GB 16392-1996 Diagnostic criteria and treatment principles for combined radiation-burn injuries
Some standard content:
National Standard of the People's Republic of China
Diagnostic criteria and principles of managementfor combined radiation-burn injuryGB 16392—1996
Combined radiation-burn injury refers to a type of combined burn in which radiation damage occurs simultaneously or successively in the human body. The radiation dose exceeds 1Gy, and the burns are mostly skin burns. Respiratory tract burns or eye burns (external eye burns and retinal burns) may also occur simultaneously. The injuries of combined radiation-burn injury can be divided into four levels: mild, moderate, severe and extremely severe. The course of moderate and severe combined radiation-burn injury can be divided into shock stage, local infection stage, extreme stage and recovery stage. The course of mild disease is mild and the stages are not obvious. The course of extremely severe disease is extremely severe, and the extreme stage is often entered after the shock stage. 1 Subject content and scope of application
This standard specifies the diagnostic criteria and management principles for combined radiation-burn injury. This standard applies to the diagnosis and treatment of patients with combined radiation and burn injuries in peacetime nuclear accidents or nuclear weapons war conditions. 2 Referenced standards
GB 8280 Diagnostic criteria and treatment principles for acute radiation sickness caused by external exposure 3 Diagnostic principles
Based on the injury history, the estimated exposure dose, burn injuries, clinical manifestations, laboratory test results, and combined with health records, a comprehensive analysis is conducted. On the basis of ascertaining the severity of both single injuries, the combined injury can have aggravating effects on each other when both single injuries are moderate or above, and a diagnosis of the combined injury is made.
4 Diagnosis and grading standards
4.1 Diagnosis
4.1.1 Radiation injury and its severity can be diagnosed with reference to GB8280. Patients with burns can be diagnosed with combined radiation and burn injuries. 4.1.2 Burns can be caused by nuclear explosion light radiation or flames, or a combination of both. The burn depth is determined by the three-degree four-point method (first degree, superficial second degree, deep second degree and third degree), and the burn area is determined by the Chinese nine-point method or the palm method. For light radiation burns, attention should be paid to retinal burns and burns under clothing.
4.1.3 Patients with burnt nasal hair, red and swollen nasal mucosa, cough, hoarseness, dyspnea, and even coughing up detached tracheal mucosa, and pulmonary edema shadows in X-ray examination can be diagnosed with respiratory burns. 4.1.4 Patients with a history of viewing nuclear explosion fireballs, abnormal vision, photophobia, tearing, pain, and decreased vision, and burn lesions in the macula of the fundus examination can be diagnosed with retinal burns.
4.1.5 Since burns are easy to see, the focus of diagnosis is whether there is a combined radiation injury and its degree. If the burn is accompanied by the initial symptoms of radiation sickness, such as nausea, vomiting and diarrhea, it can be diagnosed as a combined radiation burn injury. 4.2 Injury classification standards
4.2.1 Mild radiation injury combined with mild burns is a mild radiation-burn combined injury. 4.2.2 Moderate radiation injury combined with mild burns is a moderate radiation-burn combined injury. Approved by the State Bureau of Technical Supervision on May 23, 1996 and implemented on December 1, 1996
GB16392—1996
4.2.3 Severe radiation injury combined with mild burns, or moderate radiation injury combined with moderate burns are generally severe radiation-burn combined injuries. 4.2.4 Extremely severe radiation injury combined with burns of all degrees, or severe radiation injury combined with moderate or severe burns are all extremely severe radiation-burn combined injuries. 5 Principles of first aid and treatment
Comprehensive treatment measures should be taken according to the different injuries and stages of illness. 5.1 First aid includes extinguishing fire, covering wounds; sedation, pain relief, warming, oral rehydration to prevent shock; oral antibiotics to prevent infection; prevention and treatment of ventricular asphyxia. 5.2 Intravenous infusion of low molecular weight dextran, symptomatic treatment and nutritional supplementation. 5.3 Preventive injection of tetanus toxoid.
5.4 Use therapeutic radiation prevention and treatment drugs and drugs to increase white blood cells as soon as possible within 3 days after injury. 5.5 Protect hematopoietic function, prevent and treat bleeding, correct microcirculation disorders and water and electrolyte imbalance. 5.6 Antibiotics have been taken to prevent infection after injury. If fever does not decrease or white blood cells drop to 2.0×10°/L, sensitive antibiotics should be used instead. If the infection cannot be controlled after 3 days of use, large doses of broad-spectrum antibiotics should be used in combination, and attention should be paid to the prevention and treatment of fungal and viral infections. 5.7 When the platelet count in peripheral blood drops to 20×10°/L or there is severe bleeding, platelet solution can be transfused. The suspension must be irradiated with 15~25Gy before transfusion.
5.8 Fetal liver cell transplantation can be performed for moderate and severe patients. 5.9 For moderate and severe patients, disinfection and isolation measures should be strict, and laminar flow clean rooms should be used as needed and possible. 5.19 For extremely severe patients, allogeneic bone marrow transplantation can be considered, and attention should be paid to the prevention and treatment of host-versus-host disease. For patients with chest irradiation, attention should be paid to the prevention and treatment of interstitial pneumonia in the later period.
5.11 Treatment of burn wounds
5.11.1 Early debridement Use normal saline and 0.1% chlorhexidine solution to clean the wound. If the wound is contaminated with radionuclides, the contamination should be eliminated as soon as possible, and it can be combined with early debridement. 5.11.2 Apply a preparation with bactericidal, anti-inflammatory, astringent and healing-promoting effects on the wound surface of second-degree burns to prevent wound infection. 5.11.3 For third-degree burns, the skin should be removed (cut) and autologous skin grafted as soon as possible, and the wound should be closed before the end of the period, turning the complex injury into a single injury. However, the specific implementation must be considered comprehensively based on the overall condition. If the burn area is less than 10% and the patient is in good condition, early skin removal and autologous skin grafting can be used. If the burn area is large and the patient can still tolerate skin removal surgery, allografting or allografting and autologous skin grafting can be performed to cover the wound surface, pass the end of the period, and then autologous skin grafting can be performed. If the overall injury is serious and surgery is not suitable, the skin should be closely protected. While strengthening systemic treatment, wound infection (especially wound sepsis) should be effectively prevented and treated. After entering the recovery period, skin removal or skin removal and autologous skin grafting can be performed. 5.11.4 When removing and grafting skin, local anesthesia or ketamine intravenous combined anesthesia can be used. 5.12 When combined with respiratory burns, the oral cavity should be cleaned. When laryngeal edema poses a risk of suffocation, tracheotomy should be performed promptly. When bronchospasm occurs, bronchodilators should be given, oxygen should be inhaled, and the respiratory tract should be kept moist. 5.13 When combined with retinal burns, measures should be taken to promote edema absorption, control inflammation, and reduce scar formation. 6 Principles of treatment after treatment of combined radiation and burn injuries
For those who have been confirmed to be clinically cured after treatment, close medical follow-up observation and regular health examinations should be carried out, and attention should be paid to possible scar contracture deformity and long-term effects, and appropriate treatment should be given. Depending on the recovery situation, they can recuperate, rest, or arrange appropriate work. 374
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Appendix A
Diagnosis and management of combined burn-radiation injury
(Supplement)
A1 Combined burn-radiation injury Combined burn-radiation injury refers to a type of combined injury in which burns occur simultaneously or successively and combined with radiation injury. A2 Diagnosis and management for combined burn-radiation injury The diagnosis and management of combined burn-radiation injury can refer to this standard. The focus of diagnosis is to clarify the burn injury and find out the ionizing radiation dose received. The focus of treatment is to treat the burns,And pay full attention to the effects of radiation injury. Appendix B
Explanation of terms
(Supplement)
B1 Shock phase
It is the first stage of the course of combined radiation-burn injury. In the first few days after the injury, patients will experience irritability, thirst, nausea, vomiting, diarrhea, local fluid loss in the burn area, hemoconcentration, and a brief increase and then a decrease in the number of peripheral white blood cells and platelets. Shock is often characterized by a prolonged excitement phase and a shortened inhibition phase. When entering the inhibition phase, the effectiveness of anti-shock measures is significantly reduced. B2 Local infectious phase is the second stage of the course of combined radiation-burn injury. Neurological and gastrointestinal symptoms are relieved or disappear, but hematopoietic dysfunction continues to develop, the inflammatory response of the burn wound is weakened, and infection occurs.
Critical phase
is the most serious period of the course of radiation-burn combined injury. The general condition deteriorates, vomiting and diarrhea occur again, hematopoietic dysfunction is at its lowest point, and systemic infection occurs. The burn wound is also susceptible to infection and bleeding, and the regeneration of granulation tissue and epithelium is delayed or even stopped. B4 Recovery phase
If the condition is not serious or after appropriate treatment, it can enter the recovery phase. During this period, the condition improves, the above symptoms and signs gradually disappear, hematopoietic function is restored, and the granulation tissue and epithelium of the burn wound are regenerated and repaired. B5 Chinese nines rule of Chinese nines The head and neck of an adult accounts for 1×9% of the total body surface area, the upper limbs account for 2×9%, the trunk (including perineum 1%) accounts for 3×9%, and the lower limbs (including buttocks) account for 5×9%+1%, a total of 11×9%+1%=100%. B6 Palm rule of palm
The injured person puts his fingers together, and the palm area accounts for 1% of the body surface area. B7 Light radiation burn During a nuclear explosion, the burns caused by the direct action of light radiation on the human body are called light radiation burns. B8 Under clothing burn Light radiation acts on human skin through radiation and conduction through clothing. When the light impulse is less than the clothing combustion threshold but greater than the skin burn threshold, it can cause skin burns under clothing.
Bg Burn wound sepsis When the bacteria content of each gram of living tissue on the burn wound exceeds 105, burn wound sepsis may occur. The incidence of combined radiation-burn injury is higher than that of simple burns, and it is one of the causes of death from infectious complications. B10 Respiratory tract burn Respiratory tract damage caused by inhalation of flames or hot air, steam, dust and sand. Injury to the mouth, nose and pharynx is mild; injury to the throat and trachea375
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(above the protrusion) is moderate, and injury to the bronchi to the alveoli is severe. Inhalation injury is caused by the combined or separate inhalation of harmful gases and smoke produced by combustion, which causes respiratory damage. B11 Retinal burn
When the naked eye looks directly at the fireball, the light radiation passes through the eye refractive system to significantly increase the light impulse focused on the retina, causing retinal coagulative necrosis. It is also called fundus burn. According to the severity of the lesion, it can be divided into three levels: mild, moderate and severe. B12 Radiation injury
is the damage caused by ionizing radiation acting on the human body. The radiation injury and its degree referred to in this standard are equivalent to external acute radiation sickness and its degree.
B13 Additive effect When moderate or above radiation injury is combined with moderate or above burn, the combined injury is often more severe than simple radiation sickness of the same dose, which is manifested by rapid progression of the disease, early peak and prolonged duration, high incidence of infection, and severe bleeding. In addition, radiation injury weakens the local inflammatory response of the burn, making it more susceptible to infection, bleeding, and delayed healing. Reflected in the overall effect, the mortality rate of combined injury is often greater than the sum of the two single injuries. Appendix C
Burn injury classification
(supplement)
C1 Mild: Second-degree burns account for less than 10% of the total body surface area. C2 Moderate: Second-degree burns account for between 10% and 20% of the total body surface area; or third-degree burns account for less than 5%. C3 Severe: Second-degree burns account for 20% to 50% of the total body surface area; or third-degree burns are between 5% and 30%; or the burn area does not exceed 20%, but there are respiratory burns or deep second-degree and third-degree burns on the face and perineum. C4 Extremely severe: Second-degree burns account for more than 50% of the total body surface area; or third-degree burns are more than 30%; or there are severe respiratory burns.
Appendix D
Recommendations for drugs and treatment measures
(reference)
D1 Oral rehydration can be taken with burn drinks (each 100mL of boiled water contains 0.3g salt, 0.15g sodium bicarbonate, and appropriate amount of glucose). D2 Medication for burn wounds. Preparations for protecting the skin from degenerative changes can include 2% iodine, 1% silver sulfadiazine, and burns net (gallotalpa, euphorbia cerasifera, terminalia chebula, etc., soaked in 70% alcohol for three days, and the extract can be used for later use or rinsed and wetted with 3% chlorhexidine solution. Preparations for degenerative changes can include Wuling burn ointment (Phellodendron chinense, Astragalus membranaceus, Coptis chinensis, borneol, etc. are made into an ointment with sesame oil), Shuihuo scald ointment, etc. Degenerative drugs should be used at the beginning of the recovery period. Using them too early will delay the recovery of body temperature and white blood cells, and using them too late will delay the healing time. D3 Symptomatic treatment includes: giving sedatives (sleeping pills) to those who are excited and restless (sleeping pills) Ketone 0.1-0.2g/time, or mepantone 0.4g/time, or stir-fried jujube seeds); those with skin flushing, conjunctival congestion and other neurovascular symptoms can use anti-allergic drugs, such as diphenhydramine 25mg/time, vomiting with 30mg of chloramphenicol, and if necessary, take 3 times a day, 30mg each time, oral or intramuscular metoclopramide, or vitamin B50mg/time: severe diarrhea is given antidiarrheal drugs.
D4 Anti-bleeding drugs include vitamin C, P, K:, 6-aminocaproic acid, antifibrinolytic aromatic acid, Anluoxue and Yunnan Baiyao. D5 Radiation prevention and treatment drugs with therapeutic effects, such as madder dilipid, estriol, estradiol benzoate and ethinyl estriol. Drugs that can increase white blood cells, such as cephalothin, tremella polysaccharide and shiitake polysaccharide. The method of D6 intravenous ketamine combined anesthesia is to intramuscularly inject 100mg of luminal and 0.5mg of atropine, enter the operating room about 5 minutes later, intravenously drip 10~~20mg of diazepam (reduce the dose for shock patients), then intravenously drip 50mg of pethidine and 25mg of phenergan (add the same amount if the operation lasts more than 3 hours), and then intravenously drip 100.mg of ketamine. After 2~3 minutes, the operation can be performed. If the operation time exceeds 40 minutes, 0.1% ketamine 376
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solution can be used for intravenous drip at 40~60 drops/min to maintain Hold, stop dripping ketamine solution 5-10 minutes before the end of the operation. D7 Retinal burns can be treated with cortisone, hypertonic glucose, potassium iodide and multivitamins. D8 To eliminate wound contamination, sodium ethylenediaminetetraacetate is often used. Its effective concentration is 0.2%-0.5%, and its effective pH value is about 9. Usually, one part of disodium ethylenediaminetetraacetate is mixed with four parts of tetrasodium ethylenediaminetetraacetate. The pH of the prepared solution is about 9. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Industrial Hygiene Laboratory of the Ministry of Health. The main drafters of this standard are He Qingjia, Cheng Tianmin, Chen Zongrong, Wang Yuzhen and Huang Qilong. This standard is entrusted by the Ministry of Health to the technical coordination unit Industrial Hygiene Laboratory of the Ministry of Health for interpretation. 3775%, effective pH value is about 9, usually one part of disodium ethylenediaminetetraacetate is mixed with four parts of tetrasodium ethylenediaminetetraacetate, and the pH of the prepared solution is about 9. Additional remarks: www.bzxz.net
This standard is proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Industrial Hygiene Laboratory of the Ministry of Health. The main drafters of this standard are He Qingjia, Cheng Tianmin, Chen Zongrong, Wang Yuzhen, and Huang Qilong. This standard is interpreted by the Industrial Hygiene Laboratory of the Ministry of Health, the technical unit entrusted by the Ministry of Health. 3775%, effective pH value is about 9, usually one part of disodium ethylenediaminetetraacetate is mixed with four parts of tetrasodium ethylenediaminetetraacetate, and the pH of the prepared solution is about 9. Additional remarks:
This standard is proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Industrial Hygiene Laboratory of the Ministry of Health. The main drafters of this standard are He Qingjia, Cheng Tianmin, Chen Zongrong, Wang Yuzhen, and Huang Qilong. This standard is interpreted by the Industrial Hygiene Laboratory of the Ministry of Health, the technical unit entrusted by the Ministry of Health. 37715g, glucose in appropriate amount). D2 Medication for burn wounds, preparations used to protect the skin from decalcification can be 2% iodine, 1% silver sulfadiazine, burn net (Gallac, Euphorbia cerasifera, Terminalia chebula, etc., soaked in 70% alcohol for three days, take the extract for use or rinse and wet with 3% chlorhexidine solution, preparations used to remove decalcification can be Wuling burn ointment (Phellodendron chinense, Astragalus membranaceus, Coptis chinensis, Borneol, etc. are made into ointment with sesame oil), Shuihuo scald ointment, etc. Decalcification drugs are used at the beginning of the recovery period. Using them too early will delay the recovery of body temperature and white blood cells, and using them too late will delay the healing time. D3 Symptomatic treatment includes: giving sedatives (sleeping pills) to those who are excited and restless Ketone 0.1-0.2g/time, or mepantone 0.4g/time, or stir-fried jujube seeds); those with skin flushing, conjunctival congestion and other neurovascular symptoms can use anti-allergic drugs, such as diphenhydramine 25mg/time, vomiting with 30mg of chloramphenicol, and if necessary, take 3 times a day, 30mg each time, oral or intramuscular metoclopramide, or vitamin B50mg/time: severe diarrhea is given antidiarrheal drugs.
D4 Anti-bleeding drugs include vitamin C, P, K:, 6-aminocaproic acid, antifibrinolytic aromatic acid, Anluoxue and Yunnan Baiyao. D5 Radiation prevention and treatment drugs with therapeutic effects, such as madder dilipid, estriol, estradiol benzoate and ethinyl estriol. Drugs that can increase white blood cells, such as cephalothin, tremella polysaccharide and shiitake polysaccharide. The method of D6 intravenous ketamine combined anesthesia is to intramuscularly inject 100mg of luminal and 0.5mg of atropine, enter the operating room about 5 minutes later, intravenously drip 10~~20mg of diazepam (reduce the dose for shock patients), then intravenously drip 50mg of pethidine and 25mg of phenergan (add the same amount if the operation lasts more than 3 hours), and then intravenously drip 100.mg of ketamine. After 2~3 minutes, the operation can be performed. If the operation time exceeds 40 minutes, 0.1% ketamine 376
GB16392—1996
solution can be used for intravenous drip at 40~60 drops/min to maintain Hold, stop dripping ketamine solution 5-10 minutes before the end of the operation. D7 Retinal burns can be treated with cortisone, hypertonic glucose, potassium iodide and multivitamins. D8 To eliminate wound contamination, sodium ethylenediaminetetraacetate is often used. Its effective concentration is 0.2%-0.5%, and its effective pH value is about 9. Usually, one part of disodium ethylenediaminetetraacetate is mixed with four parts of tetrasodium ethylenediaminetetraacetate. The pH of the prepared solution is about 9. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Industrial Hygiene Laboratory of the Ministry of Health. The main drafters of this standard are He Qingjia, Cheng Tianmin, Chen Zongrong, Wang Yuzhen and Huang Qilong. This standard is entrusted by the Ministry of Health to the technical coordination unit Industrial Hygiene Laboratory of the Ministry of Health for interpretation. 37715g, glucose in appropriate amount). D2 Medication for burn wounds, preparations used to protect the skin from decalcification can be 2% iodine, 1% silver sulfadiazine, burn net (Gallac, Euphorbia cerasifera, Terminalia chebula, etc., soaked in 70% alcohol for three days, take the extract for use or rinse and wet with 3% chlorhexidine solution, preparations used to remove decalcification can be Wuling burn ointment (Phellodendron chinense, Astragalus membranaceus, Coptis chinensis, Borneol, etc. are made into ointment with sesame oil), Shuihuo scald ointment, etc. Decalcification drugs are used at the beginning of the recovery period. Using them too early will delay the recovery of body temperature and white blood cells, and using them too late will delay the healing time. D3 Symptomatic treatment includes: giving sedatives (sleeping pills) to those who are excited and restless Ketone 0.1-0.2g/time, or mepantone 0.4g/time, or stir-fried jujube seeds); those with skin flushing, conjunctival congestion and other neurovascular symptoms can use anti-allergic drugs, such as diphenhydramine 25mg/time, vomiting with 30mg of chloramphenicol, and if necessary, take 3 times a day, 30mg each time, oral or intramuscular metoclopramide, or vitamin B50mg/time: severe diarrhea is given antidiarrheal drugs.
D4 Anti-bleeding drugs include vitamin C, P, K:, 6-aminocaproic acid, antifibrinolytic aromatic acid, Anluoxue and Yunnan Baiyao. D5 Radiation prevention and treatment drugs with therapeutic effects, such as madder dilipid, estriol, estradiol benzoate and ethinyl estriol. Drugs that can increase white blood cells, such as cephalothin, tremella polysaccharide and shiitake polysaccharide. The method of D6 intravenous ketamine combined anesthesia is to intramuscularly inject 100mg of luminal and 0.5mg of atropine, enter the operating room about 5 minutes later, intravenously drip 10~~20mg of diazepam (reduce the dose for shock patients), then intravenously drip 50mg of pethidine and 25mg of phenergan (add the same amount if the operation lasts more than 3 hours), and then intravenously drip 100.mg of ketamine. After 2~3 minutes, the operation can be performed. If the operation time exceeds 40 minutes, 0.1% ketamine 376
GB16392—1996
solution can be used for intravenous drip at 40~60 drops/min to maintain Hold, stop dripping ketamine solution 5 to 10 minutes before the end of the operation. D7 Retinal burns can be treated with cortisone, hypertonic glucose, potassium iodide and multivitamins. D8 To eliminate wound contamination, sodium ethylenediaminetetraacetate is often used. Its effective concentration is 0.2% to 0.5%, and its effective pH value is about 9. Usually, one part of disodium ethylenediaminetetraacetate is mixed with four parts of tetrasodium ethylenediaminetetraacetate. The pH of the prepared solution is about 9. Additional notes:
This standard was proposed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Industrial Hygiene Laboratory of the Ministry of Health. The main drafters of this standard are He Qingjia, Cheng Tianmin, Chen Zongrong, Wang Yuzhen and Huang Qilong. This standard is entrusted by the Ministry of Health to the technical coordination unit Industrial Hygiene Laboratory of the Ministry of Health for interpretation. 377
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