GB 16852.6-2000 Diagnosis of occupational acute chemical poisoning Part 6: Diagnosis of respiratory diseases caused by occupational acute chemical poisoning
Some standard content:
GB16852.6—2000
In various occupational activities, people may be exposed to some high-concentration and highly toxic chemicals in a short period of time, which may cause acute poisoning. Some of these chemicals are known species, while others are not known to be the exact pathogenic species after the poisoning has occurred; some species are included in the "list of occupational diseases", while others are not yet included; some have independent diagnostic standards, while others have not yet developed independent diagnostic standards. However, all acute poisoning diseases have similar pathogenesis patterns, 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 acute 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", it includes the following 10 parts: The scope defined in each part will be explained in the preface of each part.
Part 1 General principles for the diagnosis of occupational acute chemical poisoning Part 2
Diagnosis of occupational acute hidden chemical poisoning Part 3
Diagnosis of multiple organ failure due to occupational acute poisoning Part 4
Part 5
Part 6
Part 7
Diagnosis of occupational acute chemical sudden death Diagnosis of occupational acute poisoning nervous system diseases Diagnosis of occupational acute chemical poisoning respiratory diseases Diagnosis of occupational acute poisoning liver diseases
Diagnosis of occupational acute poisoning kidney diseases
Part 8
Part 9
Diagnosis of occupational acute chemical poisoning heart diseases Part 10 Diagnosis of occupational acute chemical poisoning blood system diseases Appendix A and Appendix B of this standard are appendices to this standard. Appendix C of this standard is a suggestive appendix.
This standard is proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by Shanghai Yangpu District Central Hospital and Shenyang Labor Hygiene and Occupational Diseases Research Institute, and Shanghai Sixth People's Hospital, Labor Hygiene and Occupational Diseases Research Institute of Chinese Academy of Preventive Medicine, Heilongjiang Labor Hygiene and Occupational Diseases Research Institute, the Third Affiliated Hospital of Beijing Medical University, Shanghai Chemical Industry Occupational Disease Prevention and Treatment Research Institute, Huashan Hospital Affiliated to Shanghai Medical University, Shanghai Labor Hygiene and Occupational Diseases Research Institute, School of Public Health of Shanghai Medical University, etc. 390
National Standard of the People's Republic of China
Diagnosis of occupational acute chemical poisoning
Part 6: Diagnostic criteria of occupational acute toxic pulmonopathy GB 16852.6—2000
Occupational acute chemical poisoning respiratory diseases refer to systemic diseases characterized by damage to the respiratory system structure and acute functional disorders caused by short-term exposure to relatively large amounts of chemicals in occupational activities. The most serious cases may develop acute respiratory distress syndrome (ARDS). 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute chemical toxic respiratory diseases. This standard applies to the diagnosis of toxic respiratory diseases caused by occupational exposure to chemicals, and can also be used for reference in non-occupational poisoning. 2 Referenced standards
The provisions contained in the following standards constitute the provisions of this standard through reference in this standard. When this standard is published, the versions shown are valid. All standards will be revised, and the parties using this standard should explore the possibility of using the latest version of the following standards. GB5906-1997 X-ray diagnosis of pneumoconiosis
GB/T16180-1996 Identification of the degree of disability caused by work-related injuries and occupational diseases of employees 3 Diagnostic principles
Based on the occupational history of short-term exposure to large doses of chemicals, clinical symptoms, signs, chest X-ray manifestations of acute respiratory system damage, combined with blood gas analysis and other examinations, refer to the results of on-site labor hygiene surveys, and conduct a comprehensive analysis to exclude similar diseases caused by other reasons before diagnosis can be made.
4 Diagnosis and classification standards
4.1 Irritation reaction
Patients with transient eye and upper respiratory tract irritation symptoms and no abnormal chest X-ray manifestations. 4.2 Mild poisoning
Patients with any of the following conditions can be diagnosed as mild poisoning: a) Symptoms of eye and upper respiratory tract irritation, such as photophobia, rheumatism, sore throat, choking cough, chest tightness, etc., may also have aggravated cough, mucous sputum, and occasionally blood in sputum. Physical signs include conjunctival and pharyngeal congestion and edema; coarse breath sounds in both lungs, or scattered and moist rales, and chest X-ray shows increased, thickened, extended, or blurred lung texture. It is consistent with acute tracheobronchitis or peribronchitis. b) Symptoms are mainly asthma, especially difficult to exhale, accompanied by cough, chest tightness, etc. Physical signs include diffuse wheezing in both lungs, and chest X-ray manifestations may be normal. Asthma-like manifestations.
Approved by the State Administration of Quality and Technical Supervision on September 30, 2000, implemented on March 1, 2001
4.3 Moderate poisoning
GB 16852. 6—2000
Any person with any of the following conditions can be diagnosed as moderate poisoning: a) choking cough, expectoration, shortness of breath, chest tightness, etc.; there may be blood in the sputum, dry and wet rales in both lungs, often accompanied by mild cyanosis; chest X-ray shows dot-like or small patchy shadows in both middle and lower lung fields. It is consistent with acute bronchopneumonia. b) Cough, expectoration, chest tightness and shortness of breath are more severe, breath sounds on both sides of the lungs are reduced, and there may be no obvious rales. Chest X-ray shows increased lung texture, widened hilar shadows, unclear boundaries, scattered small dot-like shadows and reticular shadows in both lungs, reduced transparency of the lung field, thickening of horizontal fissures, and sometimes bronchial cuff signs and/or Kirschner B lines. It is consistent with acute interstitial pulmonary edema. c) Cough, expectoration, small to moderate sputum volume, shortness of breath, mild purple, scattered moist rales in the lungs, and chest X-ray shows a single or a few localized round-like shadows with clear contours and increased density. It is consistent with acute localized alveolar pulmonary edema. d) There is a history of inhalation of hydrocarbons or other liquid chemicals, with severe choking, expectoration, blood in sputum, rust-colored sputum, chest pain, dyspnea, and rash, often accompanied by fever, general discomfort, etc. Chest X-ray shows thickened lung texture and small flake-like shadows, which are more common on the right lower side, and a few may be accompanied by exudative pleurisy. It is consistent with acute aspiration pneumonia. 4.4 Severe poisoning
Any person with any of the following conditions can be diagnosed with severe poisoning: a) Severe cough, large amount of white or pink foamy sputum, dyspnea, obvious ulceration, dense moist rales in both lungs, chest X-ray shows that both lung fields have millet-like or cloud-like shadows of varying sizes and blurred edges, which can sometimes merge into large shadows or be distributed in a butterfly shape. Blood gas analysis PaO./FiOz<40kPa(300mmHg). It is consistent with diffuse alveolar pulmonary edema or central alveolar pulmonary edema. b) The above conditions are more serious, with a respiratory rate greater than 28 times/min or/and respiratory distress. Chest X-ray shows that both lungs are widely fused with large shadows, and blood gas analysis shows that the oxygen partial pressure/oxygen concentration (PaOz/FiO,)≤26.7kPa(200mmHg). It is consistent with acute respiratory distress syndrome.
c) Asphyxia.
d) Complications of severe pneumothorax, mediastinal emphysema or severe myocardial damage, etc. e) Sudden death.
5 Treatment principles
5.1 On-site treatment
Immediately break away from contact, keep quiet and keep warm. Those who have irritation reactions should be closely observed. For patients who have been exposed to poisons that may cause delayed respiratory tract lesions (those with a long incubation period), the observation period should be extended. During the observation period, they should avoid activities and receive symptomatic treatment. If necessary, preventive treatment drugs such as inhalation sprays, oxygen inhalation, injection of adrenal glucocorticoids, etc., and psychological treatment should be given to help control the progression of the disease. If the eyes are contaminated by chemicals, they must be rinsed thoroughly immediately and must not be sent to the hospital without rinsing to avoid irreversible serious lesions in the eyes. Skin contamination and chemical burns should also be rinsed thoroughly on site before being sent to the hospital. 5.2 Keep the airway open
Atomized inhalation therapy, bronchial detoxifiers, and defoaming agents such as dimethyl silicone oil can be given, and tracheotomy can be performed if necessary. 5.3 Etiological treatment
If there is an indication for the use of complexing agents, special antidotes, or blood purification therapy, use them in a timely manner. If a large amount of dust or liquid is inhaled, fiberoptic bronchoscopy can be considered to suck out the dust or liquid as soon as possible. 5.4 Reasonable oxygen therapy
Pay attention to reasonable oxygen therapy, maintain water and dielectric balance, support treatment and prevent complications. 6 Work capacity assessment
6.1 After mild and moderate poisoning is cured, the original work can be resumed. 6.2 After severe poisoning is cured, in principle, the worker should be transferred away from the irritant gas operation. 6.3 If there are sequelae after acute poisoning, refer to GB/T16180 and deal with it properly in combination with the actual situation. 392
Requirements for health examination
GB 16852. 6 ---2000
7.1 All workers engaged in poisonous work with the respiratory system as the main target organ must undergo a physical examination for employment. 7.2 According to the exposure situation, regular physical examinations should be conducted every 1 to 2 years after employment, including relevant items such as internal medicine, ENT and chest X-ray examinations.
7.3 Conditions should be created to carry out health monitoring work for employees. 8 Contraindications of occupational drugs
a) αi-antitrypsin deficiency.
b) More serious chronic diseases of the nose, pharynx and throat. c) Chronic respiratory diseases with mild lung function impairment. d) Organic cardiovascular diseases.
A1 Toxic substances that directly damage respiratory tissues A1.1 Irritant gases bzxz.net
GB 16852.6 -2000
Appendix A
(Appendix to the standard)
Common types of virulence agents
A1. 1. 1 Acids: nitric acid, hydrochloric acid, sulfuric acid, chromic acid, chlorosulfonic acid, etc. A1.1.2 Nitrogen oxides: nitric oxide, nitrogen dioxide, nitrogen pentoxide, etc. A1.1.3 Chlorine and other compounds: fluorine, hydrogen chloride, chlorine dioxide, phosgene, diphosgene, chloropicrin, vanadium difluoride, silicon tetrachloride, trichlorosilane, titanium tetrachloride, blue antimony chloride, arsenic trichloride, phosphorus trichloride, phosphorus oxychloride, phosphorus pentachloride, boron trichloride, etc. A1.1.4 Sulfur compounds: sulfur dioxide, sulfur trioxide, hydrogen sulfide, etc. A1.1.5 Ammonia.
A1.1.6 Ozone.
A1. 1.7 Esters: dimethyl sulfate, methyl formate, toluene diisocyanate, methyl azoformate, etc. A1.1.8 Metal compounds: oxide, hydrogen selenide, carbonyl nickel, vanadium pentoxide, etc. A1.1.9 Aldehydes: formaldehyde, acetaldehyde, acrolein, trichloroacetaldehyde, etc. A1.1.10 Fluorinated hydrocarbons: octafluoroisobutylene, fluorophosgene, hexafluoropropylene, cracking residual liquid gas and pyrolysis gas of fluoropolymers, etc. A1.1.11 Others: diborane, chloromethyl methyl ether, carbon tetrachloride, monomethylamine, dimethylamine, epichlorohydrin, etc. 2 Military poisonous gases: nitrogen mustard, Adam's gas, Lewis gas, etc. A1.1.12
A1.2 Irritating metals: beryllium, cadmium, mercury, manganese, nickel carbonyl, vanadium pentoxide. A1.3 Organic solvents: gasoline, kerosene, lubricating oil, diesel, etc. A1.4 Organic pesticides: organic phosphates, methyl bromide, phosphine, paraquat, etc. A1.5 Others: such as smoke from burning certain substances. A2 Compounds that cause acute respiratory distress syndrome (ARDS) by indirect damage. Severe toxic encephalopathy, liver disease, kidney disease, etc. caused by acute chemical poisoning can induce ARDS during the course of the disease. It is a common manifestation of multiple organ failure caused by acute poisoning and is an indirect damage-induced ARDS, which is more common in acute carbon monoxide poisoning, acute sodium pentafluorophenol poisoning, etc. Appendix B
(Standard Appendix)
Special requirements for bedside chest radiography
Bedside chest radiography uses high-voltage photography technology. Technical specifications are the same as GB5906. B1
Before the existing bedside machine in this unit is updated, it is allowed to take chest radiographs with ordinary technology. B3
Position: If the condition permits, take an anteroposterior chest radiograph in a sitting or semi-recumbent position as much as possible. B4 Target-film distance: more than 90cm.
Appendix C
(Reminder Appendix)
Instructions for the correct use of the standard
C1 There are many types of pathogenic chemicals that cause acute toxic respiratory damage. In Appendix A of this standard, common pathogenic species are listed and divided into two categories according to their modes of action, so as to facilitate a more comprehensive understanding of the common types of pathogenic substances. C2 The diagnostic principles and classification standards of this standard are general and applicable to the diagnosis of acute toxic respiratory diseases caused by various chemical species. When formulating diagnostic standards for various related species, the characteristics of acute poisoning of each species are added under the general diagnostic principles to make it both coherent and in line with the actual situation.
C3 irritation reaction is a transient reaction to contact with irritating gas, which has not yet reached the level of poisoning. There are no obvious signs in the lungs, but there may be scattered rales occasionally. However, in order to prevent and promptly detect delayed lesions and avoid aggravation of the condition due to improper treatment, it is included in the classification standard to arouse vigilance. When counting diseases, irritation reactions are not considered as poisoning cases. The principle of the C4 classification standard is: comprehensive judgment based on the location, range, nature of the lesion and the degree of hypoxemia. In clinical practice, examination items can be selected according to the patient's condition, such as electrocardiogram, myocardial enzyme spectrum, liver and kidney function tests, etc., and judgment can be made from an overall perspective to make diagnosis and classification more practical.
C5 The severity of hypoxia is often closely related to respiratory system lesions, which is particularly obvious in acute poisoning. Therefore, the measured value of oxygen partial pressure (PaO,) is used as a reference indicator for graded diagnosis. Dynamic observation data must be available for evaluation, and technical errors should also be noted. During analysis, it should be understood that hypoxemia and tissue hypoxia are both related and not equivalent concepts, so as to correctly judge the condition. Mild poisoning generally does not cause hypoxemia. The oxygen partial pressure (PaO2) of blood gas analysis is in the normal range of 10.7kPa~13.3kPa (80mmHg~100mmHg) or occasionally there is short-term mild hypoxemia. The oxygen partial pressure (PaOz) of blood gas analysis is 8kPa~～10.7kPa (60mmHg~～80mmHg). Moderate poisoning is often accompanied by mild or moderate hypoxemia, and the oxygen partial pressure (PaO2) of blood gas analysis is 8kPa～10.7kPa (60mmHg～80mmHg) or 8.0kPa～5.5kPa (60mmHg～41mmHg). Severe poisoning is accompanied by severe hypoxemia, and the oxygen partial pressure (PaO2) of blood gas analysis is ≤5.3kPa (40 mmHg).
C6 The diagnostic indicators of acute respiratory distress syndrome in this standard are formulated with reference to domestic and international data in recent years, and can be applied to ARDS caused by direct and indirect causes. The value of PaOa/FiO2 is used as the main index of toxic diffuse alveolar pulmonary edema, and PaO,/FiO226.7kPa is used as the diagnostic index of ARDS, which minimizes the misdiagnosis of non-ARDS as ARDS. In this standard, the difference in diagnostic indicators of diffuse pulmonary edema and ARDS also reflects the difference in severity between the two, which is consistent with the view that there is a quantitative change to a qualitative change from diffuse pulmonary edema to ARDS. The index reflecting pulmonary shunt Q./Q.It is of certain significance for the diagnosis of ARDS, but due to Q/Q, it needs to be carried out under the condition of inhaling pure oxygen. The mixed venous blood oxygen content needs to be measured during the actual measurement, and there is a certain error between the results obtained by the current calculation formula and the actual measurement. Therefore, A-aDO, which is often difficult to perform in clinical practice, is also obtained by calculation and is rarely used, so it is not included in this standard. C7 Aspiration pneumonia often has more typical clinical manifestations, and the diagnosis is easy to make clear. The lesions are generally limited, but if the amount of liquid or dust inhaled is too large, it can also cause diffuse pulmonary edema, which should be paid attention to. C8 If the patient has a chronic respiratory disease in the past, after inhaling irritating gases, the condition after poisoning may be more complicated, or it may induce the original respiratory disease. In this case, diagnosis and treatment must take these factors into account to determine the graded diagnosis and formulate a treatment plan.
C9 After the recovery of severe toxic respiratory damage, various diseases such as chronic bronchitis, emphysema, obstructive bronchiolitis, reactive airways dysfunction syndrome (RADS) and so on may occur. The factors causing the above situation are complicated, and are related to the type of virulence agent, absorption mode, dosage, nature and severity of the lesion, treatment and the patient's health condition before the onset of the disease. It may be that the original disease is induced, or it may have nothing to do with the current poisoning. Therefore, the diagnosis should be comprehensively analyzed to draw an objective and realistic conclusion. It is not possible to diagnose all the above lesions as "sequelae" to avoid deviation. In the future, we should do a better job of tracking and follow-up to accumulate more information to provide accurate indicators for the diagnosis of sequelae. C10 Etiological treatment refers to various treatment measures that promote the discharge of virulence agents or target their pathogenesis. Different treatment methods are used according to different types of toxicants.
C11 Hypoxia can cause many serious consequences, such as damage to mitochondria, insufficient and depleted production of adenosine triphosphate (ATP), and accelerated degradation of membrane phospholipids, leading to damage to biological membranes, intracellular calcium ion overload, and increased production of oxygen free radicals. These conditions further aggravate hypoxia and form a vicious cycle. Therefore, early correction of hypoxia and control of disease progression are important links to prevent treatment contradictions. The oxygen supply method can be selected according to the patient's condition and objective conditions, and oxygen poisoning can be prevented under the condition of inhaling high-concentration oxygen. Blood gas analysis can be used as a monitoring indicator. The principle is to select the appropriate oxygen supply method according to the condition, and use the lowest effective concentration of oxygen to correct hypoxemia in the shortest time. Maintain the arterial blood oxygen pressure at 8kPa~10kPa (80mmHg~100mmHg). Severe patients are given continuous positive ventilation from the mask (intermittent positive pressure oxygen supply) or positive end-expiratory pressure ventilation (PEEP) therapy. The end-expiratory pressure should be around 0.5kPa (5cmH2O column). High-frequency ventilation (HFV) or high-frequency jet ventilation has little effect on cardiac function and can achieve certain therapeutic effects. It can also be used. Inverse ventilation (IRV, inverseratioventilation) can also be used to treat ARDS. Extrapulmonary oxygen supply, such as photon blood therapy, can also be considered as an auxiliary treatment. Hyperbaric oxygen was rarely used to treat respiratory diseases in the past, and some people believed that it was a contraindication for the treatment of ARDS. However, in recent years, there have been reports in China that hyperbaric oxygen has been used to treat acute toxic pulmonary edema and acute respiratory distress syndrome and has achieved certain efficacy. However, no consistent conclusion has been reached through clinical observation and animal experiments. Therefore, more data are needed to explore treatment indications and evaluate efficacy. Therefore, it cannot be included in the appendix as a routine treatment measure for reference. For example, when using hyperbaric oxygen, the air pressure used is relatively low [130~～170kPa (1.3~1.7atm), and the time is preferably 30~40min. C12 nonspecific antagonists are based on the pathogenesis of acute chemical toxic pulmonary edema and ARDS, and drugs are given to the main links of the disease to achieve antagonistic effects and block the pathophysiological evolution of ARDS, so as to achieve the purpose of reducing lung and systemic damage. Therefore, it is one of the main treatment measures in rescue. Commonly used ones include adrenocortical hormones, oxygen free radical scavengers, calcium ion channel blockers, etc. The indications for the use of these drugs, the selection of drug types, dosages and courses of treatment, etc., can be reasonably used in rescue according to the condition and the experience of the rescue team. C13 Maintain good circulatory function, such as maintaining appropriate blood volume, improving cardiac pump function and correcting microcirculatory disorders, preventing microthrombosis, etc. Commonly used drugs include 6-542, Danshen, Chuanxiong, etc. C14 Correct acid-base and electrolyte disorders In the course of pulmonary edema and ARDS, there are many types of acid-base poisoning, such as respiratory alkalosis caused by hyperventilation in the early stage, severe hypoxia with CO retention in the late stage, mixed acidosis, etc. There are also various different situations of electrolyte disorders, and targeted treatment measures should be taken according to clinical and laboratory results. C15 Severe toxic respiratory diseases, once a serious secondary infection occurs, not only will the condition become more serious and complicated, but it is also one of the main reasons for the contradiction in treatment. Prolonged course of the disease can lead to hyperplasia of pulmonary granulation tissue. Although the patient's survival period is prolonged, his life cannot be saved. Therefore, from the onset of the disease, various measures should be taken to prevent secondary infection, and close monitoring, timely detection and control are important links in treatment. C16 Nutritional support, acute and severe patients, for high metabolic state, excessive energy consumption and insufficient nutrition intake during the course of the disease will lead to reduced immunity of the body, prone to secondary infection, respiratory muscle fatigue, affecting tissue repair, so nutritional support should be given as soon as possible, and calories should be supplemented in time. The total daily calories are about 150kJ/kg, and protein and fat account for about 20% and 30% of the total calories respectively. C17 Strengthen nursing work. In the whole process, improving nursing quality is the main link in rescue. C18 The formulation of treatment plans should be guided by holistic thinking. Comprehensive treatment measures should be used for serious diseases, but medication should not be overused. The efficacy and side effects should be closely observed. The treatment methods should be adjusted in time according to the changes in the condition and preventive measures should be emphasized. Support and psychological treatment are very important to promote recovery. Patients with moderate and severe poisoning should be given necessary rehabilitation treatment during the recovery period. C19 All critically ill patients are monitored with bedside chest X-rays, so Appendix B of the standard proposes bedside radiography requirements for reference when used. C20 With the progress of scientific research, new methods and drugs are provided for clinical diagnosis and treatment, such as new diagnostic indicators, advanced imaging diagnostic methods and treatment measures. For example, exogenous nitric oxide is used for treatment to improve pulmonary perfusion; natural or artificial surfactants are used; acinar is used for treatment, and the successful development of intravenous oxygenators can improve the shortcomings of positive end-expiratory pressure ventilation therapy (PEEP). These drugs and measures have been reported for clinical application, but further research is needed before they can be widely used, so they are not included in this standard. Therefore, timely grasp the relevant information and apply it in clinical practice, and accumulate data to continuously improve the level of diagnosis and treatment, and contribute to the development of this discipline. C21 Notes on reading films:
C21.1 When performing bedside photography, the patient's position, photography position, respiratory status and focal-film distance are different from those of conventional chest photography, and the imaging of various structures of the human body on the chest film also has corresponding changes. Because the shoulder bone cannot avoid being out of the lung field, the sternoclavicular joint is not required to be symmetrical. C21.2 Before reading the film, you must understand the patient's condition and photography conditions during photography. C21.3 When reading the film, you must fully consider the impact of different patients and photography conditions on the image. 396About 5kPa (5cmH2O column), high-frequency ventilation (HFV) or high-frequency jet ventilation has little effect on cardiac function and can be used to achieve certain therapeutic effects. Inverse ventilation (IRV, inverseratioventilation) can also be used to treat ARDS. Extrapulmonary oxygen administration, such as photon hemotherapy, can also be considered as an auxiliary treatment. Hyperbaric oxygen was rarely used to treat respiratory diseases in the past, and some people believed that it was a contraindication for the treatment of ARDS. However, in recent years, there have been reports in China that hyperbaric oxygen has been used to treat acute toxic pulmonary edema and acute respiratory distress syndrome and has achieved certain therapeutic effects. However, no consistent conclusion has been reached through clinical observation and animal experiments. Therefore, more data are needed to explore the indications for treatment and evaluate the efficacy. Therefore, it cannot be included in the appendix as a routine treatment measure for reference. When using hyperbaric oxygen, the gas pressure used is relatively low [130~～170kPa (1.3~1.7atm), and the time is preferably 30~40min. C12 non-specific antagonists are based on the pathogenesis of acute chemical poisoning pulmonary edema and ARDS, and are given to the main links of the disease to achieve the purpose of antagonizing and blocking the pathophysiological evolution of ARDS, so as to reduce lung and systemic damage. Therefore, it is one of the main treatment measures in rescue. Commonly used ones include adrenocortical hormones, oxygen free radical scavengers, calcium channel blockers, etc. The indications for the use of these drugs, the selection of drug varieties, dosages and courses of treatment, etc., can be reasonably used in rescue according to the condition and the experience of the rescue team. C13 maintains good circulatory function, such as maintaining appropriate blood volume, improving cardiac pump function and correcting microcirculatory disorders, preventing microthrombosis, etc. Commonly used drugs include 6-542, Danshen, Chuanxiong, etc. C14 Correct acid-base and electrolyte disorders. In the course of pulmonary edema and ARDS, there are many types of acid-base poisoning, such as respiratory alkalosis caused by hyperventilation in the early stage, severe hypoxia with CO retention in the late stage, mixed acidosis, etc. There are also various different situations of electrolyte disorders. Targeted treatment measures should be taken according to clinical and laboratory results. C15 Severe toxic respiratory diseases, once a serious secondary infection occurs, not only will the condition become more serious and complicated, but it is also one of the main reasons for the contradiction in treatment. Prolonged course of the disease can lead to hyperplasia of granulation tissue in the lungs. Although the patient's survival period is prolonged, his life cannot be saved. Therefore, from the onset of the disease, various measures should be taken to prevent secondary infection, and close monitoring, timely detection and control are important links in treatment. C16 Nutritional support. For acute and critically ill patients, in the high metabolic state, excessive energy consumption and insufficient nutrition intake during the course of the disease will lead to reduced immunity, easy secondary infection, respiratory muscle fatigue, and affect tissue repair. Therefore, nutritional support should be given as soon as possible, and calories should be supplemented in time. The total daily calories are about 150kJ/kg, and protein and fat account for about 20% and 30% of the total calories respectively. C17 Strengthen nursing work. During the whole process, improving nursing quality is the main link in rescue. C18 The formulation of treatment plans should be guided by holistic thinking. Comprehensive treatment measures should be used for serious diseases, but medication should not be too abused. The efficacy and side effects should be closely observed. The treatment method should be adjusted in time according to the changes in the condition and preventive measures should be emphasized. Support and psychological treatment are very important to promote recovery. Patients with moderate and severe poisoning should be given necessary rehabilitation treatment during the recovery period. C19 Bedside chest X-rays are used for monitoring critically ill patients. Therefore, Appendix B of the standard proposes bedside radiography requirements for reference when using. C20 With the progress of scientific research, new methods and drugs are provided for clinical diagnosis and treatment, such as new diagnostic indicators, advanced imaging diagnostic methods and treatment measures. For example, exogenous nitric oxide is used to improve pulmonary perfusion; surfactant extracted from nature or artificially produced is used; acinar is used for treatment, and intravenous oxygenator has been successfully developed to improve the shortcomings of positive end-expiratory pressure ventilation therapy (PEEP). These drugs and measures have been reported for clinical application, but further research is needed before they can be widely used, so they are not included in this standard. Therefore, timely grasp the relevant information and apply it in combination with clinical practice, and accumulate data to continuously improve the level of diagnosis and treatment, and contribute to the development of this discipline. C21 Notes on reading films:
C21.1 When performing bedside photography, the patient's position, photography position, respiratory state and focal-film distance are different from those of conventional chest photography, and the imaging of various structures of the human body on the chest film also changes accordingly. Because the shoulder bone cannot avoid the lung field, the sternoclavicular joint is not required to be symmetrical. C21.2 Before reading the film, you must understand the patient's condition and photography conditions during photography. C21.3 When reading the film, full consideration should be given to the impact of different patients and photographic conditions on the image. 396About 5kPa (5cmH2O column), high-frequency ventilation (HFV) or high-frequency jet ventilation has little effect on cardiac function and can be used to achieve certain therapeutic effects. Inverse ventilation (IRV, inverseratioventilation) can also be used to treat ARDS. Extrapulmonary oxygen administration, such as photon hemotherapy, can also be considered as an auxiliary treatment. Hyperbaric oxygen was rarely used to treat respiratory diseases in the past, and some people believed that it was a contraindication for the treatment of ARDS. However, in recent years, there have been reports in China that hyperbaric oxygen has been used to treat acute toxic pulmonary edema and acute respiratory distress syndrome and has achieved certain therapeutic effects. However, no consistent conclusion has been reached through clinical observation and animal experiments. Therefore, more data are needed to explore the indications for treatment and evaluate the efficacy. Therefore, it cannot be included in the appendix as a routine treatment measure for reference. When using hyperbaric oxygen, the gas pressure used is relatively low [130~～170kPa (1.3~1.7atm), and the time is preferably 30~40min. C12 non-specific antagonists are based on the pathogenesis of acute chemical poisoning pulmonary edema and ARDS, and are given to the main links of the disease to achieve the purpose of antagonizing and blocking the pathophysiological evolution of ARDS, so as to reduce lung and systemic damage. Therefore, it is one of the main treatment measures in rescue. Commonly used ones include adrenocortical hormones, oxygen free radical scavengers, calcium channel blockers, etc. The indications for the use of these drugs, the selection of drug varieties, dosages and courses of treatment, etc., can be reasonably used in rescue according to the condition and the experience of the rescue team. C13 maintains good circulatory function, such as maintaining appropriate blood volume, improving cardiac pump function and correcting microcirculatory disorders, preventing microthrombosis, etc. Commonly used drugs include 6-542, Danshen, Chuanxiong, etc. C14 Correct acid-base and electrolyte disorders. In the course of pulmonary edema and ARDS, there are many types of acid-base poisoning, such as respiratory alkalosis caused by hyperventilation in the early stage, severe hypoxia with CO retention in the late stage, mixed acidosis, etc. There are also various different situations of electrolyte disorders. Targeted treatment measures should be taken according to clinical and laboratory results. C15 Severe toxic respiratory diseases, once a serious secondary infection occurs, not only will the condition become more serious and complicated, but it is also one of the main reasons for the contradiction in treatment. Prolonged course of the disease can lead to hyperplasia of granulation tissue in the lungs. Although the patient's survival period is prolonged, his life cannot be saved. Therefore, from the onset of the disease, various measures should be taken to prevent secondary infection, and close monitoring, timely detection and control are important links in treatment. C16 Nutritional support. For acute and critically ill patients, in the high metabolic state, excessive energy consumption and insufficient nutrition intake during the course of the disease will lead to reduced immunity, easy secondary infection, respiratory muscle fatigue, and affect tissue repair. Therefore, nutritional support should be given as soon as possible, and calories should be supplemented in time. The total daily calories are about 150kJ/kg, and protein and fat account for about 20% and 30% of the total calories respectively. C17 Strengthen nursing work. During the whole process, improving nursing quality is the main link in rescue. C18 The formulation of treatment plans should be guided by holistic thinking. Comprehensive treatment measures should be used for serious diseases, but medication should not be too abused. The efficacy and side effects should be closely observed. The treatment method should be adjusted in time according to the changes in the condition and preventive measures should be emphasized. Support and psychological treatment are very important to promote recovery. Patients with moderate and severe poisoning should be given necessary rehabilitation treatment during the recovery period. C19 Bedside chest X-rays are used for monitoring critically ill patients. Therefore, Appendix B of the standard proposes bedside radiography requirements for reference when using. C20 With the progress of scientific research, new methods and drugs are provided for clinical diagnosis and treatment, such as new diagnostic indicators, advanced imaging diagnostic methods and treatment measures. For example, exogenous nitric oxide is used to improve pulmonary perfusion; surfactant extracted from nature or artificially produced is used; acinar is used for treatment, and intravenous oxygenator has been successfully developed to improve the shortcomings of positive end-expiratory pressure ventilation therapy (PEEP). These drugs and measures have been reported for clinical application, but further research is needed before they can be widely used, so they are not included in this standard. Therefore, timely grasp the relevant information and apply it in combination with clinical practice, and accumulate data to continuously improve the level of diagnosis and treatment, and contribute to the development of this discipline. C21 Notes on reading films:
C21.1 When performing bedside photography, the patient's position, photography position, respiratory state and focal-film distance are different from those of conventional chest photography, and the imaging of various structures of the human body on the chest film also changes accordingly. Because the shoulder bone cannot avoid the lung field, the sternoclavicular joint is not required to be symmetrical. C21.2 Before reading the film, you must understand the patient's condition and photography conditions during photography. C21.3 When reading the film, full consideration should be given to the impact of different patients and photographic conditions on the image. 396
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