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GBZ78-2010 English PDF

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GBZ78-2010: Diagnostic criteria of occupational chemical-induced sudden death
Status: Valid

GBZ78: Evolution and historical versions

Standard ID	Contents [version]	USD	STEP2	[PDF] delivered in	Standard Title (Description)	Status	PDF
GBZ 78-2010	English	209	Add to Cart	3 days [Need to translate]	Diagnostic criteria of occupational chemical-induced sudden death	Valid	GBZ 78-2010
GBZ 78-2002	English	399	Add to Cart	3 days [Need to translate]	Diagnostic Criteria of Occupational Chemicals -- Related Sudden Death	Obsolete	GBZ 78-2002

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Basic data

Standard ID	GBZ 78-2010 (GBZ78-2010)
Description (Translated English)	Diagnostic criteria of occupational chemical-induced sudden death
Sector / Industry	National Standard
Classification of Chinese Standard	C60
Classification of International Standard	13.100
Word Count Estimation	9,930
Date of Issue	2010-03-10
Date of Implementation	2010-10-01
Older Standard (superseded by this standard)	GBZ 78-2002
Quoted Standard	GBZ 73; GBZ 74
Regulation (derived from)	?Health-Communication (2010) 6
Issuing agency(ies)	Ministry of Health of the People's Republic of China
Summary	This standard specifies the principles of diagnosis and treatment of occupational chemical SCD. This standard applies to occupational activities due to chemical exposure diagnosis and treatment of sudden death. Diagnosis and treatment of non-occupational exposure to chemical substance occurs in sexual activity due to sudden death can also be performed with reference to this standard.

GBZ78-2002: Diagnostic Criteria of Occupational Chemicals -- Related Sudden Death

---This is a DRAFT version for illustration, not a final translation. Full copy of true-PDF in English version (including equations, symbols, images, flow-chart, tables, and figures etc.) will be manually/carefully translated upon your order.
Diagnostic Criteria of Occupational Chemicals-Related Sudden Death ICS 13.100 C60 GBZ People's Republic of China National Occupational Health Standards Diagnostic criteria of occupational acute chemical death Released in.2002-04-08 2002-06-01 Implementation Issued by the Ministry of Health of the People's Republic of China

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. In a variety of professional activities, may be in a short period of time contact with some high concentrations and high toxicity of chemicals and acute poison. These chemicals can be known varieties, and some are already in the event of poisoning after the unknown unknown pathogenic chemicals Species; some chemical species caused by poisoning in the list of occupational diseases in the famous, and some have not yet developed a separate diagnostic criteria. But all acute poisoning diseases have a common law of the disease, can also be developed to diagnose acute poisoning should be common Keep the rules. The rules set out in this standard series relate to the diagnosis of occupational acute chemical poisoning, which are used to ensure that The unity of the diagnostic system of industrial chemical poisoning, whether known or concealed by the cause, and whether it is caused by poisoning Of the damage to the target organ, can be in accordance with the provisions of this standard for the diagnosis. In the "occupational acute chemical poisoning Of the diagnostic "under the heading, including the following 10 parts. each part of the scope of the definition will be in the various parts of the preface and cited Statement. Part 1. Diagnostic criteria for occupational acute chemical poisoning (general); Part 2. Occupational acute occult chemical poisoning diagnostic rules; Part 3. Occupational acute chemical toxicity - Multiple diagnostic criteria for multiple organ dysfunction syndrome; Part 4. Diagnostic criteria for occupational acute exogenous death; Part 5. Occupational acute chemical toxicity - Criteria for the diagnosis of neurological diseases; Part 6 Occupational acute chemicals - Criteria for the diagnosis of toxic respiratory diseases; Part 7. Diagnostic criteria for occupational acute toxic liver disease; Part 8. Diagnostic criteria for occupational acute toxic nephropathy; Part 9 Occupational Acute Chemicals - Toxic Cardiac Disease Diagnostic Criteria; Part 10 Occupational Acute Chemicals Toxicity Diagnostic criteria for blood system diseases; In the practice of acute chemical poisoning, the accumulation of a wealth of rescue experience. In contact with high concentrations of cyanide compounds, Hydrogen sulfide, carbon monoxide, nitrogen oxides and other occupational hazards to the environment; pure nitrogen, pure carbon dioxide can cause choking hypoxia environment; Organophosphorus pesticides, barium carbonate, hydrogen sulfide and other delayed heart damage or nitroglycerin and other operators, the occurrence of potential Dirty damage, etc., often can appear sudden contact death (ie, sudden death of chemical origin). The nature of this event chemistry Sudden death, the general occupational hazards of the inevitable operation of the law, it is preventable, but also completely avoidable. In order to prevent sudden death of chemical origin, to improve the success rate of acute chemical death after the death rate, specially developed this standard. Appendix A to this standard is an informative appendix, Appendix B, C, and D are normative appendices. This standard is proposed and centralized by the Ministry of Health of the People's Republic of China. This standard by the Shanghai Yangpu District Central Hospital, Guangdong Province, Shantou City, occupational disease prevention and control hospital is responsible for drafting. Participate in the drafting unit Shanghai Sixth People's Hospital, Shanghai Changning District Health Bureau, Shanghai Zhabei District Central Hospital, Shandong Provincial People's Hospital and Safety and Health Department of the former Ministry of Chemical Industry. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic criteria of occupational acute chemical death Occupational acute chemical origin sudden death refers to the occupational activity. Due to the direct toxic effects of occupational chemicals or lead to machine Hypoxia caused by respiratory arrest or cardiac arrest.

1 Scope

This standard provides a basis for the diagnosis of occupational chemogenic sudden death, may cause high risk of the disease environment, high-risk operations Principles of management and prevention, occupational first aid principles of sudden death of occupational chemistry and high - risk population monitoring points. This standard applies to occupational activities due to exposure to chemical substances caused by sudden death. Chemistry in nonprofessional activity Sudden death can refer to the implementation.

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 71 Occupational Acute Chemical Poisoning Diagnostic Criteria (General) Rules for the diagnosis of occupational acute occult chemical poisoning GBZ 73 Occupational acute chemicals - Criteria for the diagnosis of toxic respiratory diseases Diagnostic criteria for occupational acute chemical toxic heart disease GBZ 74

3 diagnostic principles

According to the clinical and various auxiliary examination of the information, combined with on-site labor hygiene survey, a clear lethal chemical varieties, The exclusion of other causes due to sudden death, can be diagnosed.

4 diagnostic criteria

Have one of the following. a) sudden occurrence of respiratory arrest or cardiac arrest in high-risk environmental workers; b) acute chemical poisoning course or condition has been basically stable, the occurrence of unexpected respiratory arrest or cardiac arrest stop.

5 rescue principle

5.1 rapid, safe rescue the scene, while the contaminated parts of the necessary removal. Immediate "cardiopulmonary resuscitation Surgery "; 5.2 According to the disease of chemical species and disease, etc., can be applied to specific effects drugs; 5.3 to give the necessary other emergency treatment; 5.4 in the above treatment at the same time, to the hospital on the way to continue the rescue, and make a record.

6 Correct use of the description of this standard

See Appendix A (informative). 7 high-risk environment, high-risk operations management and prevention principles See Appendix B (normative appendix). 8 high-risk groups of monitoring points See Appendix C (normative). Surgical Cardiopulmonary Resuscitation of Acute Acute Chemical Death See Appendix D (normative).

Appendix A

(Informative) Correctly use the instructions in this standard A.1 Sudden death definition, has not yet reached a unified opinion, the majority of medical organizations or academic groups advocate sudden death for the unexpected Violent sudden death. And due to exogenous chemicals caused by sudden death, pathogenesis, clinical manifestations, diagnosis, treatment and Prevention and other causes of sudden death is not the same, it is particularly important as long as the strict implementation of various preventive measures, chemical source Sudden death is completely avoidable. According to its clinical characteristics, the definition of chemical death in this standard is. "due to occupation The toxic effects of chemicals or environmental hypoxia caused by access to chemicals, resulting in respiratory arrest or cardiac arrest. "This must Justice is in line with the objective situation, and embodies the need for prevention, diagnosis, rescue and the development of this standard. A.2 exogenous chemical caused by sudden death, according to its causes to the points, there are two cases. A.2.1 Due to the toxic effects of chemicals. a) Acute toxic effects include high concentrations of certain chemicals, cardiac arrest that causes contactor reflexes, or cardiac arrest; b) Delayed toxic effects. in the course of acute poisoning or recovery period, the occurrence of unexpected cardiac arrest. A.2.2 chemicals caused by hypoxia often due to rush into the chemical caused by the hypoxic environment caused by simple hypoxia The cause of suffocation is the main cause of sudden death. The above two cases caused by sudden death, the pathogenesis, clinical manifestations, rescue and pre- Anti-measures are not the same, so the diagnostic criteria are also divided. Due to heart disease caused by sudden death named as sudden cardiac death, exogenous Chemical-induced sudden death named chemical-derived sudden death. A.3 Purpose of the development of this standard. A.3.1 Carry out the principle of prevention and control, formulate the principles of management and guardianship for high-risk environment and high-risk operations; A.3.2 improve the accuracy of early diagnosis and rescue success rate; A.3.3 In the medical profession, especially in occupational medicine, the academic consensus on the sudden death of chemical origin reached a preliminary consensus, To lay the foundation for further research work. A.4 chemical death, there must be etiologic diagnosis, which is the main basis for sudden death of chemical origin, but also for targeted Treatment provided basis. But in an emergency, should be the necessary rescue treatment, while the organization of the cause of the investigation, Must not be diagnosed because the cause is not clear and delay emergency rescue. A.5 The concept of death listed in this standard is clinical death, that is, cardiac arrest or respiratory arrest. Suddenly due to sudden death Health, so cardiac arrest or respiratory arrest as a diagnostic indicator, this concept is consistent with the objective situation easy to master, because one occurs In these cases, the heart, lung, and brain resuscitation must be performed immediately. A.6 chemical origin of sudden death before, may have a short dizziness, syncope, chest tightness, palpitations, blurred consciousness and other symptoms, But also in the absence of aura symptoms of the case, immediately occurred breathing or cardiac arrest. Appendix C of this standard lists high-risk population monitoring Points, in order to facilitate early vigilance, timely treatment, to prevent further development of the disease. A.7 cardiac arrest the most prominent manifestations of deep coma, palpable less than a large artery pulse; respiratory arrest is the spontaneous breathing stopped. The emergence of these conditions should be immediately implemented cardiopulmonary resuscitation, do not have to repeatedly use the stethoscope can not hear the heart sounds or breath sounds, According to ECG examination to determine, should resume surgery as soon as possible, for recovery success. A.8 Another indicator of clinical death for the pupil to expand, due to the expansion of the pupil often breathing, heartbeat stopped later appeared in the Chemical poisoning, the pupil size by a variety of factors interfere with acute organophosphorus pesticides, carbamate pesticide poisoning can make The pupil shrinks; and atropine drugs can expand the pupil, so this standard, not using the pupil to expand as a clinical diagnosis of death index. A.9 on-site rescue is the key to rescue the sudden death of chemical origin, for the future treatment provides a good foundation. A.10 cardiopulmonary resuscitation has been the majority of medical workers and trained personnel to correctly grasp, this standard in Appendix D Included in the specific method of operation. Due to recent studies on cardiopulmonary resuscitation, rescue measures and monitoring indicators are new Progress, so to continue to update knowledge, strengthen clinical practice. To keep up with the advanced level, improve the quality of rescue. A.11 in the rescue, the application of special effects antidote varieties and methods, due to different causes vary. Some compounds are poisoned The use of special effects detoxification indicators, methods and the exact evaluation of efficacy, has not yet achieved uniform views. A.12 As a result of chemical poisoning from the scene, generally no longer continue to absorb poison, and patients often no primary disease, so Sudden death of chemical death if timely rescue, recovery rate may be higher than the sudden cardiac death, rescue should enhance confidence.

Appendix B

(Normative appendix) Management of high - risk environment and operation and precautionary principle B.1 high-risk environment refers to the presence of high concentrations of chemicals, may cause contact with sudden death of the scene. High-risk operations refer to high-risk environments or other operations that may produce sudden death chemicals. High-risk groups that enter the high-risk environment operators; or acute chemical poisoning patients, the course may occur sudden death. B.2 The relevant industrial and mining enterprises or departments, the system of this unit may occur sudden death of chemical hazards, should be a comprehensive tune check. High-risk environmental sites such as certain workshops, closed containers, warehouses, pit wells, sewage tanks, sewage tanks, sewers, septic tanks Sampling ports, venting ports and vehicles carrying chemical dangerous goods are listed as the focus of prevention of sudden death of chemical origin Bit. The use of, production or storage of chemical death may occur in the chemical species, physical and chemical properties, toxic effects, quantity, Dangerous characteristics and different causes of the accident caused by the nature of the incident, the scope of harm, etc., a comprehensive grasp, and detailed records, included file. B.3 in the comprehensive grasp of the enterprise high-risk environment, high-risk operations on the basis of the development of practical preventive measures, Including chemical emergency rescue plan, strict implementation of safety rules and regulations, to prevent illegal command, illegal operation. B.4 Hazardous substances in key places, in accordance with safe production regulations, regular fixed-point monitoring to master in the normal production Conditions or different production conditions, the concentration of chemical substances in the field changes in the field as a basis for improving the scene, and can accumulate data. In the event of an accident, the necessary data may be provided for the judgment. B.5 During the transport of chemical dangerous goods, the dangerous goods transport regulations should be strictly observed in order to maintain safety. B.6 for high-risk operators, must be pre-post examination, a professional contraindication shall not engage in this work. Before the job should be To give safe operation, self-help and rescue training, get induction certificate. And perform health care, as well as regular safe operation Practice, and constantly strengthen the awareness and technology to prevent poisoning. B.7 before entering the high-risk environment before the operation, first by the system to check, in line with safe production conditions, to allow the operation, Under special circumstances, the entrant must have to ensure the safety of protective measures, under strict supervision can be entered. B.8 in the process of high-risk environment, there must be a full guard, once the operator has found that the situation should immediately Line emergency treatment. B.9 into the high-risk environment to rescue patients, must have self-rescue knowledge, do their own protection, such as wearing a gas Type gas masks, fasten the seat belt and so on. Such as sudden accidents, the lack of suitable for their own protective equipment, you can use when the time All the conditions of the site, such as to the closed air into the fresh air, etc., to ensure the safety of the rescuer rescued the case. B.10 for high-risk environment, high-risk operations and the crowd, to develop rescue work plan. B.11 to do the rescue work, usually training, preparation is very important, such as the implementation of the rescue organization, the workshop workers Popularization of self-help knowledge and cardiopulmonary resuscitation, the need for emergency equipment, etc., in the event of a situation, rescue work can be order And can operate according to specifications. B.12 on-site rescue and hospital rescue combined, in the hospital on the way to adhere to the rescue work, and make a record, to the hospital and Hospital physician cooperation. Introduce the scene and the condition, so that the rescue work closely connected to achieve better results. B.13 If the enterprise may have acute chemical poisoning accident situation, should be linked to the hospital departments and departments to provide funding Material, so that clinicians are prepared to rescue work, is conducive to the occurrence of accidents when the rescue work. Appendix C. (Normative appendix) High - risk working population and its monitoring points C.1 Major chemicals that cause sudden death C.1.1 Chemical species that cause immediate death after exposure; a) cyanide and nitrile compounds b) Hydrogen sulfide c) volatile organic solvents d) carbon monoxide e) Extremely high concentration of irritating gas f) Very high concentrations of other chemicals C.1.2 acute poisoning course or recovery period, can cause sudden death of the main chemicals; a) organophosphorus pesticides; b) barium carbonate, barium chloride; c) sodium pentachlorophenol; d) hydrogen sulfide; e) chemicals that cause severe heart damage. C.1.3 Major chemicals that cause environmental hypoxia; a) nitrogen; b) carbon dioxide; c) nitrogen oxides (barn gas); d) methane; e) propane; f) other inert gases. C.2 Clinical features C.2.1 belongs to class C.1.1 compound poisoning, which is characterized by exposure to electric shock after death, but also first dizziness, headache, chest tightness, Dyspnea and other sudden signs of sudden death, such as continue to contact or not timely treatment. Can quickly appear consciousness disorder, convulsions, heartbeat Or respiratory arrest. C.2.2 belongs to C.1.2 class chemical poisoning caused by sudden death have different mechanisms. Resulting in breathing and cardiac arrest, so the clinical have feature. C.2.3 belongs to class C.1.3 compounds, mainly caused by environmental hypoxia, its clinical manifestations and hypoxia are closely related. a) If the oxygen concentration in the air < 6%, can quickly stop after entering, and then stop the heart and death, no aura shape. b) If the oxygen concentration in the air is 6% -10%, there may be headaches, vertigo, tinnitus, vomiting, cyanosis, obvious weariness Loss of ability and other aura symptoms, and then into a coma and respiratory arrest. c) If the oxygen concentration in the air is 10% -14%, the patient has fatigue, headache, breathing faster, Chaos, unresponsive, etc., if not out of time, the symptoms can be further aggravated. C.3 Monitoring points According to the poisonous chemical varieties and clinical manifestations were selected monitoring items, such as cardiac monitoring, respiratory monitoring, intracranial pressure Monitoring, electrolyte monitoring and/or other biochemical indicators such as monitoring. The purpose is to grasp the changes in time, take timely measures Shi, to prevent sudden death occurred. C.4 rescue measures C.4.1 In the event of heartbeat or respiratory arrest, immediate cardiac, pulmonary and brain resuscitation. See Appendix D. C.4.2 Different chemical poisoning rescue program, see the relevant occupational acute poisoning diagnostic criteria or other information. C.4.3 after the rescue to actively carry out symptomatic and supportive care.

Appendix D

(Normative appendix) Cardiopulmonary resuscitation D.1 Basic concepts D.1.1 cardiac-pulmonary-resuscitation (CPCR) when cardiac arrest or breathing Sudden recovery, spontaneous circulation, breathing and maintaining the organization of oxygen, the rescue measures taken for cardiopulmonary resuscitation. D.1.2 cardiac arrest refers to the effective pulse to stop the heart, its ECG activity can have the following performance. a) ECG activity is completely stopped; b) ventricular fibrillation; c) ventricular tachycardia, no effective ejection ability; d) bradycardia, no effective ejection ability; e) Electro-mechanical separation. D.1.3 Respiratory arrest refers to the effective ventilation of the respiratory system, ventilation function arrest. D.2 Cardiopulmonary resuscitation pointer Circulation. Suddenly the consciousness is not clear, can not touch the big artery pulse or can not hear the heart sound. Breathing. the chest can not observe the breathing activity, nose and mouth feel no gas out. D.3 Basic steps of cardiopulmonary resuscitation D.3.1 Basic life support (BLS) a) open airway, remove foreign body and secretions; b) mouth to mouth artificial ventilation, the surgeon should pay special attention to the impact of patients with exhaled breath; c) chest outside the heart press, insert the abdominal counterpulsation, the establishment of blood circulation. D.3.2 Advanced Life Support (ACLS) a) the establishment of ECG, respiration, blood pressure, blood pressure monitoring and intravenous drug access; b) further open airway. tracheal intubation, tracheotomy, cricothyroid incision or puncture; c) the implementation of artificial ventilation. air bag ventilation, general ventilator ventilation, high frequency jet ventilation, cardiopulmonary bypass membrane oxygenator Oxygenation d) correct and deal with various arrhythmias (including electric cardioversion, temporary pacemaker applications, etc.); e) Maintain effective blood circulation. D.3.3 Prolonged Life Support (PLS) a) improve cardiac output, maintain an effective cycle of blood volume and blood pressure; b) to correct all types of metabolic disorders, to maintain acid, alkali, water and electrolyte balance; c) brain protection, prevention and treatment of reperfusion injury; control of intracranial pressure, reduce brain metabolism, improve cerebral blood supply; d) to promote heart, lung, liver, kidney coagulation and digestive function recovery, prevention and treatment of multiple organ failure.

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