GB 4867-1996 Diagnostic criteria and treatment principles for occupational acute organic fluorine poisoning
Some standard content:
ICS11.020
National Standard of the People's Republic of China
GB4867—1996
Occupational acute organic fluoride poisoning
Diagnostic criteria and principles of management ofoccupational acute organic fluoride poisoningPublished on 1996-05-23
State Administration of Technical Supervision
Ministry of Health of the People's Republic of China
Implemented on 1996-12-01
National Standard of the People's Republic of China
Occupational acute organic fluoride poisoning
Diagnostic criteria and principles of management ofoccupational acute organic fluoride poisoningGB4867—1996
Replaces GB4867—85
Occupational acute organic fluorine poisoning refers to a systemic disease characterized by respiratory damage caused by workers inhaling excessive organic fluorine monomer cracking gas, residual liquid gas or thermal decomposition gas for a short period of time in the production environment. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and treatment principles for occupational acute organic fluorine poisoning. This standard applies to acute poisoning caused by inhalation of monomers such as tetrafluoroethylene and hexafluoropropylene; cracking gas and residual liquid gas such as difluoromonochloromethane; thermal decomposition gas of fluoropolymers such as polytetrafluoroethylene, polyperfluoroethylene propylene, and polytrifluorochloroethylene during the production, processing, and use of organic fluorine materials. Acute organic fluorine pesticide poisoning and fluoroether poisoning are not within the scope of this standard. 2 Reference standards
GB5906
6 X-ray diagnostic criteria and treatment principles for pneumoconiosis
3 Diagnostic principles
Based on a definite history of short-term, excessive inhalation of organic fluorine gas, combined with clinical manifestations, X-ray chest films (technical requirements see GB5906) and electrocardiogram and other related examination results, comprehensive analysis, and diagnosis can be made after excluding other diseases. 4 Diagnosis and classification standards
4.1 Observation subjects
After inhaling organic fluorine gas, symptoms of upper respiratory tract infection appear, and the symptoms gradually improve after 72 hours of observation, without cardiopulmonary damage. 4.2 Acute poisoning
4.2.1 Mild poisoning
Symptoms include headache, dizziness, cough, sore throat, nausea, chest tightness, fatigue, etc., and scattered dry rales or a small amount of moist rales in the lungs. Linear chest radiographs show signs of enhanced lung texture in the middle and lower lung fields of both lungs and blurred edges, which are consistent with the clinical signs of acute bronchitis and peribronchitis. 4.2.2 Moderate poisoning
Anyone with any of the following conditions can be diagnosed with moderate poisoning: a. The clinical manifestations of mild poisoning are aggravated, with chest tightness, chest pain, palpitations, dyspnea, irritability and mild flare-ups, decreased localized lung breath sounds, more dry or wet rales in both lungs, and enhanced lung texture, extensive reticular shadows, and scattered small dot-like shadows on the linear chest radiograph, which reduce the translucency of the lung fields, or widening of the horizontal fissure, bronchial cuff sign, and occasional Kerley's B line, which are consistent with the clinical signs of interstitial pulmonary edema.
Symptoms and signs are as above, with increased lung texture in the middle and lower lung fields, patchy shadows distributed along the lung texture, mostly seen in the middle and inner bands, extensive and dense b.
Approved by the State Administration of Technical Supervision on May 23, 1996 and implemented on December 1, 1996
It can be fused into pieces, which is consistent with the clinical signs of bronchopneumonia. 4.2.3 Severe poisoning
GB4867—1996
Anyone with any of the following conditions can be diagnosed as severe poisoning: a: Acute alveolar pulmonary edema;Www.bzxZ.net
b. Adult respiratory distress syndrome (ARDS); c. Toxic myocarditis;
d. Complicated with mediastinal emphysema, subcutaneous emphysema, and pneumothorax. 4.3 Fluoropolymer fume fever
After inhaling the pyrolysis of organic fluorine polymers, metal fume fever-like symptoms such as chills, fever, cold forehead, muscle aches may occur, which may be accompanied by cough, chest tightness, headache, nausea, vomiting, etc., and generally subside within 24 to 48 hours. 5 Treatment principles
5.1 Anyone with a definite history of accidental inhalation of organic fluorine gas, regardless of whether they have subjective symptoms or not, must leave the scene immediately, absolutely stay in bed, undergo necessary medical examinations and preventive treatment, and observe for 72 hours. 5.2 Early oxygen administration, oxygen concentration is generally controlled within 50% to 60%, and pure oxygen and hyperbaric oxygen should be used with caution. When adult respiratory distress syndrome occurs, lower pressure positive end-expiratory pressure breathing (PEEP about 0.5kPa) can be used. 5.3 Early, sufficient, and short-term use of glucocorticoids. Emphasize on-site preventive treatment such as intravenous injection of glucocorticoids for all observation subjects and poisoned patients. According to the severity of the disease, the dose of poisoning patients can be appropriately increased on the first day after poisoning, and then sufficient short-term intravenous administration can be given. For patients with moderate or above poisoning, in order to prevent and treat pulmonary fibrosis, small doses of glucocorticoids can be continued intermittently after the acute phase. 5.4 To maintain airway patency, ultrasonic atomization inhalation of bronchial spasmolytics and other agents can be given. Patients with large amounts of foamy sputum should use defoaming agent dimethyl silicone oil (defoaming net) at an early stage. Tracheotomy can be performed after dyspnea is ineffective after internal medicine treatment measures are adopted. 5.5 When toxic myocarditis and other clinical signs occur, the treatment principles are generally the same as those of internal medicine. 5.6 Reasonable selection of antibiotics to prevent and treat secondary infections. 5.7 Fluoropolymer fume fever is generally given symptomatic treatment. Those who have repeated illnesses should be given treatment to prevent and treat pulmonary fibrosis. 6 Labor capacity assessment
6.1 Cure standard
The clinical manifestations caused by acute poisoning disappear, and the results of relevant examinations such as chest X-ray basically return to normal. 6.2 After the poisoning patient is cured, he can resume his original work; if the patient has lung and heart function impairment after poisoning, he should be transferred from his original job and undergo regular reexamination.
7 Requirements for health examination
7.1 Workers working with organic fluorine should undergo pre-employment physical examination and chest X-ray (technical requirements see GB5906). 7.2 According to the degree of exposure, type of work, length of service and other conditions of the workers, regular physical examinations should be conducted every 1 to 3 years. The physical examination includes internal medicine, stomatology, chest X-ray, electrocardiogram, blood and urine routine examinations and other related examination items. Pulmonary function tests can be performed when conditions permit. 8 Occupational contraindications
Obvious chronic respiratory diseases;
b. Obvious cardiovascular diseases;
Chronic liver and kidney diseases.
GB4867—1996
Appendix A
Technical requirements for chest radiography at bedside and notes on reading (supplement)
A1 Position: Take an anteroposterior chest radiograph in a sitting or semi-recumbent position whenever possible. The chest radiograph must include the entire thorax and the costophrenic angles on both sides; the sternoclavicular joints on both sides are symmetrical, and the distance between the target slices is 100cm.
A2 Exposure: No breathing movement during exposure. The lungs, bones and soft tissues have good contrast and layers, and the 1st to 4th thoracic vertebrae are clearly visible. The exposure time should be shortened as much as possible, which should be 1/10s or shorter. The center line is aligned with the 5th thoracic vertebra and is perpendicular to the dark box. A3 Darkroom: The tissue-free area above the shoulders should be dark black, and the area below the diaphragm should be transparent. A4 Blood distribution in the lungs: When standing in the posteroanterior position, due to the gravity of the blood in the lungs, the lung texture in the upper lung field is slender, while when lying down, the lung texture in the upper lung field becomes thicker.
A5 The heart shadow increases and tends to be horizontal.
a. The diaphragm rises, causing the heart to move upward and rotate. b. When standing in the posteroanterior position, the heart is supported by the diaphragm, while when lying, it is supported by the spine, posterior mediastinum and lungs on both sides. The heart wall is more likely to change its shape if it is weak.
c. When standing, a large amount of blood is retained in the vascular bed of the abdominal organs and the sagging parts of the body; when lying, the amount of blood returning to the heart increases, causing the heart shadow to increase significantly.
d.The distance between the target and the bed-resting target changes from about 180cm to about 100cm, which significantly increases the ratio of the heart to the chest. e. In the standing posterior-anterior chest radiograph, the heart is close to the film, and the magnification is small; while in the supine anteroposterior chest radiograph, the distance between the heart and the film increases, the magnification is large, and the heart shadow is also significantly enlarged.
A6 Widening of the large vessels in the mediastinum: the shadow of the superior vena cava is more obvious. A7 The position of the aortic bulb moves up, close to the level of the clavicle. A8 The overlap of the bilateral scapula and the lung field may also affect the observation of the lesion. A small amount of pleural effusion cannot be displayed in the supine position. Therefore, careful observation is required to avoid drawing wrong conclusions.
Appendix B
Instructions for the correct use of the standard
(reference)
B1 When using this standard, a clear history of accidental occupational inhalation of organic fluorine gas must be available. Fluorine-containing polymers themselves are non-toxic and will not cause acute poisoning, but accidental inhalation of organic fluorine monomers, cracking gases, residual liquid gases, and fluoropolymer thermal decomposition gases can all cause acute organic fluorine poisoning. Organic fluorine monomer refers to a monomer in the component fluorine-containing polymer, such as tetrafluoroethylene, difluorochloromethane, trifluorochloroethylene, hexafluoropropylene, etc.
Cracked gas refers to the reaction byproduct produced when organic fluorine monomers are prepared by high-temperature cracking. For example, the cracked gas produced when tetrafluoroethylene is prepared by high-temperature cracking of difluorochloromethane (F2) contains more than 10 reaction products such as tetrafluoroethylene, hexafluoropropylene, and octafluoroisobutylene. Residual liquid gas refers to the residual liquid left after high-temperature cracking to prepare monomers, which is a gaseous compound at room temperature, including extremely toxic octafluoroisobutylene.
Pyrolysis gas refers to the gaseous pyrolysis product when fluorine-containing polymers are decomposed at high temperatures. The pyrolysis product above 400°C contains highly toxic fluorophosgene and hydrogen fluoride.
B2 Organic fluorine gases of certain components, such as fluoroalkanes and olefins, have obvious myocardial damage effects. The patients with this disease have myocardial damage and various types of arrhythmias on the electrocardiogram. After excluding previous organic heart diseases, even if the lesions on the chest X-ray are mild, they can still be diagnosed as toxic myocarditis and should be treated as severe poisoning. 3
GB4867—1996
B3 Organic fluorine gas is a highly toxic substance that affects the lungs, but patients with this disease may also have transient liver and kidney dysfunction, which is often mild and can generally recover without special treatment. The diagnosis and classification should still be based on the clinical manifestations of the respiratory system and chest X-rays. B4 Regarding the "early, sufficient, and short" principle of using glucocorticoids, all observation subjects and poisoned patients should be given preventive medication on site. Dexamethasone 10mg + 25% glucose solution 40mL can be slowly injected intravenously. Although the observation subjects do not fall into the category of acute poisoning, they can still be treated with hormones for 1~3 days during the observation period. In mild, moderate and severe poisoning, dexamethasone 20-60 mg/d or hydrocortisone 400-1200 mg/d can be used intravenously within the first 1-5 days of poisoning according to the condition. The drug can be stopped quickly after the acute symptoms of mild poisoning are controlled. After the acute phase of moderate and above poisoning, patients can continue to take small doses of oral glucocorticoids for about 2-4 weeks to prevent pulmonary fibrosis. B5 Fluoropolymer fume fever usually occurs during the hot processing of polytetrafluoroethylene and polyperfluoroethylene propylene. The sintering temperature is about 350-380℃. The workers inhale the pyrolysis products and have a cold-like reaction. The symptoms are similar to metal fume fever. It is a special clinical type. Generally, antipyretic and analgesic symptomatic treatment is given and the patient recovers within 24-48 hours. However, for patients with repeated onset, literature reports that pulmonary fibrosis can be caused, so anti-pulmonary fibrosis treatment should be given. B6 The early symptoms of poisoning are atypical, so the occupational exposure history of organic fluorine monomers, cracking, and pyrolysis gases (materials) is extremely important. All those listed as observation objects should emphasize absolute bed rest, reduce oxygen consumption, and be under close medical observation. In the early stage, attention should be paid to distinguishing from the common cold, acute tonsillitis, and acute gastroenteritis.
Additional Notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Shanghai Institute of Chemical Industry Occupational Disease Prevention and Control. This standard is interpreted by the Institute of Labor Health and Occupational Diseases of the Chinese Academy of Preventive Medicine, the technical unit entrusted by the Ministry of Health.
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