds, which mainly cause environmental hypoxia. Its clinical manifestations are closely related to the degree of hypoxia: a) If the oxygen concentration in the air is <6%, breathing may stop soon after entering, followed by cardiac arrest and death, without premonitory symptoms.
b) If the oxygen concentration in the air is 6%-10%, there may be premonitory symptoms such as headache, dizziness, tinnitus, vomiting, hair loss, obvious fatigue, loss of mobility, and then coma and respiratory arrest. c) If the oxygen concentration in the air is 10%-14%, the patient will experience fatigue, headache, rapid breathing, tinnitus, confusion, slow reaction, etc. If not separated in time, the symptoms may be further aggravated. Monitoring points
Select monitoring items according to the type of poisoning chemicals and clinical manifestations, such as heart monitoring, respiratory monitoring, intracranial pressure monitoring, electrolyte monitoring and (or) monitoring of other biochemical indicators. The purpose is to grasp the changes in the condition in a timely manner, take timely measures, and prevent sudden death.
C.4 Rescue measures
C.4.1 In case of cardiac or respiratory arrest, immediately perform cardiopulmonary and cerebral resuscitation. See Appendix D. C.4.2 For rescue plans for different chemical poisonings, refer to the relevant diagnostic standards for acute occupational poisoning or other materials. C.4.3 After the rescue survives, actively carry out symptomatic and supportive treatment. D.1 Basic concepts
Appendix D
(Normative Appendix)
Cardiopulmonary-cerebral resuscitation
D.1.1 Cardiopulmonary-cerebral resuscitation (CPCR) When the heart stops or the respiratory system stops, the rescue measures taken are cardiopulmonary-cerebral resuscitation to quickly restore autonomous circulation, breathing and maintain tissue oxygen supply. D.1.2 Cardiac arrest refers to the cessation of effective cardiac beating, and its electrocardiographic activity can be manifested in the following ways: a) Complete cessation of electrocardiographic activity;
b) Ventricular fibrillation:
c) Ventricular tachycardia, no effective ejection capacity; d) Bradycardia, no effective ejection capacity; e) Electro-mechanical separation.
D.1.3 Respiratory arrest refers to the cessation of effective ventilation and gas exchange functions of the respiratory system 2 Pointers for cardiopulmonary and cerebral resuscitation
Circulation: Sudden loss of consciousness, inability to feel the pulsation of the large arteries or to hear heart sounds. Respiratory: No respiratory activity of the chest can be observed, and no gas can be felt exhaled from the mouth and nose. D.3 Basic steps of cardiopulmonary resuscitation
D.3.1 Basic life support (BLS) a) Open the airway, remove foreign objects and secretions; b) Mouth-to-mouth artificial ventilation, the operator should pay special attention to the impact of the patient's exhaled air c) External chest compression, inserted abdominal counterpulsation, and establish blood circulation. D.3.2 Advanced life support (ACLS) a) Establish ECG, respiration, blood pressure, blood oxygen partial pressure monitoring and intravenous medication access: b) Further open the airway: endotracheal intubation, tracheotomy, cricothyroidotomy or puncture: c) Implement artificial ventilation: air bag ventilation, ordinary ventilator ventilation, high-frequency jet ventilation, extracorporeal membrane oxygenator oxygenation:
d) Correct and treat various abnormal heart rhythms (including electrical cardioversion, temporary pacemaker application, etc.): e) Maintain effective blood circulation.
D.3.3 Prolonged life support (PLS) a) Improve cardiac output, maintain effective circulating blood volume and blood pressure; b) Correct various metabolic disorders, maintain acid, alkali, water and electrolyte balance: c) Protect the brain, prevent and treat reperfusion damage: control intracranial pressure, reduce brain metabolism, and improve cerebral blood supply: d) Promote the recovery of heart, lung, liver, kidney coagulation and digestive organ functions, and prevent and treat multiple organ failure.
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