GBZ 41-2019Diagnosis of occupational heat illness (English PDF)

Foreword

Chapters 4 and 5 of this standard are mandatory and the rest are recommended.

This standard is formulated in accordance with the Law of the People's Republic this standard was drafted in accordance with the rules given in GB/T 1.1-2009.

This standard replaces GBZ 41-2002 "Diagnostic Standards for Occupational Heatstroke".

Compared with GBZ 41-2002, the main changes are as follows.

-- Revised the diagnostic principles;

-- deleted the diagnostic rating;

-- Revised the description of heatstroke, enthusiasm, heat exhaustion, and heat stroke;

-- Adjusted the content of the processing principles;

-- Revised the contents of Appendix A.

This standard was drafted. Xinjiang Uygur Autonomous Region Occupational Disease Hospital, Tongji University Affiliated Shanghai Pulmonary Hospital, Jiangsu Provincial People's Hospital, Chongqing Occupational Disease Prevention and Control Institute, Hubei Provincial Center for Disease Control and Prevention, Wuhan Occupational Disease Prevention and Treatment Institute.

Drafters of this standard. Li Ting, Yan Yanjun, Wu Dongmei, Yang Chengxin, Wang Gang, Zhang Jingbo, Wei Taoying, Yi Guilin, Wang Yongyi, Mei Liang English.

The previous versions of the standards replaced by this standard are.

--GB 11508-1989;

--GBZ 41-2002.

Diagnosis of occupational heat stroke

1 Scope

This standard specifies the principles of diagnosis and treatment of occupational heat stroke.

This standard applies to the diagnosis and treatment of occupational heat stroke.

2 Normative references

The following documents are indispensable for the application of this document. For dated references, only the dated version applies to this article.

Pieces. For undated references, the latest edition (including all amendments) applies to this document.

GB/T 16180 Labor ability appraisal employee injury and occupational disease disability level

3 Diagnostic principles

According to the occupational history of high temperature operation, clinical manifestations of elevated body temperature, tendon, syncope, hypotension, oliguria, and disturbance of consciousness appear.

Performance, combined with the results of auxiliary examinations, refer to workplace occupational hygiene survey data, comprehensive analysis, and exclude similar diseases caused by other causes Only when you are sick can you diagnose.

4 Heat shock aura

After working for a certain period of time in a high temperature working environment, dizziness, headache, fatigue, thirst, sweating, palpitations, inattention, Symptoms such as uncoordinated movements, normal or slightly elevated body temperature but less than 38.0 °C, may be accompanied by flushing, skin burning, etc., short break the symptoms will disappear.

5 Diagnosis

6 Processing principles

7 Instructions for the correct use of this standard

See Appendix A.

Appendix A

(informative appendix) Instructions for the correct use of this standard A.1 Common heatstroke operations include high temperature, strong radiation operations, such as smelting, furnaces, etc.; high temperature, high humidity operations, such as printing and dyeing, silk, Deep mine operations; summer open-air operations, such as summer construction,, farm labor, sanitation and other outdoor operations; summer high-intensity operations, such as Sports competitions and military training.

A.2 Diagnose occupational heat stroke, should understand the meteorological conditions of the patient's workplace, such as temperature, humidity and/or thermal radiation intensity. Summer dew the daily work site is mainly based on measuring temperature. High-temperature work places refer to all productive heat sources in the workplace, and the heat dissipation is greater than 23 W/(m3·h) or

84 KJ/(m3·h) workshop; or when the outdoor summer outdoor ventilation design calculates the temperature of the temperature in the outdoor area, the workplace the temperature is higher than the outdoor 2 °C or above 2 °C (including the outdoor operation in the summer ventilation outdoor temperature >= 30 °C area, excluding the mine Work below). Relative humidity above 80% is high humidity. Thermal radiation mainly refers to infrared rays and a part of visible light. Solar radiation and production Heat sources such as various hot furnaces, open flames, and melted metals in the environment can emit a large amount of radiant heat.

A.3 High temperature operation refers to abnormal meteorological conditions with high temperature, strong thermal radiation or high gas and humidity combined with WBGT index Work that exceeds the specified limits.

A.4 Heat shock aura refers to the symptoms only or the temperature rises below 38.0 °C after working for a certain period of time in a high temperature working environment.

No signs of central nervous system, cardiovascular system and water and electrolyte metabolism disorders or abnormal laboratory and auxiliary examination results.

Can be relieved. The aura of heat stroke does not belong to the diagnosis of heat stroke.

A.5 At present, internationally, heat-related diseases are classified into hot rash, hot water swelling, heat syncope, enthusiasm, heat exhaustion, heat radiation, etc., and heat stroke it only refers to heat stroke. China usually divides heatstroke into three types. enthusiasm, heat exhaustion, and heat-induced disease, and clinical manifestations often accompany each other.

Separately separated. Heat stroke refers to the high temperature working environment, due to heat balance and/or water and electrolyte metabolism disorders, effective circulating blood loss Acute systemic manifestation of elevated body temperature and/or central nervous system dysfunction and/or cardiovascular dysfunction disease. Enthusiasm is a short-term, intermittent onset of muscle spasm that may be associated with loss of sodium salt, often occurring in the first time entering a high temperature environment.

When doing, or when the amount of exercise is too large, a large amount of sweating and only water replenishment, after timely treatment, can generally be restored in a short time. Heat exhaustion is in heat stress in the case of excessive loss of body fluids and body sodium, a group of clinical syndromes characterized by insufficient circulating blood volume caused by water and electrolyte disorders, If the heat exhaustion is not diagnosed and treated in time, it can develop into a heatstroke. Heatstroke is common in high-intensity and high-humidity environments for high-intensity training or heavy weight Most laborers are onset, and a few have a prodromal period of several hours to one day. They are characterized by fatigue, headache, dizziness, nausea, and vomiting.

Spit and so on. Typical symptoms are sudden high fever, dry skin and varying degrees of disturbance of consciousness. In severe cases, multiple organ dysfunction can occur.

Nervous system sequelae. Sunstroke is a summer heat operation, solar radiation directly affects the head caused by heat stroke, due to sunstroke the pathological and clinical manifestations are basically the same as those of heatstroke, and thus the sunstroke is attributed to heatstroke.

A.6 Differential diagnosis of heat-induced disease should be differentiated from other diseases that cause high fever with conscious disturbances, such as encephalitis and meningitis, cerebral malaria Disease, postpartum infection, acute cerebrovascular disease coma.

A.7 The primary measure for heat-radiation treatment is rapid cooling. The mortality rate is closely related to hyperthermia and duration. If the cooling is delayed, die the death rate has increased significantly. When the patient leaves the high temperature environment, the temperature begins to cool down and the body temperature is continuously monitored. Cooling target. make the core temperature at 10 it drops rapidly below 39 °C in min~40 min and falls below 38.5 °C in 2 h.

A.8 The terminology of occupational heat stroke diagnosis is to indicate the name of the specific disease type after diagnosis of occupational heat stroke, such as "occupational heat stroke (hot 痉挛)", "Occupational heat stroke (heat exhaustion)", "Occupational heat stroke (hot shot)", "Occupational heat stroke (heat enthalpy, heat exhaustion)".