GBZ 29-2002 Diagnostic criteria for occupational acute phosgene poisoning
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ29—2002
Diagnostic Criteria of Occupational Acute Phosgene PoisoningPublished on April 8, 2002
Implemented on June 1, 2002
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 GB8787-1988 is inconsistent with this standard, this standard shall prevail. Acute poisoning can be caused in occupational activities involving exposure to phosgene. In order to standardize the diagnosis of acute phosgene poisoning and protect the health of those exposed to it, GB8787-1988 was issued. The revised standard is consistent with GBZ73 and highlights the characteristics of phosgene poisoning. On the basis of the original standard, it adds the diagnosis of acute respiratory distress syndrome (ARDS) and other contents, making the diagnostic classification clearer, more reasonable and easier to apply. 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 Yangpu District Central Hospital and Shanghai Wusong Chemical General Plant. The participating units include Peking University Third Hospital, Shanghai Chemical Industry Occupational Disease Prevention and Control Institute, Zhejiang Provincial Center for Disease Control and Prevention, Shanghai Occupational Disease Prevention and Control Institute, Guangdong Provincial Occupational Disease Prevention and Control Institute, Shantou Occupational Disease Prevention and Control Institute, and Gansu Yinguang Chemical Industry Company Staff Hospital. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic criteria for occupational acute phosgene poisoning
GBZ29-2002
Occupational acute phosgene poisoning is a systemic disease with acute respiratory damage caused by inhaling a large amount of phosgene in a short period of time during occupational activities. Pulmonary edema is very likely to occur. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute phosgene poisoning. This standard applies to the diagnosis and treatment of occupational acute phosgene poisoning. Non-occupational acute phosgene poisoning can be used as a reference. 2 Normative references
The clauses in the following documents become 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 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.
GB/T16180
3 Diagnostic principles
Diagnostic standards for occupational acute chemical poisoning respiratory diseases The degree of disability of workers caused by work-related injuries and occupational diseases shall be determined based on the clear occupational history of short-term exposure to phosgene, clinical symptoms and signs of acute respiratory damage, chest X-ray manifestations, combined with other examinations such as blood gas analysis, and reference to on-site labor hygiene survey data. Comprehensive analysis and exclusion of similar diseases caused by other causes can be used for diagnosis.
4 Irritation reaction
Transient eye and upper respiratory tract mucosal irritation symptoms occur, there are no positive signs in the lungs, and there are no abnormal changes in chest X-ray manifestations.
5 Diagnosis and grading standards
5.1 Mild poisoning
Cough, shortness of breath, chest tightness or chest pain, and scattered dry and wet rales in the lungs. The chest X-ray shows enhanced lung texture or blurred edges. The above manifestations are consistent with bronchitis or peribronchitis. 5.2 Moderate poisoning
One of the following conditions:
a) Chest tightness, shortness of breath, cough, sputum, etc., with blood in the sputum, often accompanied by mild fever, dry and wet rales in both lungs, chest X-ray shows dot-like or small patchy shadows in both middle and lower lung fields. The above manifestations are consistent with acute bronchopneumonia;
b) Chest tightness, shortness of breath, cough, sputum are more severe, breath sounds in both 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 lung fields, thickening of horizontal fissures, and sometimes bronchial cuff signs or Kirschner B lines. The above manifestations are consistent with acute interstitial pulmonary edema.
Blood gas analysis often shows mild or moderate hypoxemia. 5.3 Severe poisoning
One of the following conditions:
Obvious dyspnea, cyanosis, frequent coughing, white or pink foamy sputum, extensive moist rales in both lungs, a)
Chest X-ray shows small flakes, cloud-like or cotton-like shadows of varying sizes and blurred edges in both lung fields, which sometimes merge into large flakes or are distributed in a butterfly shape, and blood gas analysis shows PaO2/FiO2≤40kPa (300mmHg). The above manifestations are consistent with diffuse alveolar pulmonary edema or central alveolar pulmonary edema; b) The above conditions are more serious, with respiratory rate (>28 times/min) or (and) respiratory distress, chest X-ray shows large fused shadows in both lungs, and blood gas analysis shows PaOz/FiO2≤26.7kPa (200mmHg). The above symptoms are consistent with acute respiratory syndrome;
c) Asphyxia;
Complication of pneumothorax and mediastinal emphysema:
Severe myocardial damage:
Shock;
Coma.
6 Treatment principles
Treatment principles
Anyone who inhales phosgene should quickly leave the scene to a place with fresh air, immediately take off the contaminated clothing, and rinse the body surface with liquid 6.1.1
phosgene thoroughly with water. Keep quiet, stay in bed and keep warm. Give oxygen and drug atomization inhalation at an early stage, and use bronchial spasmolytics, antitussives, sedatives and other symptomatic treatments. Closely observe for at least 48 hours and pay attention to changes in the condition. 6.1.2 Prevention and treatment of pulmonary edema. Use glucocorticoids in an early, sufficient and short-term manner, and control fluid input. Defoaming agents such as dimethyl silicone oil aerosol can be used for inhalation, and pay attention to keeping the airway open. Reasonable oxygen supply; the inhaled oxygen concentration (Fi02) should not exceed 60%.
6.1.3 Treatment of acute respiratory distress syndrome: refer to the relevant contents of GB73. Other emergency treatments and prevention and treatment of complications are the same as the principles of medical treatment.
6.2 Other treatments
After the acute poisoning patients are cured, they can resume their original work. Severely poisoned patients who still have abnormal manifestations such as chest X-ray, blood gas analysis or lung function test should be transferred away from irritating gas operations. For those who need labor capacity assessment, refer to GB/T16180.7 Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standardbzxZ.net
A.1 Acute phosgene poisoning is mainly characterized by acute damage to the respiratory system, which is characterized by the frequent occurrence of delayed pulmonary edema, that is, the incubation period of pulmonary edema can be up to 48 hours. During this period, the patient may have no obvious clinical symptoms and signs, which should be paid attention to. A.2 This disease may be accompanied by symptoms of other systems, such as dizziness, fatigue, nausea, increased total white blood cell count, fever, etc., but they are not completely consistent with the severity of poisoning. Therefore, the poisoning diagnosis and classification standards are still based on respiratory system symptoms, signs and chest X-ray manifestations. Blood gas analysis is an important reference indicator for the severity of the disease. A.3 Severe poisoning may be complicated by damage to other organs, such as shock, myocardial damage, coma, etc., and its emergency treatment is the same as that of internal medicine. A.4 The blood gas analysis classification of hypoxemia is as follows: Mild hypoxemia; PaOz≤10.7kPa (80mmHg). Moderate hypoxemia: PaO2≤8kPa (60mmHg). Severe hypoxemia; PaOz≤5.3kPa (40mmHg). The diagnostic indicators of acute respiratory distress syndrome caused by moderate and severe poisoning in this standard are determined with reference to foreign data. PaO2/FiO2≤40kPa (300mmHg) is used as the main indicator of toxic diffuse alveolar pulmonary edema, and PaO2/FiO2≤26.7kPa (200mmHg) is used as the diagnostic indicator of ARDS. Blood gas analysis should be dynamically observed in combination with clinical manifestations. A.5 Stimulation reaction and ultrasonic nebulization inhalation of commonly used drugs for poisoning. Formula: dexamethasone 5mg; aminophylline 0.25g; gentamicin 80,000u, appropriate amount of normal saline, good efficacy. Poisoned patients should keep their airways open, and if necessary, give defoaming net nebulization inhalation or perform tracheal intubation or tracheotomy.
A.6 Comprehensive treatment should be emphasized in the prevention and treatment of acute respiratory distress syndrome: refer to the relevant content of GBZ73. A.7 After acute phosgene poisoning, bronchiolitis obliterans may occur in the recovery period, usually about 2 weeks after the acute symptoms are relieved, and attention should be paid to avoid misdiagnosis.
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