GBZ 65-2002Diagnostic Criteria of Occupational Acute Chlorine Poisoning (English PDF)

Foreword

Section 6.1 of this standard is recommended and the remainder is mandatory.

According to the "People's Republic of China Occupational Disease Prevention Law" to develop this standard. Since the implementation of the standard date, the original standard GB 4866-1996 inconsistent with this standard, subject to this standard.

In the short period of professional activities inhalation of a large number of chlorine, can occur acute poisoning. To protect the health of the contact person, in 1996 the state promulgated GB 4866-1996.

Appendix A to this standard is an informative appendix, Appendix B, and C is a normative appendix.

This standard is proposed and centralized by the Ministry of Health of the People's Republic of China.

This standard by the Shanghai Sixth People's Hospital, Chongqing Tianyuan Chemical Plant workers hospital is responsible for drafting.

This standard is interpreted by the Ministry of Health of the People's Republic of China.

Diagnostic criteria for occupational acute chlorine poisoning Occupational acute chlorine poisoning is in the course of work, short-term inhalation of a large number of chlorine caused by acute respiratory failure Harm the main systemic disease.

1 Scope

This standard specifies the diagnostic criteria and principles of occupational acute chlorine poisoning.

This standard applies to the work of exposure to chlorine caused by acute poisoning, but also for chlorine oxides, sulfides, phosphorus Chemical and other similar inorganic chlorine compounds, such as hydrogen chloride, chloric acid, chlorosulfonic acid and other acute poisoning; non-occupational poisoning can also participate According to use.

2 Normative reference documents

The terms of the following documents are hereby incorporated by reference into this standard. Any date that references the date of the document all subsequent amendments (excluding corrigenda) or revisions do not apply to this standard, however, the parties to the agreement are able to use the latest version of these documents. Those who do not mind the date of the reference file, its latest the version applies to this standard.

GBZ 70 diagnostic criteria for pneumoconiosis

3 Diagnostic principles

According to short-term inhalation of a large number of chlorine after the rapid onset, combined with clinical symptoms, signs, chest X-ray performance, reference Site labor hygiene survey results, comprehensive analysis, excluding other causes of respiratory diseases, can be diagnosed.

4 Stimulus response

There is a transient eye and upper respiratory tract mucosal irritation symptoms, no positive signs of the lungs or occasional dry rales, chest X Line no abnormal performance.

5 Diagnostic and grading standards

6 Principles of handling

7 Correctly use the instructions in this standard

See Appendix A (informative), see Appendix B, C (normative) Appendix A (Informative) Correctly use the instructions in this standard A.1 The classification of this standard is a comprehensive clinical analysis of various clinical signs, consistent with the corresponding diagnostic criteria to reach to be more comprehensive understanding of the disease, easy to master and apply.

A.2 stimulated response to contact with chlorine after a transient reaction, has not yet reached the degree of poisoning, it is not treated as poisoning.

A.3 to diffuse alveolar pulmonary edema and acute respiratory distress syndrome, the estimated prognosis, guidance and treatment are helpful Help, and for clinical case analysis, statistical information, research work to provide an objective indicator, it is of practical significance.

Such as clinical examination of complete data, close follow-up observation, help the correct clinical diagnosis.

A.4 diagnostic grade should be in the acute end of treatment of acute poisoning, comprehensive analysis before conclusion.

A.5 if the patient's original chronic respiratory diseases, inhalation of chlorine after the poisoning can be more serious, or can induce the original Disease, so the situation is more complex, treatment is more difficult. In determining the classification or treatment effect, according to the patient's past history, Combined with the clinical manifestations of poisoning, for a comprehensive analysis, as far as possible a consistent conclusion.

A.6 no history of bronchial asthma, acute poisoning can occur when the asthma-like attack. After the acute phase, re-exposure to chlorine or contact with other substances or in the absence of a clear incentive to the case, there is bronchial asthma. The pathogenesis of the above situation remains to be deep Into the study, so there is no enough basis for the determination of acute chlorine poisoning sequelae, and the withdrawal of irritating gas operations is necessary of.

A.7 oxygen way there are many, according to the patient and objective conditions to choose. In order to prevent the occurrence of oxygen under high oxygen conditions Poisoning, so the proposed reasonable oxygen therapy, blood gas analysis can be used as monitoring indicators. High-frequency ventilation oxygen in the early application of a certain role, but when there is obvious carbon dioxide retention, it may be more harm. Application of artificial auxiliary breathing apparatus must be instructed by experienced person Under the proper control and use.

A.8 aerosol inhalation therapy using early 5% sodium bicarbonate solution, can be added dexamethasone, ventroline (Ventolin) Etc .; or bronchodilator can be used to relax with asthma or Boli Kangni spray inhalation.

A.9 because the critically ill patients are bedside chest X-ray, so the list of film requirements and precautions to meet the actual needs (See Appendix B (normative).

A.10 acute chlorine poisoning, due to hypoxia, pulmonary hypertension and neurological disorders can lead to heart damage, ECG

Figure inspection may have a corresponding change, so the rescue should pay attention to this inspection, help to master the overall condition and accumulation of information.

Appendix B

(Normative appendix) Bedside chest X-ray film technical requirements and reading notes B.1 Technical requirements B.1.1 Location. As far as possible sitting position or semi-recumbent position before and after chest X-ray. Chest radiographs include all thorax (must be included when there are difficulties Ribs); both sides of the sternoclavicular joint symmetry, the center line aligned with the fifth thoracic and perpendicular to the cartridge; target - film distance of 90cm or more.

B.1.2 Exposure. No breathing action at exposure (preferably with barium fluoride high-speed screen), lung, bone and soft tissue contrast and the level of good, 1 to 4 thoracic vertebral visible.

B.1.3 darkroom. shoulders above the non-organized area should be dark black, separated by a transparent character.

B.2 Reading Notes

B.2.1 The distribution of blood in the lungs is affected by gravity, so that the lungs of the upper lung field are slender, the texture of the lungs is similar.

B.2.2 heart shadow increases and tends to horizontal a. Muscle position increased, so that the heart up and rotation;

b. Before the posterior position of the heart by the lateral support, supine position by the spine, mediastinal and bilateral lung support, heart wall comparison the weak is more likely to change its shape;

c. Standing a large number of blood left in the abdominal organs and body sagging parts of the vascular bed, supine position when the amount of blood increased, Heart shadow increases, standing and lying on the heart of the largest difference between the area can be about 25%;

d. The distance between the target and the distance from the 180cm to 90 ~ 120cm, the cardiothoracic ratio increased significantly, the apical to the upper left Shift, shallow waist or disappear, or even bulging;

e. The heart is located in front of the chest, after the front of the heart close to the film, the magnification is small, and lying before and after the heart from the film the distance increases, the magnification is larger, the mind also increases.

B.2.3 mediastinal large blood vessels widened, superior vena cava shadow more obvious.

B.2.4 The position of the aortic ball moves up close to the clavicle level.

B.2.5 A small amount of chest water can not be displayed when lying. Double scapula and lung field overlap, affecting the lesion. To this end, should be careful and careful Read the film, to avoid causing false conclusions.

Appendix C.

(Normative appendix) Blood gas analysis and lung respiratory function C.1 Department of lung-based respiratory function, including pulmonary ventilation and ventilation. The former due to thoracic or neuromuscular lesions, call Absorbance fatigue, increased respiratory resistance can cause alveolar hypoventilation, hypoxia and carbon dioxide retention; the latter due to lung pass Gas/blood flow imbalance, increased arterial shunt, diffuse dysfunction caused by hypoxia.

C.2 arterial blood gas analysis PaCO2 and PaO2 can reflect alveolar ventilation and ventilation function, but because of lung respiratory function and Compensatory ability, PaCO2 is a normal range, does not mean that the patient ventilation function is normal, when PaCO2 greater than 6kPa (45mmHg), indicating that ventilation has been compensatory state, PaO2 also have the same meaning.

C.3 Purpose of blood gas analysis a. To determine what nature of respiratory insufficiency, such as simple hypoxia, or with carbon dioxide retention;

b. Determine the severity of respiratory insufficiency, can be used as a basis for the diagnosis of severe poisoning;

c. Guide the treatment and treatment of the assessment.

C.4 arterial blood gas analysis includes PaO2, SaO2, PaCO2, pH, SB (standard bicarbonate), AB (actual heavy carbon Acid salt), BB (buffer base), BE (alkali residue), SBE (extracellular caustic soda residue). Which SB, AB, BB, BE, SBE are representative of the metabolic acid and alkali indicators, so the pH of the combination of PaCO2, AB and K, Na, Cl - can be better assessed the state of the patient's acid-base balance.

C.5 intravenous arterial flow measurement allows the patient through the unidirectional valve flap pure oxygen for 20min, for arterial blood gas analysis, the resulting knot Fick's formula can be obtained indirectly.

QS/QT = [0.0031 x (PAO2-PaO2)]/[0.0031 (PAO2-PaO2) - (CaO2-CVO2)] (C1) where. QS/QT - anatomy and the sum of intrahepatic arteriovenous shunt;

PAO2 = atmospheric pressure of 47 (37 °C water vapor partial pressure) a PaCO2;

CaO2-CVO2 - arterial blood and mixed venous blood oxygen difference, healthy people to 5 into, patients with heart and lung disease to 3.5 entry.

Alveolar collapse, atelectasis, pneumonia and pulmonary edema can cause increased intrahepatic shunt. Dynamic follow - up of patients with venous artery shunt the amount can reflect the changes in the disease and the efficacy of the assessment.

C.6 Evaluation of blood gas analysis should be closely integrated with the clinical, if not consistent, we must understand the reliability of laboratory tests. The pH, O2 and CO2 electrodes for quality control, available standard pH solution, standard O2 and CO2 concentrations with blood balance solution or human hematopoietic Calibration.