Some standard content:
GB17056—1997
Acute monomethylamine poisoning may occur in occupational activities involving exposure to monomethylamine. This standard is formulated to protect the health of those exposed to monomethylamine and facilitate the prevention and treatment of its poisoning. This standard specifies the diagnostic criteria and treatment principles for occupational acute monomethylamine poisoning. This standard shall be implemented from December 1, 1998. Appendix A of this standard is a reminder appendix.
This standard is proposed by the Ministry of Health of the People's Republic of China. The responsible drafting unit of this standard: Shanghai Institute of Chemical Occupational Disease Prevention and Control. Participating drafting units: Shangrao District Health Bureau of Jiangxi Province, Shangrao District People's Hospital, Shangrao First People's Hospital, Shangrao County People's Hospital, and Shangrao Railway Hospital of Shanghai Railway Bureau. This standard is interpreted by the Chinese Academy of Preventive Medicine, the technical management unit entrusted by the Ministry of Health. 397
National Standard of the People's Republic of China
Diagnostic criteria of occupationalacute monomethylamine poisoning
Diagnostic criteria of occupationalacute monomethylamine poisoningGB17056—1997
Occupational acute monomethylamine poisoning is a systemic disease characterized by respiratory damage as the main manifestation caused by inhaling a large amount of monomethylamine gas in a short period of time during occupational activities, often accompanied by eye and skin burns. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute monomethylamine poisoning. This standard is applicable to the diagnosis and treatment of occupational acute monomethylamine poisoning, and can also be used as a reference for non-occupational acute monomethylamine 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 parties using this standard should explore the possibility of using the latest version of the following standards. GB16371-1996 Occupational chemical skin burns diagnostic criteria and treatment principles GB16374-1996 Occupational chemical eye burns diagnostic criteria and treatment principles GB/T16180-1996 Identification of the degree of disability caused by work-related injuries and occupational diseases 3 Diagnostic principles
Based on the exact history of occupational exposure to monomethylamine, typical clinical manifestations of acute respiratory system damage, chest X-ray manifestations, combined with other examination results such as blood gas analysis, reference to on-site labor hygiene survey data, comprehensive analysis, and exclusion of similar diseases caused by other causes, a diagnosis can be made. 4 Diagnosis and grading standards
4.1 Irritation reaction
After contact, transient eye and upper respiratory tract irritation symptoms appear, there are no positive signs in the lungs, and no abnormal findings in chest X-ray examination. 4.2 Mild poisoning
Symptoms of eye and upper respiratory tract irritation, conjunctival and pharyngeal congestion and edema; first- to second-degree inspiratory dyspnea with laryngeal edema; chest X-ray findings consistent with acute tracheobronchitis or peribronchitis. 4.3 Moderate poisoning
Moderate poisoning can be diagnosed in any of the following cases: a) third-degree inspiratory dyspnea with laryngeal edema; b) chest X-ray findings consistent with acute bronchopneumonia or interstitial pulmonary edema. Blood gas analysis of moderate poisoning is often accompanied by mild to moderate hypoxemia. 4.4 Severe poisoning
Any person with any of the following conditions may be diagnosed with severe poisoninga) Asphyxia due to severe laryngeal edema or necrosis and detachment of bronchial mucosa; GB17056-1997, approved by the State Bureau of Technical Supervision on November 11, 1997 and implemented on December 1, 1998b) Chest X-ray findings consistent with alveolar pulmonary edema;c) Acute respiratory distress syndrome (ARDS); d) Sudden death;
e) Complications of severe pneumothorax, mediastinal emphysema, subcutaneous emphysema or atelectasis, etc. Severe poisoning is often accompanied by severe hypoxemia in blood gas analysis. 4.5 Eye or skin burns
Mild, moderate and severe acute poisoning may be accompanied by eye or skin burns. The diagnosis and classification shall refer to GB16374 or GB16371. 5 Treatment principles
5.1 On-site treatment. Immediately leave the scene and move to the upwind area, take off the contaminated clothes, and immediately rinse the contaminated eyes or skin thoroughly with a large amount of running water. The eye flushing time shall be at least 10 minutes. Those who have irritation reactions need to rest in bed, generally observe closely for 48 hours, and give necessary examinations and treatment.
5.2 Keep the airway open, and give drug atomization inhalation, bronchial spasmolytics, and defoaming agents (such as 10% dimethyl silicone oil). If necessary, tracheotomy should be performed early. Pay attention to postural drainage and encourage patients to slightly expel necrotic mucosal tissue. 5.3 Reasonable oxygen therapy. Choose the appropriate oxygen supply method according to the condition, and the inhaled oxygen concentration (Fi0,) should not exceed 60%. When accompanied by acute carbon dioxide retention, while actively improving ventilation, adjust the oxygen concentration to make the blood oxygen saturation (SaO2) greater than 90%; if high-concentration oxygen is required, positive end-expiratory pressure (PEEP) can be given, and the PEEP pressure is less than 0.49kPa (5cmH2O). 5.4 Use glucocorticoids as early as possible, in sufficient quantities, and for a short period of time. For moderate and severe poisoning, alkaloids can be used in combination. 5.5 In the early stage of the disease, strictly limit the amount of fluid replacement, control the infusion rate, and maintain urine output greater than 30mL/h. Add diuretics when necessary to improve ventilation function. Correct acidosis, alkalosis and electrolyte disorders. 5.6 Actively prevent and treat complications. bZxz.net
5.7 Treatment of eye and skin burns, refer to GB16374 or GB16371.6 Assessment of labor capacity
After treatment of mild and moderate poisoning, after a short rest, the original work can be arranged after health recovery; severe poisoning should be transferred from the original work, and rest or work arrangement should be decided according to the health recovery. If there are sequelae, it can be determined and handled in accordance with the relevant provisions of GB/T16180. 7 Requirements for health examination
7.1 Personnel engaged in monomethylamine operation should undergo employment physical examination, including internal medicine, ophthalmology and chest X-ray examination. 7.2 Workers engaged in monomethylamine operation should undergo physical examination every 2 to 3 years. In addition to the same examination items as employment physical examination, lung function and electrocardiogram examination should be performed when necessary.
8 Occupational contraindications
a) Chronic respiratory diseases with decreased lung function. b) Organic cardiovascular diseases.
c) Keratitis.
GB17056—1997
Appendix A
Appendix of Prompts)
Instructions for the Correct Use of the Standard
A1-Methylamine aqueous solution can be inhaled in the form of gas through the respiratory tract due to vaporization, so this standard is also applicable to the inhalation of rashes associated with skin burns caused by monomethylamine aqueous solution.
A2 Inspiratory dyspnea caused by laryngeal edema due to acute monomethylamine poisoning is divided into four degrees. First degree: no dyspnea when quiet, inspiratory dyspnea when active or crying; second degree: there is also mild "three-concave sign" when quiet, which worsens when active, but does not affect sleep, and there is no restlessness; third degree: obvious inspiratory dyspnea, "three-concave sign" is obvious, and there is restlessness and difficulty in sleeping; fourth degree: in addition to the symptoms of third degree dyspnea, there are also restlessness, limbs moving, cold sweat, pale or purple complexion, and finally coma until cardiac arrest. A3 The diagnostic classification proposed in this standard is based mainly on the degree of damage to the respiratory system, and the irritation reaction does not fall into the category of acute poisoning. Laryngeal edema and acute bronchitis with first- to second-degree inspiratory dyspnea are the diagnostic starting points for this disease. A4 The PaO2 measurement value of blood gas analysis is a reference indicator for diagnostic classification. Hypoxemia is divided into three degrees: mild [PaO2 less than 10.7kPa (80mmHg)], moderate [PaO2 less than 8kPa (60 mmHg)], and severe [PaO2 less than 5.3kPa (40 mmHg)]. To judge the severity of hypoxia, clinical manifestations should be combined with dynamic observation to eliminate technical errors. A5 The poisoned person has diffuse alveolar pulmonary edema and a large amount of secretions from the mouth and nose; coma with obvious purple; patients with third- to fourth-degree inspiratory dyspnea should undergo tracheotomy in a timely manner.
A6 The focus of rescue in the early stage of the disease is to prevent and treat laryngeal edema and pulmonary edema; some patients are prone to relapse, and they still need to be closely observed after the pulmonary edema is controlled, and actively prevent and treat complications such as secondary lung infection and airway mucosal detachment and obstruction. A7 There is no specific antidote for the treatment of this disease, and non-specific antagonists such as adrenocortical hormones are commonly used. Patients with moderate and severe poisoning can be combined with alkaloid drugs, such as 0.3~0.6mg/time or 654-210～20mg/time, intravenous administration, should be used early and reach a certain therapeutic dose, but it is not emphasized to achieve efficacies. In principle, the dose is large at first and then small, and the interval time is short at first and then long. A8 drug atomization inhalation is one of the indispensable methods in treatment. The commonly used atomization liquid composition is: dexamethasone 5mg + gentamicin 80,000u + 654-210mg + furosemide 20mg + normal saline 50~~100mL, ultrasonic atomization inhalation, 10~~20mL each time, the interval time is determined according to the severity of the disease. The atomization liquid can also be placed in the oral anesthesia device for artificial spraying. If the patient is obviously hypoxic or has impaired consciousness, the ultrasonic atomizer can be connected to the oxygen cylinder, and oxygen is used to deliver the ultrasonic atomization liquid. You can also choose the hormone preparations Pulmicort, Bicodon spray inhalation, β2 stimulant 0.5% salbutamol solution 1mL or terbutaline solution 1mL nebulization inhalation; cholinergic blocker 0.5% ipratropium bromide solution 1mL nebulization inhalation.
A9 Not only should we pay attention to the first aid of systemic poisoning symptoms, but also should not ignore the local treatment of eye and skin burns. For patients with skin burns greater than or equal to 20% or Ⅱ burns greater than or equal to 10% or head and face burns caused by monomethylamine aqueous solution, we should be alert to the fact that monomethylamine can be absorbed through the skin and aggravate the poisoning. Even if the respiratory symptoms are not obvious in the early stage, chest X-ray, blood gas analysis and other examinations should be performed routinely, and attention should be paid to observe changes in respiratory symptoms and lung signs. If necessary, preventive treatment should be given. 400
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