GBZ 102-2002 Diagnostic criteria for combined radiation and impact injuries

GBZ 102-2002 Diagnostic Standard for Combined Radiation-Impact Injury GBZ102-2002 Standard download and decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ102—2002
Diagnostic criteria for combined radiation-blast injury2002—04—08Published
Ministry of Health of the People's Republic of China
200206-01Implementation
GBZ102-2002
Chapter 3, 4, 6, 5.1 and Appendix A, Appendix B, 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 GB16391-1996 and this standard, this standard shall prevail. Combined radiation-blast injury refers to a type of combined injury in which radiation injury occurs simultaneously or successively in the human body as the main combined blast injury. Among them, indirect blast injury is similar to many traumas. The injury of radiation-shock combined injury can be divided into four levels: mild, moderate, severe and extremely severe. The course of the disease can generally go through four stages: shock stage, local infection stage, critical stage and recovery stage. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. The drafting units of this standard are: 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, and Tan Shaozhi. This standard is interpreted by the Ministry of Health of the People's Republic of China. 2
1 Scope
Diagnosis standard of radiation-shock combined injury
This standard specifies the diagnosis standard and treatment principles of radiation-shock combined injury. GBZ102-2002
This standard is applicable to the diagnosis and treatment of radiation-shock combined injury casualties under the conditions of nuclear accidents or nuclear weapons war in peacetime.
2 Normative referenced documents
The clauses in the following documents become the 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 reaching 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. GBZ103 Diagnostic criteria for combined radiation and burn injuries
GBZ104 Diagnostic criteria for acute radiation sickness caused by external exposure 3 Diagnostic principles
Based on the injury history, the exposure dose provided by the personal dose monitoring records or the on-site personal dose survey results, find out the location and severity of the blast injury, combine the clinical manifestations and laboratory test results, refer to the health records, conduct a comprehensive analysis, and make a correct judgment. The focus of diagnosis is the exposure dose and visceral blast injury. 4 Diagnosis and grading standards
4.1 Diagnosis
Radiation injury and its severity can be diagnosed with reference to GBZ104. Patients with one or more of the following injuries can be diagnosed as combined radiation and blast injuries.
4.1.1 In case of combined hearing injury, tinnitus, ear pain, hearing impairment, serous or bloody fluid flowing out of the external auditory canal, and otoscope examination can show perforation and bleeding of the eardrum. 4.1.2 In case of combined chest injury, if there is lung injury, chest pain, cough, hemoptysis and foamy sputum and breathing difficulty will occur. X-ray examination: when there is pulmonary hemorrhage, there will be a sheet-like shadow in the lung field; when there is pleural effusion, an arc-shaped shadow with an upper edge can be seen in the lower part of the lung field; when there is pneumothorax, it shows that the chest cavity on the injured side accumulates air, the lung is compressed, and the mediastinum is biased to the healthy side. When there is heart injury, there will be precordial pain, chest tightness, a sense of suffocation and cold sweat, and electrocardiogram examination will show myocardial damage.
4.1.3 In case of combined abdominal injury, abdominal pain, tenderness, abdominal muscle tension, weakened or disappeared bowel sounds and pneumoperitoneum will occur. In severe cases, there may be symptoms of hemorrhagic shock such as irritability, thirst, dry tongue, pale face, tachycardia, and decreased blood pressure. Abdominal puncture, peritoneal lavage, X-ray examination, B-type ultrasound examination, etc. are all of significance for confirming the diagnosis. 4.1.4 In case of compound fracture, there is pain, bleeding, swelling and movement disorder in the injured area, and X-ray examination can obtain a clear diagnosis.
4.1.5 In case of compound closed craniocerebral injury, there are clinical manifestations such as concussion, cerebral contusion, and brain compression (intracranial hematoma, etc.).
4.1.6 In case of compound limb compression injury, the injured limb is significantly swollen, becomes solid and less elastic, numb or paralyzed, the distal arterial pulsation is weakened or disappeared, and hypovolemic shock and myoglobinuria may occur. 4.1.7 In case of compound soft tissue injury, there may be clinical manifestations such as contusion, laceration, and injury caused by flying objects and broken glass.
4.1.8 When there is a combined eye injury, there may be corresponding clinical ocular manifestations. 4.2 Injury classification standards
4.2.1 Mild radiation injury combined with mild impact injury is a mild radiation-impact combined injury. 4.2.2 Moderate radiation injury combined with mild impact injury is a moderate radiation-impact combined injury. 4.2.3 Severe radiation injury combined with mild impact injury, or moderate radiation injury combined with moderate impact injury is generally a severe radiation-impact combined injury.
4.2.4 Extremely severe radiation injury combined with various degrees of impact injury, or severe radiation injury combined with moderate and severe impact injury is an extremely severe radiation-impact combined injury
5 First aid and treatment principles
Comprehensive treatment should be adopted according to the overall injury and different injured parts. For those with more serious visceral injuries, they should rest in bed and avoid overload to prevent aggravation of pulmonary hemorrhage, pulmonary edema, rupture of visceral hematoma and heart failure.
GBZ102-2002
5.1 First aid on the spot includes hemostasis, fixation, bandaging, analgesia, shock prevention, asphyxia prevention, etc. 5.2 Systemic treatment
5.2.1 Preventive injection of tetanus toxoid.
5.2.2 Blood transfusion and fluid replacement to prevent shock. If there is lung injury, the amount and speed of infusion should be controlled to prevent the occurrence or aggravation of pulmonary edema.
5.2.3 Use radiation prevention and treatment drugs, infection prevention and treatment, bleeding prevention and treatment, platelet transfusion, fetal liver cell and bone marrow transplantation, etc., refer to GBZ103 and GBZ104. 5.3 Local treatment
5.3.1 In case of complex hearing injury, the external auditory canal should be plugged with a sterile cotton ball to prevent infection. If it is infected, it should be washed with 4% warm boric acid water and then drained with gauze strips. Tympanic membrane perforation can be repaired during the recovery period. 5.3.2 In case of combined chest injuries, patients with lung injuries should keep their airways open, inhale 95% alcohol atomized oxygen, and be given drugs to promote the absorption of edema; patients with hemothorax should undergo thoracentesis to drain the accumulated blood, and patients with hemothorax that is difficult to aspirate should undergo closed drainage; patients with open pneumothorax should immediately seal and bandage the wound tightly; patients with tension pneumothorax should undergo closed drainage to exhaust the air. Patients with heart injuries should take appropriate rest, avoid activities, and receive symptomatic treatment; patients with heart failure should use digoxin or Convolvulus toxicus.
5.3.3 In case of combined abdominal injuries, such as hematoma of the liver or spleen, and gastrointestinal contusion, patients should absolutely rest in bed and receive symptomatic treatment; patients with rupture of the liver or spleen, and gastrointestinal perforation should undergo emergency surgery to stop bleeding and repair. 5.3.4 In case of combined fractures, fracture reduction and fixation surgery should be performed as soon as possible. The fracture fixation time is longer than that of general fractures, and the specific time depends on clinical manifestations and X-ray examination results. 5.3.5 In case of complex brain injury, the mild case (concussion) should be given sedation, analgesia, and bed rest; the severe case should undergo surgery as soon as possible, such as repair of scalp laceration, repair of skull fracture, and removal of intracranial hematoma. 5.3.6 In case of complex soft tissue injury and radionuclide contamination, the contamination should be eliminated as soon as possible; when excessive radionuclide enters the body, radionuclide accelerated excretion treatment should be performed; after early expansion of soft tissue injury, initial suture or delayed suture should be performed.
5.3.7 In case of complex limb compression injury, the injured limb should be fixed to avoid unnecessary activities, and deep fascia incision and decompression should be performed along the longitudinal axis of the injured limb. After surgery, it should be bandaged and fixed with a thick layer of dressing. Pay attention to the prevention and treatment of acute renal failure. 5.3.8 In case of complex eye injury, it should be treated by an ophthalmologist after first aid. 5.3.9 Local anesthesia should be used for surgical anesthesia. Ketamine and sodium γ-hydroxybutyrate, ketamine and meperidine or 5
GBZ 102-2002
combined anesthesia with procaine is relatively safe. Inhalation anesthesia and intravenous anesthesia can be used in the shock period, local infection period and recovery period, but ether anesthesia is prohibited in the case of combined lung impact injury and respiratory tract burns. 6 Principles of treatment after treatment of combined radiation and impact 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 disability and long-term effects, and give corresponding treatment. 6
Appendix A
Diagnosis and treatment of combined blast-radiation injury
(Normative Appendix)
jcombined blast-radiation injuryA.1 Combined blast-radiation injury
GBZ102-2002
Combined blast-radiation injury refers to a type of combined injury in which the human body suffers blast injury as the main injury and radiation injury simultaneously or successively.
A.2 Diagnosis and management for combined blast-rabiation injury
The diagnosis and management of combined blast-rabiation injury can refer to this standard. The focus of diagnosis is to clarify the blast injury (pay special attention to visceral blast injury) while finding out the ionizing radiation dose received. During treatment, the focus is on treating blast injuries and paying full attention to the impact of radiation damage. 7
B.1 Blast injury
Appendix B
Explanation of terms
(Normative appendix)
GBZ102-2002
The injury caused by the shock wave generated by a nuclear explosion, explosive explosion or other explosion acting on the human body is called a blast injury.
B.2 Direct blast injury Direct blast injury The injury caused by the blast wave directly acting on the human body is called a direct blast injury. B.3 Indirect blast injury Indirect blast injury The injury caused by the shock wave acting on the human body through objects, buildings, etc. is called indirect blast injury8
Appendix C
Grade of blast injury
(Normative Appendix)
GBZ102-2002wwW.bzxz.Net
C.1 Mild: Mild concussion, hearing damage, internal bleeding spots or skin abrasions may occur. Clinically, transient consciousness, headache, dizziness, tinnitus, hearing loss, congestion or rupture of the tympanic membrane may occur, and generally there are no obvious systemic symptoms.
C.2 Moderate: Concussion, severe hearing damage, multiple spotty hemorrhages in the internal organs, mild pulmonary hemorrhage, edema, soft tissue contusion and simple debridement may occur. Clinically, there may be temporary loss of consciousness, headache, dizziness, ear pain, tinnitus, hearing loss, tympanic membrane rupture, chest pain, chest tightness, cough, blood in sputum, occasional rales, swelling and pain in the injured area, and movement disorders.
C.3 Severe: Obvious pulmonary hemorrhage, edema, rupture of abdominal organs, and fractures of important bones may occur. Clinically, there may be chest pain, dyspnea, hemoptysis, dullness and bubbling sounds on chest examination, abdominal pain, tension and tenderness of the abdominal wall, decreased blood pressure, signs of diffuse peritonitis, varying degrees of shock or coma, and corresponding symptoms and signs of local fractures. C.4 Extremely severe: Severe pulmonary hemorrhage, pulmonary edema, severe rupture of the liver and spleen, and severe craniocerebral injury may occur. Clinically, there may be extreme dyspnea, rashes, restlessness, and convulsions, dullness areas on chest examination, dry and wet rales, and bloody foamy fluid spray, signs of critical acute abdomen, and severe shock or coma. 9
Appendix D
Recommendation on the use of drugs
(Informative Appendix)
GBZ102-2002
D.1 The method of intravenous combined anesthesia of ketamine and sodium γ-hydroxybutyrate is to first drip 0.3-0.6 mg of dongshiruo alkaloids with a Murphy's dropper, then slowly drip 2 ml of non-mixture (100 mg of meperidine and 50 mg of phenergan, a total of 4 ml) and 50-100 mg of ketamine, and maintain anesthesia for about 30 minutes. After that, add 1/2 of the first dose of ketamine (no more than 3 times), and anesthesia can continue for another 30 minutes. If 2.0-5.0 g of sodium γ-hydroxybutyrate is slowly dripped on the basis of the first use of ketamine, anesthesia can be maintained for about 2 hours. Ketamine can increase intracranial pressure and is not suitable for cranial surgery. Diazepam should be used instead.
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