GBZ72-2002 English PDF

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GBZ72-2002: Diagnostic Guideline of Occupational Acute Obscure Chemicals Poisoning
Status: Obsolete

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Basic data

Standard ID: GBZ 72-2002 (GBZ72-2002)
Description (Translated English): Diagnostic Guideline of Occupational Acute Obscure Chemicals Poisoning
Sector / Industry: National Standard
Classification of Chinese Standard: C60
Word Count Estimation: 8,861

GBZ72-2002: Diagnostic Guideline of Occupational Acute Obscure Chemicals Poisoning

---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 Guideline of Occupational Acute Obscure Chemicals Poisoning ICS 13.100 C60 GBZ People's Republic of China National Occupational Health Standards Diagnostic rules of occupational acute occult chemical poisoning Diagnostic Guideline of Occupational Acute Obscure Chemical Poisoning Released in.2002-04-08 2002-06-01 Implementation Issued by the Ministry of Health of the People's Republic of China

Foreword

Article 5.1 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 16852.2-1997 inconsistent with this standard, the standard shall prevail. In a variety of professional activities, may be in a short period of time exposure to some high concentrations and high toxicity of chemicals and acute poison. Some of these chemicals, some known species; and some are poisoned after the moment is not clear pathogenic species; Of the species caused by poisoning has been included in the list of occupational diseases, and some have not yet included; some have independent diagnostic criteria, while others Has not yet developed a separate diagnostic criteria. But all acute poisoning diseases have a common incidence of the law can be developed also necessary Develop rules that should be observed when diagnosing acute poisoning. The rules set out in this series of standards relate to the diagnosis of occupational acute chemical poisoning, which are used to ensure that The diagnosis of acute chemical poisoning is unified, whether it is known or concealed by the cause, and whether it is poisoned The damage to which the target organ is caused can be diagnosed in accordance with the rules prescribed in this standard. "Occupational acute chemical poisoning Of the diagnosis "includes the following sections, each of which will be defined in the preface and the introduction to each section. Part 1. Diagnosis of Occupational Acute Chemical Poisoning (General); Part 2. Diagnostic rules for occupational acute occult chemical poisoning; Part 3. Diagnostic criteria for occupational acute toxic multi - organ dysfunction syndrome; Part 4. Diagnostic criteria for occupational acute exogenous death; Part 5. Diagnostic criteria for occupational acute toxic neurological diseases; Part 6. Diagnostic criteria for occupational acute toxic respiratory diseases; Part 7. Diagnostic criteria for occupational acute toxic liver disease; Part 8. Diagnostic criteria for occupational acute toxic nephropathy; Part 9. Diagnostic criteria for occupational acute toxic heart disease; Part 10 Occupational Acute Toxicity System for the Diagnosis of Hematological Diseases; Appendix A to this standard is an informative appendix, Appendix B, and C is a normative appendix. This standard is proposed and centralized by the Ministry of Health of the People's Republic of China. This standard by the Shanghai Sixth People's Hospital, Jinan City Occupational Disease Prevention and Control Hospital, China Center for Disease Control and Prevention Occupational Health And the Center for Drug Control, Shanghai Municipal Center for Disease Control and Prevention, Shandong Provincial Hospital, Shenyang Institute of Labor Hygiene and Occupational Diseases, Shanghai Changning District Health Bureau is responsible for drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic rules of occupational acute occult chemical poisoning Occupational acute occult chemical poisoning refers to the workers in the professional activities, a short period of time do not perceive the situation to absorb large Dose of occupational chemicals caused by poisoning.

1 Scope

This standard specifies the diagnostic rules for occupational acute occult chemical poisoning. This standard applies to occupational activities in the unaware, not aware of contact with chemicals caused by acute poisoning. In the non Occupational activities due to unknowingly, the absorption of chemicals caused by the diagnosis of acute poisoning, can also refer to 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 71 Occupational Acute Chemical Poisoning Diagnosis (General)

3 diagnostic principles

According to clinical, laboratory, field investigation prompted the acute poisoning clues, and further access to adequate evidence of etiology, Combined with the corresponding clinical manifestations and (or) the necessary field data and other comprehensive analysis, excluding similar diseases, can be diagnosed as occupation Acute acute poisoning.

4 Diagnosis points

4.1 clear cause Patients with occult poisoning can not provide a history of toxic exposure. Clear the cause of the first from the history, signs, laboratory inspection Check or (and) on-site investigation of possible clues to poisoning. From the clues to be inspired, and then in-depth observation, inspection, transfer Research, biological material testing, etc., to clear the cause of poisoning, including a) Viral species; b) causes of poisoning; c) time to absorb poison; d) invasive approach; e) estimate the absorbed dose and so on. These are the primary basis for the diagnosis of chemical poisoning. 4.2 more complete clinical data 4.3 Comprehensive analysis A comprehensive analysis, including the differential diagnosis, to arrive at the cause and disease have a definite causal relationship between the conclusions. Concealed chemical poisoning after a clear cause, the diagnostic methods, grading standards, etc., and general acute chemicals Poison exactly the same, should be treated according to GBZ 71. 4.4 Toxicology test If there is little toxicological information on suspicious pathogens, it is necessary to carry out the necessary toxicology when there is difficulty in judging the diagnosis Experiment to clarify the toxic and toxic effects of the poison, as one of the diagnostic comprehensive analysis data.

5 Principles of handling

5.1 Principles of treatment Determine treatment regimens based on pathogen species, clinical features, severity, etc. (see GBZ 71). In the diagnosis of poisoning is not clear, should be based on the specific circumstances of patients, to give the necessary inspection, rescue and various treatment measures. 5.2 Other processing According to the specific circumstances (see GBZ 71).

6 Correct use of the description of this standard

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

Appendix A

(Informative) Correctly use the instructions in this standard A.1 acute occult poisoning once a clear cause of chemical poisoning, the diagnosis should be GBZ 71 treatment, but also refer to the relevant Diagnostic criteria of occupational acute toxic target system (organ). A.2 found that patients with acute chemical poisoning possible clues, is a key breakthrough in diagnosis. This standard will be acute concealment Type of poisoning diagnosis methods, steps and access to poison may be the source of possible clues as Appendix B, will occur in the case of acute occult poisoning See the reasons listed in Appendix C for reference and application. A.3 Epidemiological survey In the case of group morbidity, epidemiological investigation to elucidate the cause, disease occurrence and development of the law, affect the disease and pre- After the factors such as, can provide scientific information. In some cases, it is one of the important ways to solve the concealment of poisoning According to the situation applied. A.4 corpse pathology examination In the absence of a definite diagnosis of suspected acute chemical poisoning, or the deceased before the diagnosis of acute chemical poisoning But there are some important issues can not explain, but also should do autopsy. Autopsy can systematically observe the pathological changes of each organ Out of pathology diagnosis and determine the cause of death. But because of many toxic substances caused by acute poisoning autopsy no specific pathological changes, so a variety of ways to clear the cause, still The necessary basis for diagnosis. Autopsy, as far as possible the determination of the main organs of the pathogen content. A.5 to prevent "prosecution", "indiscriminate", exposing "pseudo-diagnosis" In the case of high vigilance with acute chemical poisoning possible, should pay attention to prevent "prosecution", "indiscriminate". "The clinic" is Refers to the history of toxic contact, but did not occur poisoning and diagnosis of chemical poisoning. "Abuse" refers to the history of toxic contact is not clear, Nor poisoning and diagnosed as chemical poisoning. These two cases are misdiagnosed in the multi-poisoning should pay attention to prevent the occurrence. "Pseudopathic" means that the doctor knows not to poison, in order to achieve a certain purpose, and to give the diagnosis of chemical poisoning. This Diagnosis is forged, so called pseudo-diagnosis. This is a serious violation of medical ethics and the law of the act, once found must be exposed. So it is possible to obtain clues for acute chemical poisoning, only the first step, just a clue rather than a conclusion. Will also be necessary Need to do further work to collect more material in order to make a diagnosis. A.6 good history, good physical examination, in the diagnosis of occult poisoning is even more important, must be carefully implemented Throughout the diagnostic process, accurate and complete material is the only basis for making a diagnosis. Material must be accurate and inaccurate The material will lead to erroneous analysis to judge. The material must also be complete, to avoid relying on isolated material as the only basis for the diagnosis, Even if it is specific. A.7 development of occult poisoning diagnostic criteria, not only contribute to clinical diagnosis and treatment work, and can cause wide attention and the relevant departments Attention, take comprehensive measures to do preventive work.

Appendix B

(Normative appendix) Diagnostic and differential diagnosis of occupational acute occult and other occult poisoning Due to acute occult poisoning special poisoning way, a clear diagnosis must have the exact etiology based on. Specific methods and Proceed as follows. B.1 Getting the clues to acute chemical poisoning is the first step in identifying the diagnosis and a key step. B.1.1 Get clues from history a) Occupational history, the operator does not understand the situation of exposure to toxic substances, or other possible conditions of poisoning; b) in the same environment, multiple people at the same time or short-term successively similar syndromes, and can not be common infectious diseases or Side disease interpretation; c) onset or (and) disease progression does not meet the laws of the disease to be diagnosed; d) past history of epilepsy, psoriasis, mental illness and other ills, had accepted earthwork, remedies or informal doctors treatment history; e) life history in the commonly used tin (lead) pot drinking history, or particularly like a history of drug addiction, solvent and so on; f) the patient's mental state, emotional, interpersonal, etc., from which to consider whether the poison murder, the possibility of suicide. B.1.2 Get clues from the sign Detailed physical examination, which may be found for acute poisoning clues, for example; a) exhaled breath of the special smell. organophosphorus pesticide garlic smell, vulcanized odor of hydrogen sulfide, organic solvent aroma, Methanol or alcohol, etc .; b) sweating degree. sweat found in sodium pentachlorophenate, dinitrophenol, organophosphorus pesticides and other acute poisoning; sweat seen in the proposed Pyrethroids, carbamate pesticide poisoning; no sweat seen in atropine poisoning; c) hair loss. seen in thallium, chloroprene and other poisoning; d) mucosal and skin color. purple brown, and systemic hypoxia symptoms lighter, should consider methemoglobinemia; lips Cheeks were cherry red, seen in some acute carbon monoxide poisoning; e) pupil. shrink seen in acute organophosphorus pesticides, carbamate pesticides, morphine sleeping pills poisoning; In the atropine category, methanol poisoning; both sides of the size of different morphological changes seen in acute toxic encephalopathy; f) oral ulcers, gum erosion. seen in acute mercury poisoning, oral corrosive poison; g) limb pain, limbs were gloves socks-like abnormalities, pain, soles of the feet feel sensitive, may be associated with movement disorders, Common in acute poisoning caused by multiple peripheral neuropathy. B.1.3 Get clues from laboratory tests From the laboratory or other auxiliary examination of the results can not be initially diagnosed with the disease to explain, should consider whether the acute Poison may be, from which to obtain clues. B.1.4 Obtain a clue that may be poisoned from a field investigation. B.2 Get the basis of etiology B.2.1 According to the above may be the cause of acute poisoning clues to explore the cause, that is, the pathogen species. a) from the scene of the ambient air, suspicious disease of food, containers, water, earth chemicals and other materials, the determination of toxic Varieties and their contents; b) determining the toxicant species and their contents from the patient's biological material; c) Determination of toxicants and their contents from other materials and samples, depending on the circumstances. B.2.2 Through investigation, the time, cause, route of ingestion and possible dose of the drug are obtained. B.2.3 analysis of the above situation, to determine the patient has the basis for the absorption of toxic substances, access to a clear etiology of information. B.3 establish the diagnosis B.3.1 Obtain a clear etiology based on B2. B.3.2 Complete clinical data, especially the nature and severity of major target system (organ) damage, Change the situation. B3.3 comprehensive analysis to arrive at the causal relationship between the cause (poison) and the disease. The analytical method can be found in GBZ 71. B3.4 do a differential diagnosis, to prevent "prosecution", "indiscriminate". Appendix C. (Normative appendix) The common cause of acute occult poisoning C.1 Occupational factors Acute occupational poisoning is classified as a concealed poison in the following cases. C.1.1 operators do not understand the toxic contact in the production, poisoning can not provide contact with toxic conditions. Such as the production of plastic Water contains organic solvents, and workers do not understand, in the work did not pay attention to protection and poisoning. Leather adhesive in the amount of benzene content of 90 %, While the provider lied to toluene, resulting in short-term occurrence of benzene poisoning caused by severe aplastic anemia. C.1.2 contact with the original material that is non-toxic, due to chemical reactions and produce toxic substances, such as ferrosilicon ore water solution generated phosphorus Hydrogen, arsenic-containing arsenic, etc., after poisoning can not provide the exact contact poison species. C.1.3 As a result of occupational exposure to indirect poisoning, such as the use of poison poisoning uniforms, cleaning of toxic substances, Protective equipment, etc., after the work is not completely clean poison and pollution caused by family members of acute poisoning. C.1.4 due to scientific research, industrial and agricultural production does not pay attention to environmental protection, so that air, water, soil pollution by occupational poison, Is caused by the majority of residents occurred in one of the main causes of occult poisoning. C.2 Food contamination C.2.1 poison directly contaminated food, edible people do not know and poisoning, such as pesticides contaminated vegetables, fruits, soaking pesticides Seeds processed as food and so on. C.2.2 Toxic poisoned poultry, livestock or fish that have been contaminated with toxicants, such as Minamata disease in Japan. C.2.3 Contains foods and beverages containing poisons, such as low-grade tin pots (containing high lead content). Caused by lead colic and so on. C.2.4 misuse of poisons as condiments, starter, etc., such as sodium nitrite as salt, sodium fluorosilicate as baking soda, Ethylene glycol mistaken for beverages and so on. C.2.5 consumption of inappropriate items, such as Jiangxi "Mouth disease" is due to consumption of cotton oil without proper heating; consumption of "flowers Gun salt "caused by thallium poisoning and so on. C.3 Water pollution C.4 Air pollution C.5 abuse of poison With poison applied to clothes, bedding, etc., as insecticides, disinfectants, absorbed by the skin poisoning. C.6 poisoning with earth, remedies or other drugs, such as the use of lead-containing soil medicine treatment of epilepsy, with arsenic, mercury and soil treatment of silver Disease and so on. C.7 iatrogenic factors Such as mistakenly red Seoul washed milk, sodium nitrite as a saline enema and so on. C.8 murder With the poison murder, the victim unknowingly poisoned. ......

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