GBZ 40-2002 Diagnostic criteria for occupational acute dimethyl sulfate poisoning
Some standard content:
1CS13.100
National Occupational Health Standard of the People's Republic of China GBZ40—2002
Diagnostic Criteria of Occupational Acute Dimethyl Sulfate 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 GB11507-1989 is inconsistent with this standard, this standard shall prevail. Dimethyl sulfate is a methylated substance widely used in the chemical industry. Acute dimethyl sulfate poisoning can be caused in occupational activities involving exposure to dimethyl sulfate. In order to protect the health of the contactors and prevent and treat acute dimethyl sulfate poisoning, GB11507-1989 has been revised based on the latest progress in clinical research. The revised standard is based on the principle of being connected with the Diagnosis of Occupational Acute Chemical Poisoning Respiratory Diseases (GB165852-6) and highlighting the characteristics of acute dimethyl sulfate poisoning. On the basis of the original standard, the classification of laryngeal edema, blood gas analysis and chest X-ray characteristics are added to make 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 Liaoning Provincial Occupational Disease Prevention and Control Institute and Shanghai Yangpu District Central Hospital. Shanghai Chemical Occupational Disease Prevention and Control Institute, Benxi City Occupational Disease Prevention and Control Institute of Liaoning Province, Dandong City Occupational Disease Prevention and Control Institute, Chaoyang City Labor Health Occupational Disease Prevention and Control Institute and Fushun Aluminum Factory participated in the drafting.
This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic criteria for occupational acute dimethyl sulfate poisoning GBZ40-2002
Occupational acute dimethyl sulfate poisoning is a systemic disease with respiratory damage as the main manifestation caused by exposure to a large amount of dimethyl sulfate in a short period of time during occupational activities. It is often accompanied by chemical burns to the eyes and skin. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute dimethyl sulfate poisoning. This standard applies to acute poisoning caused by exposure to dimethyl sulfate in occupational activities. The diagnosis of acute poisoning caused by exposure to dimethyl sulfate in non-occupational activities can also refer to this standard. 2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For all dated referenced documents, 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 documents, the latest version shall apply to this standard
GB/T16180
3 Diagnostic principles
Diagnostic standards for occupational chemical skin burnsDiagnostic standards for occupational chemical eye burns
Diagnostic standards for occupational acute chemical toxicity and respiratory diseases Assessment of the degree of disability caused by work-related injuries and occupational diseases of employees The diagnosis can only be made based on the occupational history of short-term exposure to large amounts of dimethyl sulfate, the clinical manifestations of acute respiratory system damage, and chest X-ray findings, with reference to blood gas analysis and on-site labor hygiene investigation data, and comprehensive analysis, and exclusion of similar diseases caused by other causes.
4 Irritation reaction
Only transient eye and upper respiratory tract irritation symptoms, no positive signs in the lungs, no abnormalities in chest X-rays, 5 Diagnosis and grading standards
5.1 Mild poisoning
One of the following conditions:
a) Obvious eye and upper respiratory tract mucosal irritation symptoms, such as eye pain, tearing, sore throat, hoarseness, choking, chest tightness, etc.: Signs include conjunctival congestion and edema, even eyelid edema, uvula congestion and edema, scattered dry or (and) wet rales in both lungs; chest X-ray shows increased and thickened lung texture, blurred edges, and halo signs in some parts. The above manifestations are consistent with acute bronchitis or peribronchitis. b) Obvious upper respiratory tract irritation symptoms, first to second degree laryngeal edema; no abnormal signs in the lungs; chest X-ray examination may also show no positive signs.
5.2 Moderate poisoning
One of the following conditions:
a) Cough, expectoration, chest tightness, shortness of breath, often with mild: Dry or wet rales can be heard 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) Cough, expectoration, chest tightness, severe shortness of breath, and weakened breath sounds in both lungs. Chest X-ray shows increased lung texture; enlarged and blurred hilar shadows, scattered small dot-like or reticular shadows in both lungs, reduced lung field transparency, often visible bronchial halo signs, widened interlobar fissures and discoid atelectasis. The above manifestations are consistent with acute interstitial pulmonary edema; c) Third degree laryngeal edema.
Blood gas analysis often shows mild to moderate hypoxemia. 5.3 Severe poisoning
One of the following conditions:
a) Obvious dyspnea, coughing up a lot of white or pink foamy sputum; diffuse moist rales in both lungs: chest X-ray shows flake or cloud-like shadows of different sizes and blurred edges in both lungs, which sometimes merge into large flake shadows. The above manifestations are consistent with alveolar pulmonary edema.
b) Acute respiratory distress syndrome:
Fourth degree laryngeal edema:
d) Necrosis and shedding of bronchial mucosa leading to ventricular asphyxia; e) Complication of severe pneumothorax or mediastinal emphysema.
Blood gas analysis often shows severe hypoxemia. bZxz.net
Treatment principles
6.1 Treatment principles
6.1.1 Leave the scene quickly and safely, take off contaminated clothes, and immediately rinse contaminated eyes and skin thoroughly with running water. Those who have irritation symptoms should be closely observed for 24 hours. During the observation period, they should avoid activities, rest in bed and keep quiet. Symptomatic treatment should be given to control the progression of the disease and prevent the occurrence of laryngeal edema and pulmonary edema. 6.1.2 Keep the airway open. Atomization inhalation therapy, bronchial spasmolytics, defoaming agents (such as dimethyl silicone oil) can be given. Tracheotomy can be performed when necessary.
6.1.3 Reasonable oxygen therapy.
6.1.4 Early, sufficient and short-term application of glucocorticoids. 6.1.5 Prevent infection, prevent and treat complications, and maintain water and electrolyte balance. 6.1.6 Treatment of eye and skin burns should be carried out in accordance with GBZ54 or GBZ51. 6.2 Other treatments
Patients with mild and moderate poisoning can resume their original work after recovery: patients with severe poisoning should be transferred from their original jobs; if labor capacity assessment is required, it should be handled in accordance with GB/T16180. Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 The diagnostic classification of this standard is mainly based on the degree of damage to the respiratory system. Irritation reactions do not fall into the category of acute poisoning. Acute bronchitis or peribronchitis and first to second degree laryngeal edema are the diagnostic starting points for this disease. A.2 Laryngeal edema is one of the prominent manifestations of acute dimethyl sulfate poisoning, and its severity can directly reflect the severity of the disease. Inspiratory dyspnea caused by laryngeal edema due to acute dimethyl sulfate poisoning is divided into four degrees: first degree: no dyspnea at rest, but dyspnea during activity; second degree: mild "three-depression sign" at rest, aggravated during activity, but does not affect sleep, and there is no restlessness; third degree: obvious inspiratory dyspnea, "three-depression sign" is significant, and there is restlessness and difficulty falling asleep; fourth degree: in addition to the manifestations of third-degree dyspnea, there is also restlessness, cold sweat, pale or purple complexion, and finally coma or even cardiac arrest. A.3 Blood gas analysis The determination of PaO2 can objectively reflect the severity of hypoxia. Therefore, it can be used as a reference indicator for diagnostic grading. Hypoxemia is divided into three degrees: PaO2≤10.7kPa (80mmHg), moderate PaO,≤8kPa (60mmHg), and severe PaO2≤5.3kPa (40mmHg). The judgment of the degree of hypoxia should also be combined with clinical and dynamic observation to eliminate technical errors. A.4 The diagnostic indicators of acute respiratory distress syndrome in this standard refer to GBZ72. A.5 Mild, moderate and severe acute dimethyl sulfate poisoning may be accompanied by chemical burns of the eyes or skin. For the diagnostic classification, refer to GBZ54 or GBZ51.
A.6 Acute poisoning is often accompanied by transient changes in electrocardiogram and liver and kidney function. Because it is considered to be caused by secondary hypoxia and has no specificity, it is not included in the diagnostic terms. A comprehensive analysis can be made according to the specific situation during diagnosis. A.7. Nebulizer inhalation is one of the effective methods for treating acute toxic respiratory diseases. Ultrasonic nebulizer inhalation should be performed 3-5 times a day according to the condition. If the uvula edema is severe or the laryngeal edema is obvious, ultrasonic nebulizer inhalation will make ventilation more difficult. At this time, an oral anesthesia device can be used for artificial spraying, or the ultrasonic nebulizer can be connected to an oxygen cylinder for use. A.8 If the poisoned person has third to fourth degree laryngeal edema, once conservative treatment is ineffective, tracheal opening should be performed in time to avoid serious consequences.
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