GBZ 14-2002 Diagnostic criteria for occupational acute ammonia poisoning
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ14—2002
Diagnostic Criteria of Occupational Acute Ammonia Poisoning2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
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 GB7800-1987 is inconsistent with this standard, this standard shall prevail. Acute ammonia poisoning may be caused in occupational activities involving contact with ammonia. In order to protect the health of those exposed to ammonia and facilitate the prevention and control of poisoning, the state promulgated GB7800-1987 in 1987. The main contents of this revision are as follows: According to the requirements of the "Rules for the Drafting and Expression of Occupational Disease Diagnosis Standards Part 1: Basic Regulations for the Preparation of Occupational Disease Diagnosis Standards", the text and structure are changed, and the diagnosis system is linked to GBZ71. While linking with the "Diagnosis Standards for Occupational Acute Toxic Respiratory Diseases", combined with the research progress in the past decade, this standard has made changes to the provisions of pulmonary edema, severe laryngeal edema, and ARDS caused by severe poisoning. This standard also adjusts the treatment principles.
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 is drafted by the hospital of Dahua Group Co., Ltd. Shanghai Chemical Industry Occupational Disease Prevention and Treatment Institute, Jilin Chemical Industry Group Occupational Disease Prevention and Treatment Research Institute, Shandong Provincial Hospital, the Second Affiliated Hospital of Shanxi Medical University, Dalian Institute of Labor Hygiene, Anhui Province Bengbu Medical College Affiliated Hospital, and Hubei Province Wuhan Chemical Industry Occupational Disease Prevention and Treatment Research Institute participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. ..comDiagnostic criteria for occupational acute ammonia poisoning
GBZ14-2002
Occupational acute ammonia poisoning is a systemic disease caused by inhalation of high concentrations of ammonia in a short period of time during occupational activities, which is mainly characterized by respiratory damage, often accompanied by eye and skin burns, and in severe cases, acute respiratory distress syndrome may occur. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute ammonia poisoning. This standard applies to the diagnosis and treatment of occupational acute ammonia poisoning. Non-occupational acute ammonia poisoning can also be implemented as a reference. 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 document, its latest version shall apply to this standard
GB/TI6180
3 Diagnostic principles
Diagnostic standards for occupational chemical skin burnsDiagnostic standards for occupational chemical eye burns
Diagnostic standards for occupational acute chemical poisoning respiratory diseasesIdentification of the degree of disability caused by work-related injuries and occupational diseases of workersBased on the occupational history of inhaling high-concentration ammonia in a short period of time, clinical manifestations mainly with respiratory damage, and chest X-ray images, combined with blood gas analysis and on-site labor hygiene survey results, comprehensive analysis is conducted to exclude similar diseases caused by other causes before diagnosis can be made.
4 Irritation reaction
Only transient eye and upper respiratory tract irritation symptoms, no positive signs in the lungs, and no abnormal findings in chest X-ray images.
5 Diagnosis and classification standards
5.1 Mild poisoning
With one of the following symptoms:
a) Tearing, sore throat, hoarseness, cough, expectoration; dry rales in the lungs; chest X-ray examination shows increased lung texture. It is consistent with acute air-bronchitis. b) First to second degree laryngeal edema.
5.2 Moderate poisoning
With one of the following symptoms:
a) Hoarseness, chest tightness, dyspnea, severe cough, sometimes with bloody sputum; respiratory rate, mild sputum, dry and wet rales in the lungs: chest X-ray examination shows increased and disordered lung texture, and scattered patchy shadows with blurred edges. It is consistent with bronchopneumonia.
Blood gas analysis: often shows mild to moderate hypoxemia. b) Third degree laryngeal edema.
5.3 Severe poisoning
Those with one of the following manifestations:
a) Severe cough, large amount of pink foamy sputum, chest tightness, shortness of breath, palpitations; dyspnea, obvious rashes, dry and wet rales all over the lungs: chest X-ray imaging examination shows patchy or cloud-like shadows of varying sizes with blurred edges in both lung fields, some of which can merge into large pieces or butterfly-shaped shadows. It is consistent with the manifestation of alveolar pulmonary edema. Blood gas analysis shows severe hypoxemia;
b) Acute respiratory distress syndrome (ARDS): c) Fourth degree laryngeal edema;
d) Complicated with heavier pneumothorax or mediastinal emphysema;
e) Asphyxia.
5.4 Eye or skin burnswww.bzxz.net
Mild, moderate and severe acute poisoning may be accompanied by eye or skin burns, and the diagnostic classification refers to GBZ54 or GBZ18. Principles of treatment
6.1 Principles of treatment
6.1.1 Quickly and safely move the patient to a place with fresh air to maintain respiratory and circulatory functions; thoroughly rinse the contaminated eyes and skin. 6.1.2 Keep the airway open: bronchial control agents, defoaming agents (such as 10% dimethyl silicone oil), and nebulizer inhalation therapy can be given; if necessary, tracheotomy can be performed to clear airway obstructions to prevent suffocation. 6.1.3 Early prevention and treatment of pulmonary edema: glucocorticoids and alkali drugs can be used early, in sufficient quantities, and for a short period of time. In particular, attention should be paid to strictly limiting the amount of fluid replacement to maintain water, electrolyte and acid-base balance. 6.1.4 Reasonable oxygen therapy.
6.1.5 Actively prevent and control infection, use antibiotics in a timely and reasonable manner, and prevent and treat secondary diseases. 6.1.6 Treatment of eye and skin burns, refer to GBZ54 or GBZ51. 6.2 Other treatments
Mildly poisoned patients can return to their original positions after recovery. Moderate and severe poisoning patients should be transferred away from irritating gas work depending on the recovery of the disease. For those who need to be assessed for their work ability, they can refer to GB/T16180 for treatment.
7 Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
..comAppendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard applies to acute ammonia poisoning caused by ammonia gas released from liquid ammonia, ammonia water or other ammonia-containing substances. A.2 Key points for diagnosis of this disease: The diagnosis of this disease is mainly based on the occupational history of inhaling high-concentration ammonia in a short period of time, clinical manifestations mainly of respiratory system damage, chest X-ray images and blood gas analysis results. Ammonia poisoning is particularly prominent in tracheal and bronchial damage, and the course of the disease is prone to recurrence, so diagnosis and classification must be comprehensively analyzed and considered comprehensively; close observation of respiratory conditions, degree of flare-ups, and heart rate changes are of great value in judging the condition and guiding treatment. A.3 Blood gas analysis is of great significance for the diagnosis of the disease and should be tested as soon as possible. A.4 Most ammonia compounds are liquids, so when an accident causes ammonia poisoning, it is often accompanied by skin and eye burns. Ammonia is highly corrosive and can easily denature tissue proteins and saponify adipose tissue, causing soluble necrosis. The lesions are prone to develop deep, so the contaminated eyes and skin must be immediately and thoroughly rinsed, and appropriate treatment measures must be given to lay the foundation for further rescue. A.5 Correcting hypoxemia is the key to critical care. The principle is to choose the appropriate oxygen delivery method according to the specific situation during the course of the disease. However, due to the strong corrosiveness of ammonia, it is often easy to cause pneumothorax, mediastinal emphysema, etc., so it should be very cautious when using positive pressure oxygen. A.6 Prevention and treatment of pulmonary edema is the focus of early treatment of acute ammonia poisoning. In addition to the active use of glucocorticoids, alkaloids such as dongbiidine or 654-2 can also be used. A.7 Prevention and treatment of airway obstruction is crucial for acute ammonia poisoning: the mucous membranes of trachea and bronchus are burned and necrotic, which are easy to fall off about 3-7 days after poisoning. Drug atomization inhalation should be performed as soon as possible, and patients should be encouraged to cough up necrotic tissue. If airway obstruction is found, the obstruction should be removed as soon as possible, and tracheotomy should be performed if necessary. A.8 Strictly limiting the amount of fluid replacement is of special significance for the treatment of this disease: ammonia poisoning is often accompanied by obvious skin burns, and infusion is one of the conventional treatment measures for burns. Clinically, it is common to see that the condition is aggravated by improper fluid replacement. Therefore, it is not advisable to quickly and in large quantities to avoid inducing and aggravating pulmonary edema: and attention should be paid to the balance of acid, alkali and electrolytes, so it should be taken seriously. A.9 Prevention and treatment of infection is of great significance for ammonia poisoning: comprehensive measures should be taken, such as strict disinfection and isolation, enhanced nursing, and rational use of antibiotics.
A.10 In the treatment principle of this disease, the focus of early rescue is to prevent and treat pulmonary edema so as to stabilize vital signs as soon as possible; after pulmonary edema is controlled, infection, airway obstruction and other secondary symptoms should be prevented and treated in a planned manner. Grasping the main contradictions at different stages of the disease and taking measures in a planned and focused manner are the key to rescue of acute ammonia poisoning. Rescue treatment of mass cases is particularly important.
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