GBZ 103-2002 Diagnostic criteria for combined radiation-burn injuries

GBZ 103-2002 Diagnostic Standard for Combined Radiation-Burn Injury GBZ103-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National occupational health standard of the People's Republic of China GBZ103-2002
Diagnostic criteria for combined radiation-burn injury2002-04-08 Issued
Issued by the Ministry of Health of the People's Republic of China
Implemented on 2002-06-01
GBZ103-2002
Chapters 3, 4, 6 and 5.1 to 5.5 and Appendix A, Appendix B and Appendix C of this standard are mandatory, and the rest are recommended. This standard is specially formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". In case of any inconsistency between the original standard GB16392-1996 and this standard, this standard shall prevail.
Combined radiation-burn injury refers to combined burns in which radiation injury occurs simultaneously or successively in the human body. When the radiation dose exceeds 1Gy, the burns are mostly skin burns, and respiratory burns (external eye burns and retinal burns) may also occur at the same time. The injuries of radiation-burn combined injuries can be divided into four levels: mild, moderate, severe and extremely severe. The course of moderate and severe radiation-burn combined injuries can be divided into shock stage, local infection stage, extreme stage and recovery stage. The mild course is mild and the stages are not obvious. The extremely severe course is extremely severe, and often enters the extreme stage after the shock stage. Appendix A, Appendix B and Appendix C of this standard are normative appendices, and Appendix D is an informative appendix. This standard is proposed and coordinated by the Ministry of Health of the People's Republic of China. This standard was drafted by the Third Military Medical University of the Chinese People's Liberation Army and the Institute of Radiation Protection and Nuclear Safety Medicine of the Chinese Center for Disease Control and Prevention.
The main drafters of this standard are: He Qingjia, Cheng Tianmin, Chen Zongrong, Wang Yuzhen, and Huang Qilong. This standard is interpreted by the Ministry of Health of the People's Republic of China. 2
1 Scope
Diagnostic criteria for combined radiation-burn injuries
This standard specifies the diagnostic criteria and treatment principles for combined radiation-burn injuries. This standard applies to the diagnosis and treatment of combined radiation-burn injuries in peacetime nuclear accidents or nuclear weapons war conditions. 2 Normative referenced documents
GBZ103-2002
The clauses in the following documents become clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties to an agreement based on this standard are encouraged to study whether to use the latest versions of these documents. For any undated referenced document, the latest version shall apply to this standard. GBZ104Www.bzxZ.net
3 Diagnostic criteria
Diagnostic criteria for acute radiation sickness caused by external exposure
Based on the injury history, the exposure dose, burn condition, clinical manifestations, and laboratory test results provided by the personal dose monitoring records or on-site exposure personal dose survey results, a comprehensive analysis is conducted in combination with the health records. On the basis of finding out the severity of the two single injuries, the diagnosis of the combined injury is made in reference to the characteristics that the combined injury can have a mutually aggravating effect when both single injuries reach moderate or above. 4 Diagnosis and Grading Criteria
4.1 Diagnosis
4.1.1 Radiation injury and its severity can be diagnosed in accordance with GBZ104. Those with burns can be diagnosed as radiation-burn combined injury. 4.1.2 Burns can be caused by nuclear explosion light radiation or flames, or by a combination of the two. The burn depth is determined by the three-degree four-point method (first degree, shallow second degree, deep second degree, and third degree), and the burn area is determined by the Chinese nine-point method or the palm method. For light radiation burns, attention should be paid to retinal burns and burns under clothing.
4.1.3 Patients with burnt nasal hair, red and swollen nasal mucosa, cough, hoarseness, dyspnea, and even coughing up detached tracheal mucosa, and pulmonary edema shadows on X-ray examination can be diagnosed with respiratory burns. 4.1.4 Patients with a history of observing nuclear explosion fireballs, abnormal vision, photophobia, tearing, pain, and decreased vision, and burn lesions in the macula of the fundus examination can be diagnosed with retinal burns. 4.1.5 Since burns are easy to observe, the focus of diagnosis is whether there is combined radiation damage and its degree. If burns are accompanied by the initial symptoms of radiation sickness, such as nausea, vomiting and diarrhea, it can be diagnosed as combined radiation and burn injuries at an early stage. 4.2 Injury classification standards
4.2.1 Mild radiation damage combined with mild burns is mild combined radiation and burn injuries. 4.2.2 Moderate radiation damage combined with mild burns is moderate combined radiation and burn injuries. 4.2.3 Severe radiation injury combined with mild burns, or moderate radiation injury combined with moderate burns are generally severe radiation-burn combined injuries. 4.2.4 Extremely severe radiation injury combined with burns of all degrees, or severe radiation injury combined with moderate or severe burns are all extremely severe radiation-burn combined injuries. 5 Principles of first aid and treatment
Adopt comprehensive treatment measures according to the different injuries and stages of illness. 5.1 First aid includes extinguishing fire, covering wounds; sedation, analgesia, warming, oral rehydration to prevent and treat shock; oral antibiotics to prevent infection; prevention and treatment of ventricular asphyxia.
5.2 Intravenous infusion of low molecular weight dextran, symptomatic treatment and nutritional supplementation. 5.3 Preventive injection of tetanus toxoid.
5.4 Apply therapeutic radiation prevention and treatment drugs and drugs to increase white blood cells as soon as possible within 3 days after injury 5.5 Protect hematopoietic function, prevent and treat bleeding, and correct microcirculatory disorders and water and electrolyte imbalance. 5.6 Antibiotics have been taken after injury to prevent infection. If fever does not go down or white blood cell count drops to 2.0×10\/L, sensitive antibiotics should be used instead. If the infection cannot be controlled after 3 days, large doses of broad-spectrum antibiotics should be used in combination, and attention should be paid to the prevention and treatment of fungal and viral infections. 5.7 When the platelet count in peripheral blood drops to 20×10/L or there is severe bleeding, platelet suspension can be transfused. Before the suspension is transfused, it must be irradiated with 15-25Gy3
GBZ103-2002
5.8 For patients with moderate or above injuries, disinfection and isolation measures should be strict, and laminar clean rooms should be used as needed and possible. 5.9 For extremely seriously injured patients, allogeneic bone marrow transplantation can be considered, and attention should be paid to the prevention and treatment of host-vs-host disease. For patients with chest irradiation, attention should be paid to the prevention and treatment of interstitial pneumonia in the later period.
5.10 Treatment of burn wounds
5.10.1 Early debridement Use physiological saline and 0.1% chlorhexidine solution to clean the wound. If the wound is contaminated with radionuclides, the contamination should be eliminated as soon as possible, and it can be combined with early debridement. 5.11.2 Apply a preparation with bactericidal, anti-inflammatory, astringent and healing-promoting effects on the second-degree burn wound to prevent wound infection. 5.11.3 For third-degree burns, it is generally necessary to excise (cut) the burns and autologous skin grafting as soon as possible, and try to close the wound before the end of the disease, turning the complex injury into a single injury, but the specific implementation must be considered comprehensively based on the overall condition. If the burn area is less than 10% and the patient is in good condition, early excision and autologous skin grafting can be used. If the burn area is large and the patient can still tolerate excision surgery, allografting or allografting and autologous skin grafting can be used to cover the wound, pass the end of the disease, and then autologous skin grafting can be performed. If the overall injury is too serious to be suitable for surgery, the wound should be carefully protected. While strengthening systemic treatment, wound infection (especially wound sepsis) should be effectively prevented and treated. Debridement or autologous skin grafting can be performed after entering the recovery period. 5.11.4 When skin is removed and grafted, local anesthesia or ketamine intravenous combined anesthesia can be used. 5.12 When combined with respiratory burns, the oral cavity should be cleaned. When there is a risk of suffocation due to laryngeal edema, tracheotomy should be performed in time. In case of bronchoconstriction, bronchodilators should be given, oxygen should be inhaled, and the respiratory tract should be kept moist. 5.13 When combined with retinal burns, measures should be taken to promote edema absorption, control inflammation and reduce scar formation. 6 Principles of treatment after treatment of combined burn-radiation injury
Those who have been confirmed to be clinically cured after treatment should undergo strict medical follow-up observation and regular health examinations, pay attention to possible scar contracture deformity and long-term effects, and give corresponding treatment. 4
Appendix A
Diagnosis and treatment of combined burn-radiation injury
(Normative Appendix)
5 combined burn-radiation injury A1 Combined burn-radiation injury
Combined burn-radiation injury refers to a type of combined injury in which burns occur simultaneously or successively in the human body and radiation damage occurs. GBZ1032002
Diagnosis and management for combined burn-radiation injury A2
The diagnosis and treatment of combined burn-radiation injury can refer to this standard. The key point of diagnosis is to clarify the burn injury and find out the ionizing radiation dose. When treating, focus on treating the burn and pay full attention to the impact of radiation damage. 5
GBZ103-2002
B1 shock phase
Appendix B
Explanation of terms
(Normative Appendix)
It is the first stage of the course of radiation-burn combined injury. In the first few days after the injury, there will be irritability, thirst, nausea, vomiting, diarrhea, local fluid loss in the burn area, hemoconcentration, and a brief increase and then a decrease in the number of peripheral white blood cells and platelets. Shock is often characterized by a prolonged excitement phase and a shortened inhibition phase. When entering the inhibition phase, the effectiveness of anti-shock measures is significantly reduced. B2 Local infectious phase is the second phase of the course of radiation-burn combined injury. Neurological and gastrointestinal symptoms are relieved or disappear, but hematopoietic dysfunction continues to develop, the inflammatory response of the burn wound is weakened and infection occurs. B3 critical phase is the most serious period of radiation-burn combined injury. The general condition deteriorates, vomiting and diarrhea occur again, hematopoietic dysfunction is at its lowest point, and systemic infection occurs. The burn wound is also prone to infection and bleeding, and the regeneration of granulation tissue and epithelium is delayed or even stopped. B4 recovery phase If the condition is not serious or after appropriate treatment, it can enter the recovery phase. During this period, the condition improves, the above symptoms and signs gradually disappear, hematopoietic function recovers, and the granulation tissue and epithelium of the burn wound are regenerated and repaired. B5 rule of Chinese nines The head and neck of an adult accounts for 1×9% of the total body surface area, the upper limbs account for 2×9%, the trunk (including perineum 1%) accounts for 3×9%, and the lower limbs (including buttocks) account for 5×9% + 1%, a total of 11×9% + 1% = 100%. B6 rule of palm
The injured person's fingers are put together, and the area of ​​the palm is 1% of the body surface area. B7 light radiation burns During a nuclear explosion, the burns caused by the direct action of light radiation on the human body are called light radiation burns. B8 under clothing burns
Light radiation acts on human skin through radiation and conduction through clothing. When the light impulse is less than the clothing combustion threshold but greater than the skin burn reading, it can cause skin burns under clothing.
B9 Burn wound sepsis Burn wound sepsis occurs when the number of bacteria per gram of living tissue on the burn wound exceeds 10, and the incidence of burn combined injury is higher than that of simple burn, and it is one of the causes of death from infectious complications. B10 Respiratory tract burn Respiratory tract injury caused by inhalation of flames or hot air, steam, dust and sand. Injury to the mouth, nose, and pharynx is mild; injury to the throat and trachea (above the carina) is moderate; injury to the bronchi to the alveoli is severe. Inhalation injury to the respiratory tract caused by combined or separate inhalation of harmful gases and smoke produced by combustion is called inhalation injury. B11 Retinal burn retinal burn
When the naked eye looks directly at the fireball, the light radiation passes through the eye's refractive system to significantly increase the light impulse focused on the retina, causing retinal coagulative necrosis. It is also called fundus burn. According to the severity of the lesion, it can be divided into three levels: mild, moderate, and severe. B12 Radiation injury radiationinjury
is the injury caused by ionizing radiation acting on the human body. The radiation injury and its degree referred to in this standard are equivalent to external irradiation acute radiation sickness and its degree respectively:
B13 Mutually aggravating effect additive effect When moderate or above radiation injury is combined with moderate or above burn, the injury after the combination is often more severe than that of simple radiation sickness of the same dose, which is manifested as rapid progression of the disease, early peak and prolonged duration, high incidence of infection, severe bleeding, and radiation injury weakens the local inflammatory response of the burn, making it prone to infection, bleeding, and delayed healing. Reflected in the outcome of the overall effect, the mortality rate of combined injury is often greater than the sum of the two single injuries. 6
GBZ103-2002
Appendix C
Burn injury classification
(Normative Appendix)
C.1 Mild: Second-degree burns account for less than 10% of the total body surface area. C.2: Moderate: Second-degree burns account for 10% to 20% of the total body surface area; or third-degree burns are less than 5%. C.3 Severe: Second-degree burns account for 20% to 50% of the total body surface area; or third-degree burns are between 5% and 30%; or although the burn area does not exceed 20%, there are respiratory burns or deep second-degree and third-degree burns on the face and perineum. C.4 Extremely severe: Second-degree burns account for more than 50% of the total body surface area; or third-degree burns are more than 30%; or combined with severe respiratory burns.
Appendix D
Recommendations for drugs and treatment measures
(Informative Appendix)
D1 Oral rehydration can be taken with burn beverages (each 100mL of boiled water contains 0.3g of salt, 0.15g of sodium bicarbonate, and appropriate amount of glucose). GBZ103-2002
D2 Medication for burn wounds, for preparations used to protect the skin, you can choose 2% iodine, 1% sulfadiazine silver, burn net (gallanthus, eucalyptus leaves, seeds, etc., soak in 70% alcohol for three days, take the extract for later use) or 3% chlorhexidine solution for flushing and wet compresses: for preparations used for burns, you can choose Wuling burn ointment (Phellodendron chinense, Astragalus membranaceus, Coptis chinensis, borneol, etc. are prepared into an ointment with sesame oil), water and fire scald ointment, etc., burn medicines should be used at the beginning of the recovery period. Using it too early will delay the recovery of body temperature and white blood cells, and using it too late will postpone the healing time. D3 Symptomatic treatment includes: sedatives (methaquinone 0.1-0.2g/time, or meprobamate 0.4g/time, or stir-fried jujube kernel) are given to patients with restlessness; anti-allergic drugs can be used for patients with neurovascular symptoms such as skin flushing and conjunctival congestion, such as diphenhydramine 25mg/time. For vomiting, take 30mg of chloramphenicol, 3 times a day, 30mg each time, orally or intramuscularly, or vitamin B50mg/time: antidiarrheal drugs are given to patients with severe diarrhea.
D4 Drugs for preventing and treating bleeding include vitamin C, P, K3, 6-aminocaproic acid, antifibrinolytic aromatic acid, anloxin and Yunnan Baiyao. D5 Radiation prevention and treatment drugs with therapeutic effects, such as madder double fat, estriol, estradiol benzoate and ethinyl estriol. Drugs that can increase white blood cells, such as dry golden vine, tremella polysaccharide and shiitake polysaccharide. D6 The method of intravenous ketamine combined anesthesia is to intramuscularly inject 100 mg of luminal and 0.5 mg of atropine, enter the operating room about 5 minutes later, intravenously drip 10-20 mg of diazepam (reduced for patients in shock), then intravenously drip 50 mg of meperidine and 25 mg of phenergan (the same amount is added if the operation lasts more than 3 hours), and then intravenously drip 100 mg of ketamine. After 2-3 minutes, the operation can be performed. If the operation time exceeds 40 minutes, 0.1% ketamine solution can be dripped intravenously at 40-60 drops/min to maintain, and the drip of ketamine solution should be stopped 5-10 minutes before the end of the operation. D7 Retinal burns can be treated with cortisone, hypertonic glucose, potassium iodide and multivitamins. D8 To eliminate wound contamination, sodium ethylenediaminetetraacetate is often used, with an effective concentration of 0.2%-0.5% and an effective pH of about 9. It is usually mixed with one part of disodium ethylenediaminetetraacetate and four parts of tetrasodium ethylenediaminetetraacetate, and the pH of the prepared solution is about 9.5%, with an effective pH of about 9. It is usually prepared by mixing one part of disodium EDTA with four parts of tetrasodium EDTA. The pH of the prepared solution is about 9.5%, with an effective pH of about 9. It is usually prepared by mixing one part of disodium EDTA with four parts of tetrasodium EDTA. The pH of the prepared solution is about 9.5%, with an effective pH of about 9. It is usually prepared by mixing one part of disodium EDTA with four parts of tetrasodium EDTA. The pH of the prepared solution is about 9.5%, with an effective pH of about 9. It is usually prepared by mixing one part of disodium EDTA with four parts of tetrasodium EDTA. The pH of the prepared solution is about 9.15g, glucose in appropriate amount). GBZ103-2002
D2 Medication for burn wounds, for preparations used to protect the skin, you can choose 2% iodine, 1% sulfadiazine silver, burn net (gallotalpa, Eucalyptus globulus, seeds, etc., soaked in 70% alcohol for three days, take the extract for use) or 3% chlorhexidine solution for washing and wet compressing: for preparations used for debridement, you can choose Wuling burn ointment (Phellodendron, Astragalus, Coptis chinensis, Borneol, etc. are made into ointment with sesame oil), Shuihuo scald ointment, etc. Debridement drugs are used at the beginning of the recovery period. Using them too early will delay the recovery of body temperature and white blood cells, and using them too late will delay the healing time. D3 Symptomatic treatment includes: sedatives (methaquinone 0.1-0.2g/time, or meprobamate 0.4g/time, or stir-fried jujube kernel) are given to patients with restlessness; anti-allergic drugs can be used for patients with neurovascular symptoms such as skin flushing and conjunctival congestion, such as diphenhydramine 25mg/time. For vomiting, take 30mg of chloramphenicol, 3 times a day, 30mg each time, orally or intramuscularly, or vitamin B50mg/time: antidiarrheal drugs are given to patients with severe diarrhea.
D4 Drugs for preventing and treating bleeding include vitamin C, P, K3, 6-aminocaproic acid, antifibrinolytic aromatic acid, anloxin and Yunnan Baiyao. D5 Radiation prevention and treatment drugs with therapeutic effects, such as madder double fat, estriol, estradiol benzoate and ethinyl estriol. Drugs that can increase white blood cells, such as dry golden vine, tremella polysaccharide and shiitake polysaccharide. D6 The method of intravenous ketamine combined anesthesia is to intramuscularly inject 100 mg of luminal and 0.5 mg of atropine, enter the operating room about 5 minutes later, intravenously drip 10-20 mg of diazepam (reduced for patients in shock), then intravenously drip 50 mg of meperidine and 25 mg of phenergan (the same amount is added if the operation lasts more than 3 hours), and then intravenously drip 100 mg of ketamine. After 2-3 minutes, the operation can be performed. If the operation time exceeds 40 minutes, 0.1% ketamine solution can be dripped intravenously at 40-60 drops/min to maintain, and the drip of ketamine solution should be stopped 5-10 minutes before the end of the operation. D7 Retinal burns can be treated with cortisone, hypertonic glucose, potassium iodide and multivitamins. D8 To eliminate wound contamination, sodium ethylenediaminetetraacetate is often used, with an effective concentration of 0.2%-0.5% and an effective pH of about 9. It is usually mixed with one part of disodium ethylenediaminetetraacetate and four parts of tetrasodium ethylenediaminetetraacetate, and the pH of the prepared solution is about 9.15g, glucose in appropriate amount). GBZ103-2002
D2 Medication for burn wounds, for preparations used to protect the skin, you can choose 2% iodine, 1% sulfadiazine silver, burn net (gallotalpa, Eucalyptus globulus, seeds, etc., soaked in 70% alcohol for three days, take the extract for use) or 3% chlorhexidine solution for washing and wet compressing: for preparations used for debridement, you can choose Wuling burn ointment (Phellodendron, Astragalus, Coptis chinensis, Borneol, etc. are made into ointment with sesame oil), Shuihuo scald ointment, etc. Debridement drugs are used at the beginning of the recovery period. Using them too early will delay the recovery of body temperature and white blood cells, and using them too late will delay the healing time. D3 Symptomatic treatment includes: sedatives (methaquinone 0.1-0.2g/time, or meprobamate 0.4g/time, or stir-fried jujube kernel) are given to patients with restlessness; anti-allergic drugs can be used for patients with neurovascular symptoms such as skin flushing and conjunctival congestion, such as diphenhydramine 25mg/time. For vomiting, take 30mg of chloramphenicol, 3 times a day, 30mg each time, orally or intramuscularly, or vitamin B50mg/time: antidiarrheal drugs are given to patients with severe diarrhea.
D4 Drugs for preventing and treating bleeding include vitamin C, P, K3, 6-aminocaproic acid, antifibrinolytic aromatic acid, anloxin and Yunnan Baiyao. D5 Radiation prevention and treatment drugs with therapeutic effects, such as madder double fat, estriol, estradiol benzoate and ethinyl estriol. Drugs that can increase white blood cells, such as dry golden vine, tremella polysaccharide and shiitake polysaccharide. D6 The method of intravenous ketamine combined anesthesia is to intramuscularly inject 100 mg of luminal and 0.5 mg of atropine, enter the operating room about 5 minutes later, intravenously drip 10-20 mg of diazepam (reduced for patients in shock), then intravenously drip 50 mg of meperidine and 25 mg of phenergan (the same amount is added if the operation lasts more than 3 hours), and then intravenously drip 100 mg of ketamine. After 2-3 minutes, the operation can be performed. If the operation time exceeds 40 minutes, 0.1% ketamine solution can be dripped intravenously at 40-60 drops/min to maintain, and the drip of ketamine solution should be stopped 5-10 minutes before the end of the operation. D7 Retinal burns can be treated with cortisone, hypertonic glucose, potassium iodide and multivitamins. D8 To eliminate wound contamination, sodium ethylenediaminetetraacetate is often used, with an effective concentration of 0.2%-0.5% and an effective pH of about 9. It is usually mixed with one part of disodium ethylenediaminetetraacetate and four parts of tetrasodium ethylenediaminetetraacetate, and the pH of the prepared solution is about 9.
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