GB 8787-1988 Diagnostic criteria and treatment principles for occupational acute phosgene poisoning
Some standard content:
National Standard of the People's Republic of China
Occupational Acute Phosgene Poisoning
Diagnostic criteria and management principles of occupational acute phosgene poisoningULXC616-057: 616
-07/-08 * 661
GB 8787—88
Occupational acute phosgene poisoning is a systemic disease with acute respiratory damage caused by inhalation of phosgene in a production environment. Its clinical characteristics are that the symptoms are mild at the time of contact, a certain incubation period before the onset, and pulmonary edema is prone to occur. 1 Diagnostic principles
Based on a comprehensive analysis of the clear history of phosgene exposure and the clinical symptoms, signs, chest X-rays and gas analysis results of acute respiratory damage, similar diseases caused by other causes are excluded before diagnosis. 2 Diagnosis and classification standards bzxz.net
2. 1 Irritation reaction
Within 48 hours of inhaling phosgene, transient eye and upper respiratory tract mucosal irritation symptoms occur. There are no positive signs in the lungs and no abnormal changes in the chest X-ray.
2.2 Mild poisoning
Based on the symptoms, signs, X-ray manifestations and necessary blood gas analysis data, a comprehensive judgment can be made to diagnose mild poisoning with cough, shortness of breath, chest tightness or chest pain, and scattered dry rales in the lungs. Chest X-ray manifestations: enhanced lung texture or blurred edges, consistent with the X-ray findings of bronchial carbon monoxide or peribronchitis. Blood gas analysis: When breathing air, arterial oxygen partial pressure is normal or lower than the expected value of 10~-20 mmHg. 2.3 Degrees: moderate cough, choking, coughing, small amount of sputum, bloody, shortness of breath, chest pain or mild dyspnea, mild purpura, and rales or local moist rales in the lungs.
X-ray film performance: increased texture of both lungs, blurred edges, and reticular and granular shadows; or local punctate and fuzzy shadows, and decreased translucency of both lung fields. Combined X-ray findings of interstitial pulmonary edema. Analysis: When inhaling 50% edema of nicotine, the arterial oxygen partial pressure can be maintained greater than 60 mmHg. 2.4 Degrees: frequent cough, coughing, large amount of white or pink foamy sputum, rapid breathing, bright purpura, extensive dry and pot-shaped rales in both lungs, mediastinal and subcutaneous emphysema, pneumothorax, acute respiratory or circulatory failure, myocardial damage, and coma may occur. X-ray chest film: diffuse distribution of punctate, cloud-like or cotton-like shadows of varying sizes, uneven density and blurred edges throughout the lungs, some of which merge into large shadows, which are consistent with the X-ray findings of alveolar pulmonary edema: Gas analysis: When inhaling 50% oxygen concentration, the arterial oxygen partial pressure is still lower than 60 mmHg3 Treatment principles
3.1 Anyone who inhales phosgene should quickly leave the scene and go to a place with fresh air, immediately take off the contaminated clothes, and rinse the parts of the body surface stained with liquid phosgene with water. Keep quiet, absolutely lie on ice to rest, and keep warm appropriately. Only give oxygen, use bronchial decoction, sedation, antitussive and other symptomatic treatments and supportive therapies. Closely observe for 24-48 hours and pay attention to changes in the condition. 3.2 To prevent and treat pulmonary edema, glucocorticoids should be used in the early stage of poisoning to control fluid input. For patients with pulmonary edema, the dose of glucocorticoids can be increased and the application time can be appropriately extended according to the situation. Defoaming agents such as dimethyl silicone oil aerosol can be used for inhalation, and attention should be paid to keeping the airway open. Reasonable oxygen supply can be carried out according to the specific situation of the patient and refer to the treatment principles of adult respiratory distress syndrome to correct the hypoxic state as soon as possible. Diuretics or dehydrating agents and morphine should be used with caution. Other emergency treatments and prevention and treatment of complications are the same as the principles of medical treatment. 4 Work capacity adjustment
After the acute poisoning patient is cured, the original work can be resumed. For example, if the severely poisoned patient continues to have obvious respiratory symptoms or is complicated by regressive obliterative bronchiolitis after the acute phase, the necessary treatment can be given in combination with the results of chest X-ray, blood gas analysis and pulmonary function test, and the irritant gas operation can be adjusted and resumed regularly. 5 Requirements for health examinations
Phosgene workers should undergo a pre-employment physical examination and a regular health examination every 1 to 2 years after employment depending on the degree of exposure. In addition to the internal medicine physical examination, a chest X-ray should be taken when necessary. Blood gas analysis and pulmonary function tests can be performed when conditions permit. Pulmonary function test items include: forced vital capacity (FVC), first second vital capacity (FEV1), maximum mid-expiratory flow rate (FEF25~75%), etc. 6 Occupational contraindications
2. Obvious chronic respiratory diseases;
b. Obvious cardiovascular diseases.
A.1 Scope of application of this standard
GB 878788
Appendix A
Instructions for the correct use of the standard
(reference)
This standard is not applicable to acute poisoning caused by exposure to phosgene. A.2 This disease is mainly characterized by acute damage to the respiratory system, and may also be accompanied by symptoms of other systems, such as dizziness, fatigue, nausea, increased portal cell count, fever, etc., but the severity of poisoning is not completely consistent. Therefore, the diagnostic grading standard for poisoning is based on respiratory system symptoms, signs and chest X-ray manifestations, and blood gas analysis is an important reference indicator. If the clinical manifestations do not match the chest X-ray signs, the diagnosis should be made based on the more serious main indicators, and attention should be paid to distinguishing lung lesions caused by other diseases. A.3 Blood gas analysis has important reference value for diagnosis and treatment, and conditions should be created to observe more and accumulate data for in-depth research. A.4 There is often a certain incubation period before the occurrence of pulmonary edema, generally 1 to 24 hours or longer). During this period, the patient may have no obvious clinical symptoms and signs, but in fact the foot lesions are developing. Therefore, close contacts or elderly patients with serious illness should stay in bed and rest, closely observe respiratory rate, lung auscultation and other changes in the condition, and give oxygen and adopt preventive treatment measures such as glucocorticoids as soon as possible to prevent the condition from worsening and complications. Timely chest X-ray examination can detect interstitial pulmonary edema early to prevent missed diagnosis. A.5 The treatment of this disease mainly adopts comprehensive symptomatic treatment measures, the purpose of which is to prevent and treat pulmonary edema, hypoxia, cardiovascular dysfunction, infection and other complications. The principles of emergency treatment are basically the same as those of internal medicine. A.6 Hexamethylenetetramine has no therapeutic effect on acute phosgene poisoning and should not be used clinically. Additional statement:
This standard was proposed by the Occupational Disease Diagnosis Subcommittee of the National Health Standard Technical Committee. This standard was drafted by the Beijing Institute of Labor Health and Occupational Disease Prevention and Control, Shenyang Institute of Labor Health and Occupational Disease, Taiyuan Chemical Plant Hospital, Shanghai Institute of Labor Health and Occupational Disease Prevention and Control, Shanghai Chemical Industry Bureau Occupational Disease Prevention and Control Institute, and Tianjin Occupational Disease Prevention and Control Institute. This standard was entrusted by the Ministry of Health to the Institute of Labor Health and Occupational Diseases of the Chinese Academy of Preventive Medicine for interpretation.
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.