GB 16852.1-1997 Diagnosis of occupational acute chemical poisoning Part 1: General principles for diagnosis of occupational acute chemical poisoning
Some standard content:
GB 16852.11997
In various occupational activities, people may be exposed to some high-concentration and highly toxic chemicals in a short period of time, which may cause acute poisoning. Some of these chemicals are known species, while others are pathogenic species that are still unclear after the poisoning has occurred. Some of the poisoning caused by some species has been included in the "List of Occupational Diseases" issued by the Ministry of Health (87) Weifangzi No. 60, while others have not yet been included; some have independent diagnostic standards, while others have not yet developed independent diagnostic standards. All acute poisoning diseases have common pathogenesis patterns, so it is possible and necessary to formulate and follow common rules for the diagnosis of acute poisoning. The various rules specified in this series of standards involve the diagnosis of occupational acute chemical poisoning. These rules are used to ensure the unification of the diagnostic system of occupational acute chemical poisoning. Regardless of whether the cause is known or hidden, and regardless of which target organ is damaged after poisoning, the diagnosis can be made according to the rules specified in this standard. "Diagnosis of Occupational Acute Chemical Poisoning" consists of the following parts. The scope of each part will be stated in the foreword and introduction of each part:Www.bzxZ.net
Part 1
General principles for the diagnosis of occupational acute chemical poisoning; Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
Part 8
Part 9
Part 10||tt ||Diagnostic rules for occupational acute hidden chemical poisoning; Diagnosis of occupational acute poisoning multiple organ failure, diagnosis of occupational acute chemical-induced sudden death; Diagnosis of occupational acute poisoning nervous system diseases; Diagnosis of occupational acute cystic respiratory system diseases, diagnosis of occupational acute poisoning liver diseases; Diagnosis of occupational acute poisoning kidney diseases, diagnosis of occupational acute poisoning heart diseases, diagnosis of occupational acute poisoning blood system diseases; This standard specifies the general rules for the diagnosis of acute chemical poisoning. Appendix A of this standard is a prompt appendix. This standard was proposed by the Ministry of Health of the People's Republic of China. The drafting units of this standard: Shanghai Sixth People's Hospital, Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, Shanghai Institute of Chemical Occupational Disease Prevention and Control.
This standard is entrusted to the Institute of Labor Hygiene and Occupational Diseases, Chinese Academy of Preventive Medicine, the technical unit responsible for the interpretation. 378
National Standard of the People's Republic of China
Diagnosis of occupational acute chemical poisoning
Part 1:
General diagnostic guideline of occupational acute chemical poisoningDiagnosis of occupational acute chemical poisoningPart 1:General diagnostic guideline ofoccupational acute chemical poisoningGB16852.11997
Occupational acute chemical poisoning refers to the poisoning caused by workers absorbing large doses of occupational chemicals in a short period of time during their occupational activities. 1 Scope
This standard specifies the general diagnostic guideline for occupational acute chemical poisoning. This standard applies to acute poisoning caused by occupational chemicals in occupational activities. 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 versions of the following standards. GB/T16180—1996 Assessment of the degree of disability caused by work-related injuries and occupational diseases GB16852.2—1997 Diagnosis of occupational acute chemical poisoning Part 2: Diagnostic rules for occupational acute latent chemical poisoning
GB16852.7—1997 Diagnosis of occupational acute chemical poisoning Part 7: Diagnosis of occupational acute toxic liver disease 3 Diagnostic principles
Based on the exact occupational history and the corresponding clinical manifestations of acute poisoning, refer to the necessary labor hygiene investigation data, and exclude similar diseases caused by other reasons, a diagnosis can be made. 4 Diagnosis and classification standards
4.1 Observation objects
After being exposed to a large dose of poison in a short period of time, or to poisons with a long incubation period of disease, there is no obvious clinical manifestation at the time, or only mild symptoms and acute poisoning cannot be diagnosed, and further medical observation is required. 4.2 Mild poisoning
Clinical manifestations of mild functional and (or) organic diseases of the corresponding target organs (systems) caused by the absorption of poisons. 4.3 Moderate poisoning
The severity of poisoning is between mild and severe poisoning. 4.4 Severe poisoning
Severe poisoning can be diagnosed when one of the following conditions occurs: a) functional failure of the corresponding target organs (systems) caused by the absorption of poisons; b) multiple organ (system) lesions caused by the absorption of poisons. Approved by the State Administration of Technical Supervision on June 16, 1997 and implemented on January 1, 1998
5 Treatment principles
5.1 On-site rescue
GB 16852.1-—1997
5.1.1 Rescue the poisoned person from the scene and move him to a safe area. Rescuers entering the scene must have safety protection measures. 5.1.2 Take emergency measures to maintain respiratory and circulatory functions, such as performing cardiopulmonary and cerebral resuscitation when the heart and breathing stop. 5.1.3 If there is eye contamination, rinse with clean water promptly and fully. 5.1.4 Take off contaminated clothing and rinse the contaminated skin thoroughly with plenty of clean water. 5.1.5 After emergency treatment, send to a medical institution immediately, continue to provide necessary rescue on the way, and record the condition. 5.2 Etiological treatment
5.2.1 Prevent the continued absorption of the poison.
5.2.2 Try to eliminate the absorbed poison or its metabolites in the body, such as using metal chelating agents, blood purification therapy, etc. 5.2.3 Use specific antidotes to reverse the toxic effects of the poison and achieve the purpose of detoxification. 5.3 Symptomatic treatment
5.3.1 Eliminate or reduce the pathological and physiological changes caused by the poison damaging the main systems (organs). 5.3.2 Application of non-specific anti-drugs.
5.3.3 Maintain the balance of the body's internal environment.
5.3.4 Alleviate the patient's pain.
5.4 Supportive treatment
5.4.1 Improve the body's resistance to disease. 5.4.2 Psychological treatment.
5.4.3 Rehabilitation treatment.
5.5 Preventive treatment
5.5.1 Prevent various possible lesions and complications. 5.5.2 Properly handle treatment conflicts.
5.6 Others
5.6.1 Traditional Chinese medicine.
5.6.2 Good care.
6 Assessment of work ability
Based on the diagnosis and classification, combined with the recovery situation, determine the work ability and make suggestions on the nature, intensity and working hours of future work. 7 Requirements for health examinations
7.1 Employment physical examinations
The purpose is to understand the health status of workers before employment and to find occupational contraindications. 7.2 Regular physical examinations
The physical examination items and intervals depend on occupational toxicants. 8 Occupational contraindications
Refers to diseases or anatomical, physiological and other conditions that make people unsuitable for certain jobs. If one of the following conditions may occur due to contact with certain chemicals in this state, it should be regarded as an occupational contraindication for working with the chemical. a) Exacerbation of the original disease;
b) Inducement of potential diseases;
c) Susceptibility to certain occupational chemical hazards and more likely to occur in the occupation; d) Affecting the health of offspring.
A1 Scope of application of this standard
GB16852.1-1997
Appendix A
(Indicative Appendix)
Instructions for the correct use of this standard
The essential content of this standard is the diagnostic principles of acute occupational poisoning, which is applicable to the diagnosis, classification and treatment of acute poisoning caused by various occupational poisons. It is more appropriate for poisoning by poisons for which no diagnostic standards have been established. The clinical manifestations and treatment of subacute poisoning are basically the same as those of acute poisoning, so it belongs to the category of acute poisoning. The two have different contact time, but it is difficult to divide the boundary with a specific time, so subacute poisoning is not listed separately in this standard. If the national-level diagnostic standards and treatment principles for occupational acute poisoning of a certain chemical have been promulgated, the clinical application shall be based on this standard. If necessary, the relevant items in this standard can be used as a reference. This standard can be used as a reference for non-occupational acute poisoning. A2 Diagnostic principles of this standard
Based on the toxicity of the poisoning species and the principle of dose-effect relationship, combined with three main indicators such as the time factors of exposure and onset, a comprehensive analysis is conducted to clarify the causal relationship between the cause (poison) and the disease (acute poisoning) as the main basis for diagnosis. Cause: Based on occupational history, on-site labor hygiene survey, biological material testing, etc., clarify the type of poison, on-site conditions, invasion route, estimated dose absorbed, etc.; if more than one poison or other hazardous factors are exposed at the same time, the impact of combined effects should be considered. Disease: From clinical manifestations, auxiliary examinations, etc., clarify the nature and severity of the disease. Based on the data on the cause and disease, a comprehensive analysis is conducted to draw preliminary opinions and make differential diagnosis. The key points are: a) whether the time of absorption of the poison and the onset of the disease are consistent with the pathogenesis of acute poisoning of the poison; b) whether the toxicity of the poison is consistent with the clinical manifestations of the patient; c) whether the estimated absorbed dose is basically consistent with the severity of the disease. In the comprehensive analysis, various other factors that affect the clinical manifestations of acute poisoning should be considered, such as the patient's gender, age, health and nutritional status, allergic constitution, etc. It should also be noted that the poison contains impurities or that under certain conditions, chemical reactions occur to produce another poison.
In some cases, the pathogenic substance is not clear enough, or there is a lack of information on the toxic effect. If necessary, on-site simulation tests or toxicological tests can be performed to provide a basis for diagnosis. The deceased should be given a home anaesthesia as much as possible to obtain a pathological diagnosis, which will help improve the quality of rescue work in the future. During home anaesthesia, the content of poison in major organs should be measured as much as possible. A3 Grading Standards
A3.1 The grading standard for acute occupational poisoning is divided according to the severity of the poison, which is of reference significance for graded rescue, guiding treatment, labor capacity assessment, and assessing the hazard of this accident. A3.2 According to the clinical manifestations of acute occupational poisoning, with reference to the toxicity of the pathogen, it can be divided into three levels, two levels, or no grading. A3.3 Mild acute poisoning is the starting point for the diagnosis of acute poisoning. Since this standard covers a wide range, it is impossible to propose specific diagnostic indicators. When applied, it can be determined according to the specific clinical situation, or it can refer to the relevant sub-standards of this standard. A3.4 If the clinical manifestations do not reach the diagnostic starting point, it can be diagnosed as an inhalation reaction, irritation reaction, etc. according to the situation. A3.5 In the initial stage of rescue, a preliminary graded diagnosis can be made based on the patient's main clinical manifestations at the time and the possible progression of the disease to facilitate emergency treatment. In the emergency rescue of multiple people with acute poisoning, graded treatment is an important organizational and medical measure. A3.6 The final diagnosis of acute occupational poisoning (including graded diagnosis) should be assessed when the patient's medical treatment is over, when he is discharged from the hospital, or after his death. A3.7 The naming of the diagnosis: It should include the nature, type, severity of the poisoning, and the type of pathogenic chemicals. The damage to the main target organs and the severity, complications, sequelae, etc. should also be included. A4
On-site rescue
GB 16852.1-1997
On-site rescue is the first important link in rescue work. Good on-site rescue can buy time for further treatment and create good conditions. To ensure proper, rapid, effective and successful on-site rescue, the key is that the rescuers have emergency response capabilities, have received qualified training, and have the necessary equipment, so preparation work is very important. When multiple people are acutely poisoned, a temporary rescue command organization should be established to control the on-site environment and chaotic conditions in a short period of time, maintain order, and urgently and properly handle critically ill patients, general patients and contacts. Emergency treatment of critically ill patients Transfer
Care room, emergency education department, further diagnosis and treatment Transfer
Emergency room, emergency education department, further diagnosis and treatment General patients and preliminary examination and
Necessary treatment of close contacts
Local medical institutions
Observation and treatment
On the scene
In the hospital
Intensive care unit
Observation room
Follow-up after treatment at home
Figure A1 Schematic diagram of graded treatment of multiple acute middle-aged patients Such graded treatment has its own focus and characteristics, and can be closely linked to each other and adjusted in time to maximize the limited human and material resources. A5 Etiological treatment
Etiological treatment is the main measure to remove the cause of the disease during rescue: A5.1 Preventing the absorption of poisons: Take various measures according to the situation to remove the poisons that have not been absorbed or prevent the continued absorption of poisons. Although some of these measures are relatively simple, early removal is more effective than taking detoxification, special drugs or other treatments after the poison is absorbed into the body and has a toxic effect. It also causes less damage to the body and requires less manpower and material resources. Therefore, it must not be ignored because it is a general rescue routine and should be implemented seriously as soon as possible. A5-2 Eliminate the poisons and their metabolites absorbed by the body: a) Reasonable use of metal chelators;
b) Blood purification therapy: Its instruments and methods are constantly updated and progress is very fast. According to the type and characteristics of the poison, the appropriate method can be selected and applied early.
A5.3 Special antidotes: Use them as soon as possible if there is an indication. A6 Symptomatic treatment
Take preventive and treatment measures for the damage caused by the poison. Regardless of whether there is a special antidote, symptomatic treatment plays a very important role in rescue. A6.1 Eliminate or reduce the poisoning lesions of the main systems or organs, such as cerebral edema, pulmonary edema or liver and kidney damage, so as to control the deterioration of the lesions and promote the improvement of the condition.
A6.2 Non-specific antagonist drugs refer to glucocorticoids, sulfhydryl-containing drugs and anti-free radical drugs. These drugs have a certain antagonistic effect on the damage caused by many poisons, but they are not specific and can be used reasonably according to specific circumstances. A6.3 Maintaining the balance of the body's internal environment: In acute poisoning, maintaining water, electrolyte, acid-base balance, preventing and promptly correcting hypoxia are all very important treatment measures to create a better environment and promote the recovery of damaged organs. A7 Supportive treatment
Supportive treatment is to improve the body's resistance through various measures. 382
GB16852.1—1997
Acute poisoning often causes great mental disturbance, psychological stimulation and trauma to patients, and may also produce various mental pressures, which bring unfavorable factors to treatment. Therefore, psychological treatment should be done well to reduce their mental pressure, enhance their confidence in overcoming the disease, fully cooperate with medical measures, and turn unfavorable factors into favorable factors. This is especially important when multiple people are poisoned. At the same time, ideological work should be done well for family members so that they can cooperate and collaborate throughout the entire course of the disease. Ideological work for family members of critically ill and comatose patients is particularly important. These tasks require the joint cooperation of relevant departments and organizations of the hospital to proceed smoothly.
A8 Preventive treatment
Preventive treatment is based on the characteristics of the toxic effects of the cysts, combined with clinical manifestations, etc., to analyze the possible changes in the disease, take targeted measures to prevent its occurrence or reduce its severity, and prevent the formation of a vicious cycle. If there is a contradiction in treatment, analyze the pros and cons of various treatment measures according to the objective condition and deal with them properly. Reasonable preventive treatment can play a great role in controlling the development of the disease, and it should be targeted in combination with the condition.
A9Other treatments
Traditional Chinese medicine can play a great role in the treatment of acute poisoning. In addition to some drugs such as Danshen and Junzhihuang, which have been used, others can be implemented according to the principle of syndrome differentiation and treatment. Nursing work is very important in the whole rescue process. In some cases, it is the key to the success of rescue. Various measures should be taken to ensure the quality of nursing work.
A10General treatment principles
The human body is an organic whole. Although the lesions of a certain system or organ are more prominent in acute cysts, they are all systemic diseases; the lesions of various systems and organs must also affect each other. Therefore, in the whole course of the disease, the treatment must be guided by the overall view. The treatment plan should be formulated according to the clinical manifestations and various examinations. Do not make decisions based on the results of a single examination. Etiology, symptomatic, supportive and preventive treatments are all interrelated and inseparable. The clinical thinking of diagnosis and treatment must be principled and analyzed in combination with specific circumstances to be practical. For patients with severe poisoning, if conditions permit, they should be admitted to the intensive care unit as much as possible to create better conditions for enhanced observation and timely rescue. The blue test indicators can be determined according to specific circumstances.
A11 Assessment of labor capacity
The assessment of labor capacity is to assess the labor capacity of the patient based on the recovery of his health, and make reasonable arrangements for the nature, intensity, working hours, etc. of future work.
In addition to the above principles, its specific content can refer to GB/T16180 formulated by the Ministry of Labor and the Ministry of Health of the People's Republic of China. A12 Requirements for health examination
The requirements, methods and specific items of health examination can be determined according to the type of poison contact. Health examinations should be strictly implemented in accordance with the Occupational Disease Prevention and Control Law and relevant laws and regulations promulgated by my country. A13 General occupational prohibition certificate
Occupational contraindications for different poisons should be specifically formulated according to the different properties of each poison. 383
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