GBZ 66-2002Diagnostic Criteria of Occupational Acute Fluoro hydrocarbon Poisoning (English PDF)

Foreword

Article 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 4867-1996 inconsistent with this standard, the standard shall prevail.

In the organic fluorine materials in the production, processing, use and other professional activities in the process of inhalation of organic fluorine monomer, pyrolysis gas, residual Liquid gas and fluoropolymer pyrolysis gas cause acute poisoning. This standard highlights the characteristics of acute organic fluoride poisoning. According to organic fluoride poison the role of the main target organ respiratory system damage was diagnosed hierarchically modified, the toxic myocardial damage included in the moderate Poison, so that the diagnosis of this standard is more clear, reasonable and easy to use.

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

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

1 Scope

This standard specifies the diagnostic criteria and principles of occupational acute organic fluorosis.

This standard applies to the production of organic fluorine materials, processing, use and other processes, inhalation of tetrafluoroethylene, hexafluoropropylene and other monomers;

Fluoro-methyl chloride and other pyrolysis gases, residual liquid gas; polytetrafluoroethylene, polyfluoroethylene propylene, polychlorotrifluoroethylene and other fluoropolymer heat Gas poisoning caused by acute poisoning.

Acute organic fluoride pesticide poisoning and fluoride ether poisoning is not within the scope of this standard.

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 the exact short-term, excessive organic fluorine gas inhalation history, combined with clinical manifestations, X-ray and ECG Check the results, comprehensive analysis, excluding other diseases can be diagnosed later.

4 Observation object

Inhalation of organic fluorine gas, the upper respiratory tract infection-like symptoms, observed 72h symptoms gradually improved, no heart and lung injury.

5 Diagnostic and grading standards

6 Principles of handling

7 Correctly use the instructions in this standard

See Appendix A (informative), Appendix B (normative).

Appendix A

(Informative)

Correctly use the instructions in this standard A.1 The use of this standard, must have a clear occupational exposure to organic fluorine gas accident history. Fluoropolymer itself is non-toxic, Does not cause acute poisoning, but accidental inhalation of organic fluorine monomer, pyrolysis gas, residual liquid gas, fluoropolymer pyrolysis gas, can cause Acute Organic Fluorosis.

The organic fluorine monomer refers to a monomer in a fluoropolymer, such as tetrafluoroethylene, difluoro-methyl chloride, chlorotrifluoroethylene, Hexafluoropropylene and so on.

Cracking gas refers to the reaction by-product produced when pyrolysis of organic fluorine monomer is prepared at high temperature. Such as difluoro-methyl chloride (F22) Pyrolysis of pyrolysis produced by the preparation of tetrafluoroethylene, which components are tetrachlorethylene, hexafluoropropylene, octafluoroisobutylene, etc.

More than 10 kinds of reaction products.

Residual gas refers to the case of high temperature pyrolysis of the monomer after the remaining residue, at room temperature for the gaseous compounds, there are very toxic Octafluoroisobutylene and the like.

Pyrolysis gas refers to the pyrolysis of fluoropolymers at high temperature pyrolysis, products greater than 400 ° C contain highly toxic fluorophos and hydrogen fluoride.

A.2 Some components of organic fluorine gas, such as fluoroalkanes and olefins, have a significant effect on myocardial damage. The patients with ECG

Figure shows myocardial damage and various types of arrhythmias, excluding the previous heart after organic disease, even if X-ray

Lesions lighter, can still be diagnosed as toxic myocarditis, should be treated by severe poisoning.

A.3 organic fluorine gas is a pro-lung highly toxic substances, but the disease can also be a transient liver and kidney dysfunction, the process Degrees are often lighter, generally do not need special treatment can be recovered, the diagnosis should still be based on the clinical manifestations of respiratory system and X-ray as the basis.

A.4 on the use of glucocorticoid "early, short, short" principle, all observed and poisoned patients should be on-site prevention Sex medication, optional dexamethasone 10mg + 25% glucose solution 40 mL intravenous slow injection. Although the observation object is not acute Drug category, but in the observation period can still be used hormone preventive treatment 1 ~ 3d. Light, medium and severe poisoning in the first 1 ~ 5d poisoning According to the disease, optional dexamethasone 20 ~ 60mg/d or hydrocortisone 400 ~ 1200mg/d intravenous medication. Mild poisoning anxious Symptoms of the symptoms can be quickly discontinued. Moderate or more poisoning patients after the acute phase, for anti-pulmonary fibrosis, can continue to small doses Oral glucocorticoid 2 to 4 weeks or so.

A.5 fluoropolymer dust heat usually occurs in the polytetrafluoroethylene, poly perfluoro-ethylene propylene hot forming process, the sintering temperature in the 350 ~ 380 °C or so, the workers inhalation of its pyrolysis caused by the cold-like reaction, the symptoms resemble metal smoke, is a special A clinical type, generally given antipyretic analgesic symptomatic treatment, within 24 ~ 48h more. But repeated onset, the literature can be reported Induced pulmonary fibrosis, it should be given anti-pulmonary fibrosis treatment.

A.6 early poisoning symptoms of this disease is not typical, so the organic fluorine monomer, crack, pyrolysis gas (material) occupational exposure history is extremely important, where listed as the object of observation, should be stressed that the absolute bed rest, reduce oxygen consumption, strict medical observation, early attention should be with the ordinary Cold, acute tonsillitis, acute gastroenteritis phase identification.

Appendix B

(Normative appendix) Bedside chest X-ray film technical requirements and reading notes B.1 Location. As far as possible to take the seat or semi-recumbent front and rear chest radiograph. Chest radiograph must include all thorax and ribs on both sides;

Both sides of the sternoclavicular joint symmetry, target - slice distance of 100 cm.

B.2 Exposure. No breath when exposed. Lung, bone and soft tissue contrast and good level, the first 1 to 4 thoracic vertebrae clearly visible, Putting the time should be as short as possible, should be 1/10s or less than 1/10s. The centerline is aligned with the fifth thorax and perpendicular to the cartridge.

B.3 darkroom. no shoulders above the tissue should be dark black, under the diaphragm was transparent character.

B.4 lung blood distribution. standing before the posterior position due to the relationship between lung blood gravity, upper lung lung texture slim, and when lying, on the lungs and lungs texture thickening.

B.5 heart shadow increases and tends to horizontal.

a. Diaphragm position, so that the heart up and rotation.

b. Standing before the posterior position, the heart by the diaphragm support, supine position by the spine, mediastinal and bilateral lung support, heart wall More weak are more likely to change their shape.

c. Standing when a large number of blood stuck in the abdominal organs and body sagging parts of the vascular bed; supine when the amount of blood More, so that the mind is significantly increased.

d. The distance between the target and the target was shifted from about 180 cm to about 100 cm, and the proportion of the heart was significantly increased.

e. Standing before the chest radiograph close to the film, the magnification is smaller; and lying position before and after the chest radiograph heart high film distance increased Large, large magnification, heart shadow is also significantly increased.

B.6 mediastinal large blood vessels widened. superior vena cava shadow more obvious.

B.7 Aortic ball position shift, close to the level of clavicle.

B.8 bilateral shoulder blade and lung field overlap, may also affect the observation of the lesion. When lying down a small amount of pleural effusion can not be displayed. therefore, Need to carefully observe, to avoid the wrong conclusion.