GBZ 15-2002 Diagnostic criteria for occupational acute nitrogen oxide poisoning

This standard specifies the diagnostic criteria and treatment principles for occupational acute nitrogen oxide poisoning. This standard applies to occupational acute nitrogen oxide poisoning and can also be used as a reference for non-occupational acute nitrogen oxide poisoning. GBZ 15-2002 Occupational acute nitrogen oxide poisoning diagnostic criteria GBZ15-2002 standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ15—2002
Diagnostic Criteria of Occupational Acute Nitrogen Oxides 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 there is any inconsistency between the original standard GB7801-1987 and this standard, this standard shall prevail. Nitrogen oxides are an irritating gas that is widely present in chemical production processes. In occupational activities involving exposure to nitrogen oxides, acute poisoning can be caused. In order to protect the health of the contactors, prevent and treat acute nitrogen oxide poisoning, and better improve this standard, GB7801-1987 is revised based on the latest progress in clinical research. The revised new standard is not only connected with GBZ73, but also highlights the characteristics of acute nitrogen oxide poisoning. On the basis of the original standard, the content of acute respiratory distress syndrome is added, making the diagnostic classification clearer, more reasonable and easier to apply. Appendix A of this standard is an informative appendix, and Appendix B is a normative 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 Staff Hospital of Jilin Chemical Group Corporation and the Shenyang Institute of Occupational Disease Prevention and Control. The participating units include Shanghai Chemical Occupational Disease Prevention and Control Institute, Dalian Chemical Industry Company Staff Hospital, the Second Affiliated Hospital of Shanxi Medical University, the Affiliated Hospital of Bengbu Medical College, the Occupational Disease Department of Shandong Provincial Hospital, and Jilin Medical College. This standard is interpreted by the Ministry of Health of the People's Republic of China. Occupational Acute Nitrogen Oxide Poisoning Diagnostic Standard GBZ15-2002
Occupational acute nitrogen oxide poisoning refers to a systemic disease with respiratory damage caused by inhaling a large amount of nitrogen oxide gas in a short period of time during occupational activities. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute nitrogen oxide poisoning. This standard applies to occupational acute nitrogen oxide poisoning, and non-occupational acute nitrogen oxide poisoning can also be implemented by reference. 2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For all referenced documents with dates, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties who reach an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated referenced documents, the latest versions apply to this standard.
GB/T16180
3 Diagnostic principles
Diagnostic standards for occupational acute chemical poisoning respiratory diseases Evaluation of the degree of disability caused by work-related injuries and occupational diseases of employees Based on the occupational history of inhaling a large amount of nitrogen oxides in a short period of time, the clinical manifestations of respiratory damage and chest X-ray signs, combined with blood gas analysis and on-site labor hygiene survey data, comprehensive analysis, and exclusion of similar diseases caused by other reasons, a diagnosis can be made. Www.bzxZ.net
4 Stimulation reaction
Transient chest tightness, cough and other symptoms, no positive signs in the lungs, no abnormalities in chest X-ray examination 5 Diagnosis and grading standards
5.1 Mild poisoning
Chest and cough symptoms, scattered dry rales in the lungs; chest X-ray signs: enhanced lung texture, with blurred edges; consistent with acute tracheobronchitis or peribronchitis. 5.2 Moderate poisoning
Symptoms such as worsening chest tightness, aggravated cough, dyspnea, sputum or hemoptysis: signs are mild, dry and wet rales can be heard in both lungs; chest X-ray signs: decreased lung field transparency, increased, disordered, blurred lung texture, reticular shadows, consistent with interstitial pulmonary edema; or patchy shadows with blurred edges, consistent with bronchopneumonia. Blood gas analysis often shows mild to moderate hypoxemia. 5.3 Severe poisoning
One of the following:
a) Obvious dyspnea, severe cough, large amount of white or pink foamy sputum, obvious cough, and moist rales in both lungs; chest X-ray signs: patchy or cloud-like shadows of varying sizes and blurred edges in both lung fields, some of which can merge into large shadows, consistent with alveolar pulmonary edema. Blood gas analysis often shows severe hypoxemia. b) Acute respiratory distress syndrome;
c) Complicated with more severe pneumothorax or mediastinal emphysema; d) Asphyxia.
Treatment principles
6.1 Treatment principles
On-site treatment
Quickly and safely leave the poisoning site, lie still, keep warm, avoid activities, and breathe oxygen immediately; and give symptomatic treatment. 6.1.2 For those who react to irritation, they should be observed for 24-72 hours. During the observation period, they should strictly limit their activities, rest in bed, keep quiet and give symptomatic treatment.
6.1.3 Keep the airway open
Give nebulizer inhalation, bronchial decoction, defoaming agent (such as dimethyl silicone oil), and give tracheotomy when necessary. 6.1.4 Early, sufficient and short-term use of glucocorticoids. 6.1.5
Reasonable oxygen therapy.
, prevent and control infection, prevent and treat complications, and maintain water, electrolyte and acid-base balance. 6.1.6
6.2 Other treatments
Acute mild and moderate poisoning patients can resume their original work after recovery; patients with severe poisoning should be transferred away from irritating gas operations depending on the recovery of the disease. If labor capacity assessment is required, it shall be handled in accordance with GB/T16180. 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 disease is mainly characterized by respiratory damage, so respiratory system symptoms, signs and chest X-ray signs are the main diagnostic basis. If the clinical manifestations and chest X-ray manifestations are inconsistent, a graded diagnosis is made based on the more serious indicators. A.2 The characteristics of this disease are a long incubation period and delayed pulmonary edema is prone to occur, so close medical observation should be carried out. A.3 In the late stage of acute poisoning, this disease is prone to delayed obstructive bronchiolitis, which should be taken seriously. The main manifestations are: pulmonary edema basically recovers about 2 weeks, and symptoms such as cough, chest tightness and progressive respiratory distress occur again, physical signs have obvious development, and dry rales and/or fine wet rales can be heard in both lungs; in a few cases, after inhaling nitrogen oxides, there may be no obvious acute poisoning symptoms, and the above lesions occur 2 weeks later. Chest X-ray signs: Both lungs are covered with chestnut-like shadows. Patients with delayed obstructive bronchiolitis should be treated with glucocorticoids. A.4 Refer to GBZ73 for the diagnosis of acute respiratory distress syndrome. A.5 Blood gas analysis is of great significance as a reference indicator for diagnostic grading, refer to GBZ73. A.6 Reasonable oxygen therapy is of great significance in the treatment of nitrogen oxide poisoning, refer to GBZ73. A.7 The key to the treatment of this disease is to actively prevent and treat pulmonary edema, early, sufficient, and short-term use of glucocorticoids, and can be combined with alkali drugs such as 654-2.
A.8 Nebulizer inhalation is one of the effective methods for the treatment of acute toxic respiratory diseases. Ultrasonic nebulizer inhalation should be performed 2-3 times a day according to the condition.
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