GBZ 80-2002 Diagnostic criteria for occupational acute methylamine poisoning
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ80—2002
Diagnostic Criteria of Occupational Acute Monomethylamine PoisoningPublished on April 8, 2002
Implemented on June 1, 2002
Published by the Ministry of Health of the People's Republic of China
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". From the date of implementation of this standard, if the original standard GB17056-1997 is inconsistent with this standard, this standard shall prevail. Acute monomethylamine poisoning may be caused by occupational activities involving exposure to monomethylamine. This standard is formulated to protect the health of those exposed to monomethylamine and facilitate the prevention and control of its poisoning. Appendix A of this standard is an informative appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by Shanghai Chemical Industry Occupational Disease Prevention and Control Institute, and the Shangrao District Health Bureau of Jiangxi Province, Shangrao District People's Hospital, Shangrao First People's Hospital, Shangrao County People's Hospital, and Shanghai Railway Bureau Shangrao Railway Hospital participated in the drafting. The Ministry of Health of the People's Republic of China is responsible for interpreting this standard. Occupational acute monomethylamine poisoning diagnosis standard GBZ80-2002
Occupational acute monomethylamine poisoning is a systemic disease with respiratory damage as the main manifestation caused by inhaling a large amount of monomethylamine gas in a short period of time during occupational activities, often accompanied by eye and skin burns. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute monomethylamine poisoning. This standard is applicable to the diagnosis and treatment of occupational acute monomethylamine poisoning, and non-occupational acute monomethylamine poisoning can also be implemented as a reference.
2 Normative reference standards
The clauses in the following documents become the clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties reaching 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.
GB/T16180
3 Diagnostic principles
Diagnostic criteria for occupational chemical skin burns Diagnostic criteria for occupational chemical eye burns
Evaluation of the degree of disability caused by work-related injuries and occupational diseases of employees Based on the exact history of occupational exposure to monomethylamine, typical clinical manifestations of acute respiratory system damage, chest X-ray manifestations, combined with other examination results such as blood gas analysis, reference to on-site labor hygiene survey data, comprehensive analysis, and exclusion of similar diseases caused by other causes, a diagnosis can be made.
Irritation reaction
After contact, transient eye and upper respiratory tract irritation symptoms appear, there are no positive signs in the lungs, and no abnormal findings in chest X-ray examination. bZxz.net
5 Diagnosis and classification standards
5.1 Mild poisoning
There are symptoms of eye and upper respiratory tract irritation, conjunctival and pharyngeal congestion and edema: first to second degree inspiratory dyspnea with laryngeal edema: chest X-ray findings consistent with acute tracheobronchitis or peribronchitis 5.2 Moderate poisoning
Anyone with any of the following conditions can be diagnosed as moderate poisoninga) Laryngeal edema with third degree inspiratory dyspnea; chest X-ray findings consistent with acute bronchopneumonia or interstitial pulmonary edema. b)
Blood gas analysis often shows mild to moderate hypoxemia. 5.3 Severe poisoning
Any person with any of the following conditions can be diagnosed as severe poisoning: Asphyxia due to severe laryngeal edema or necrosis and detachment of bronchial mucosa: a)
Chest X-ray manifestations consistent with alveolar pulmonary edema; b)
Acute respiratory distress syndrome (ARDS); c)
d) Sudden death;
e) Complications of severe pneumothorax, mediastinal emphysema, subcutaneous emphysema or atelectasis. Blood gas analysis often shows severe hypoxemia.
5.4 Eye or skin burns
Mild, moderate and severe acute poisoning can be accompanied by eye or skin burns, and the diagnostic classification refers to GBZ54 or GBZ51. Treatment principles
6.1 Treatment principles
6.1.1 On-site treatment. Immediately leave the scene and move to the upwind area, take off the contaminated clothes, and immediately rinse the contaminated skin thoroughly with plenty of running water. The eye flushing time is at least 10 minutes. Those who react to irritation need to rest in bed, generally closely observe for 48 hours, and give necessary examinations and treatment. 6.1.2 Keep the airway open, and give drug atomization inhalation, bronchial spasmolytics, and defoaming agents (such as 10% dimethyl silicone oil). If necessary, tracheotomy should be performed early. Pay attention to postural drainage, and encourage the patient to slightly expel necrotic mucosal tissue. 6.1.3 Reasonable oxygen therapy. Choose the appropriate oxygen delivery method according to the condition, and the inhaled oxygen concentration (FiO2) should not exceed 60%. When accompanied by acute carbon dioxide retention, while actively improving ventilation, adjust the oxygen concentration to make the blood oxygen saturation (SaO2) greater than 90%; if high-concentration oxygen is required, positive end-expiratory pressure (PEEP) can be given, and the PEEP pressure is less than 0.49kPa (5cmH0).
6.1.4 Apply glucocorticoids as soon as possible, in sufficient quantity and for a short period of time. For moderate and severe poisoning, alkali drugs can be used in combination. 6.1.5 In the early stage of the disease, the amount of fluid replacement should be strictly limited, the infusion rate should be controlled, and the urine volume should be maintained at more than 30mL/h. Diuretics should be added when necessary. Correct acidosis, alkalosis and electrolyte disorder. 6.1.6 Actively prevent and treat complications.
6.1.7 Treatment of eye and skin burns, refer to GBZ54 or GBZ51. 6.2 Other treatments
After a short rest after treatment of mild and moderate poisoning, the original work can be arranged after health recovery: Severe poisoning should be transferred from the original work, and rest or work arrangement should be decided according to the health recovery situation: If there are sequelae, refer to the relevant provisions of GB/T16180 for treatment.
7 Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A1 Monomethylamine aqueous solution can be inhaled in gaseous form through the respiratory tract due to vaporization, so this standard is also applicable to inhalation poisoning associated with skin burns caused by monomethylamine aqueous solution. A.2 Acute monomethylamine poisoning caused by laryngeal edema and inspiratory dyspnea is divided into four degrees. First degree: no dyspnea when quiet, inspiratory dyspnea when active or crying: Second degree: there is also mild "three-concave sign" when quiet, which worsens when active, but does not affect sleep, and there is no irritability; Third degree: obvious inspiratory dyspnea, "three-concave sign" is obvious, and there is irritability and difficulty falling asleep; Fourth degree: in addition to the manifestations of third degree dyspnea, there are also restlessness, limbs moving, cold sweat, pale or cyanotic complexion, and finally coma until cardiac arrest.
A.3 The diagnostic classification proposed in this standard is based mainly on the degree of damage to the respiratory system, and the irritation reaction does not fall into the category of acute poisoning. Laryngeal edema and acute bronchitis with first- to second-degree inspiratory dyspnea are the diagnostic starting points for this disease. A.4 The PaO2 measurement value of blood gas analysis is a reference indicator for diagnostic classification. Hypoxemia is divided into three degrees: mild [PaO2 less than 10.7kPa (80mmHg)], moderate [PaO2 less than 8kPa (60mmHg)], and severe [PaO2 less than 5.3kPa (40mmHg)]. To judge the severity of hypoxia, clinical manifestations should be combined with dynamic observation to eliminate technical errors. A.5 The poisoned person has diffuse alveolar pulmonary edema, a large amount of secretions from the mouth and nose: coma with obvious purple: patients with third- to fourth-degree inspiratory dyspnea should undergo tracheotomy in a timely manner. A.6 The focus of rescue in the early stage of the disease is to prevent and treat laryngeal edema and pulmonary edema: some patients are prone to recurrence, and they still need to be closely observed after the pulmonary edema is controlled, and actively prevent and treat complications such as secondary lung infection and airway mucosal detachment and obstruction. A.7 There is no specific antidote for the treatment of this disease, and non-specific antidote adrenocortical hormone is commonly used. Moderate and severe poisoning can be combined with alkaloid drugs, such as orbiquinone 0.3~0.6mg/time or 654-210~20mg/time, intravenous administration, and should be used early and reach a certain therapeutic dose, but it is not emphasized to achieve edema. In principle, the dose is large at first and then small, and the interval time is short at first and then long.
A.8 Drug atomization inhalation is one of the essential methods in treatment. The commonly used atomization liquid ingredients are: dexamethasone 5mg + gentamicin 80,000 U + 654-210mg + furosemide 20mg + normal saline 50~100mL, ultrasonic atomization inhalation, 10~20mL each time, the interval time is determined according to the severity of the disease. The atomization liquid can also be placed in an oral anesthesia device for artificial spraying. If the patient is obviously hypoxic or has impaired consciousness, the ultrasonic atomizer can be connected to the oxygen cylinder and oxygen can be used to deliver the ultrasonic atomization liquid. Hormone preparations pulmicort and beconazole can also be used for spray inhalation; β2 stimulants 0.Inhalation of 1 mL of 5% salbutamol solution or 1 mL of terbutaline solution; inhalation of 1 mL of 0.5% ipratropium bromide solution, a cholinergic blocker. A.9 Pay attention to first aid for systemic poisoning symptoms, and do not ignore local treatment of eye and skin burns. Patients with I° skin burns greater than or equal to 20% or II° burns greater than or equal to 10% or head and face burns caused by monomethylamine aqueous solution should be alert to the fact that monomethylamine can be absorbed through the skin and aggravate poisoning. Even if respiratory symptoms are not obvious in the early stage, chest X-rays, blood gas analysis and other examinations should be performed routinely, and respiratory symptoms and changes in lung signs should be observed. Preventive treatment should be given when necessary.
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