Contents 1 Pinyin 2 1 Overview 3 2 Investigation and treatment of poisoning incidents 4 3 Collection and detection of poisoning samples 5 4 Treatment in the hospital 6 5 Termination of emergency response 7 Attachment 1. Qualitative and semi-tracheal examination Quantitative determination of oxygen in the air 8 Attachment 2. Portable oxygen detector for quantitative determination of oxygen in the air 9 Attachment 3. Portable methane detector for quantitative determination of methane in the air 1 Pinyin
jí xìng dān chún zhì xī xìng qì tǐ zhòng dú shì jiàn wèi shēng yìng jí chù zhì jì shù fāng àn
The "Technical Plan for Health Emergency Response to Acute Simple Asphyxiating Gas Poisoning Incidents" was issued by the Ministry of Health on July 6, 2011. [2011]Issued No. 94.
Health emergency response technical plan for acute simple asphyxiating gas poisoning events
Simple asphyxiating gas refers to a gas that reduces the oxygen content in the air due to its presence, causing the body to suffocate due to lack of oxygen. Common ones include: methane, carbon dioxide, nitrogen, inert gases, water vapor, etc. Acute simple asphyxiating gas poisoning refers to a systemic disease mainly caused by damage to the central nervous system after inhaling a large amount of simple asphyxiating gas in a short period of time. 2 1 Overview
Methane (CH4) is a colorless, odorless flammable gas that is difficult to dissolve in water; carbon dioxide (CO2), also known as dry ice, is a colorless and odorless gas that is soluble in water. Water is heavier than air; nitrogen (N2) and inert gases (including helium, neon, argon, krypton, and xenon) are colorless, odorless gases that are difficult or slightly soluble in water.
The acute toxic effects of simple asphyxiating gases are mostly caused by the increase in simple asphyxiating gases in the air within a short period of time, resulting in a decrease in the oxygen content in the air. When the oxygen content in the air drops below 16, people can develop symptoms of hypoxia; when the oxygen content drops below 10, varying degrees of consciousness disorders and even death can occur; when the oxygen content drops below 6, sudden death can occur. After people inhale carbon dioxide with a concentration of about 8 to 10%, they will have obvious symptoms of poisoning.
Simple asphyxiating gases enter the human body through inhalation of the respiratory tract. Common exposure opportunities include: cleaning pulp tanks, sedimentation tanks, wine tanks, cesspools, molasses tanks, sewers, manure pits, cellars, etc.; construction site pile wells , shafts, mines, etc.; production of soft drinks, beer and other beverages, dry ice, fire extinguishing agents, fermentation industry; acetylene, hydrogen, synthetic ammonia and carbon black, nitromethane, monochloromethane, methylene chloride, chloroform, carbon disulfide, tetrachloride, etc. Chemical synthesis of carbon chloride, hydrocyanic acid and other substances; gas phase flushing of reaction towers/kettles, storage tanks, cylinders and other containers and pipelines, etc. 3 2 Investigation and treatment of poisoning incidents
2.1 Personal protection of on-site personnel
During on-site rescue, we must first ensure the safety of staff, and at the same time take necessary measures to avoid or reduce the impact on public health. further harm. On-site rescue and investigation work requires the cooperation of more than 2 people. When entering a severely hypoxic environment (such as an environment where coma/dead cases or dead animals occur, or the oxygen level is quickly detected below 18 on site), a self-contained air breathing apparatus (SCBA) must be used and an oxygen gas alarm must be worn; entry is open In an environment with good ventilation and rapid on-site detection of oxygen levels higher than 18, there is generally no need to wear personal protective equipment. On-site disposal personnel must wear safety belts (ropes) and carry communication tools when conducting rescue and investigation underground, at the bottom of pools, tunnels, warehouses, and tanks. There are no special requirements for wearing protective clothing during on-site rescue and investigation work.
Medical rescue personnel do not need to wear protective equipment when treating poisoned patients in the on-site medical area.
2.2 Investigation of Poisoning Incident
After investigators arrive at the poisoning scene, they should first understand the general situation of the poisoning incident. The on-site investigation content includes on-site environmental conditions, meteorological conditions, ventilation measures, production process and other related information, and on-site air methane, carbon dioxide, and oxygen concentrations are measured as early as possible; if necessary, toxic gases such as carbon monoxide, hydrogen sulfide, and nitrogen oxides are measured to ensure Determine whether it is mixed gas poisoning. At the same time, suggestions are made to the on-site command on the control measures at the incident site (such as ventilation, cutting off the air source, etc.), personal protection of rescuers, on-site isolation belt setting, personnel evacuation, etc. Investigate poisoned patients and related personnel to learn about the incident, the time, place, and method of exposure to the poison, the number, name, gender, type of work of the poisoned person, the main symptoms and signs of poisoning, laboratory examinations, and rescue procedures. At the same time, learn more about relevant information from the clinical treatment unit (such as the rescue process, clinical treatment information, laboratory test results, etc.). Keep good records of the on-site investigation data. It is best to take on-site photos, audio recordings, video recordings, etc. Evidence collection materials must have the signature of the person under investigation.
2.3 Detection of on-site air methane, carbon dioxide, and oxygen concentrations
It is necessary to detect the oxygen content of on-site air as soon as possible. The detection method is recommended to use the oxygen gas detection tube method or a portable oxygen detector ( Annex 1 and Annex 2).
If the hypoxic environment is suspected to be caused by methane, it is recommended to use a portable methane detector to measure the concentration of methane in the air (Appendix 3).
If the hypoxic environment is suspected to be caused by carbon dioxide, it is recommended to use non-spectral infrared gas analysis to quantitatively measure carbon dioxide in the air. (See GBZ/T160.28.32004)
2.4 Confirmation and Identification of Poisoning Incidents
2.4.1 Confirmation Standards for Poisoning Incidents
The following three points must be met at the same time, It can be confirmed as an acute simple asphyxiating gas poisoning event:
a) The poisoned patient has the opportunity to be exposed to simple asphyxiating gas;
b) The poisoned patient appears to have damage to the central nervous system within a short period of time The main clinical manifestations are that severe patients often die suddenly;
c) Air sampling at the poisoning site simply increases the concentration of asphyxiating gases and decreases the oxygen content.
2.4.2 Identification of poisoning events
Differentiate from acute carbon monoxide poisoning events, acute hydrogen sulfide poisoning events, etc. Simple asphyxiating gas poisoning sites are often accompanied by harmful gases such as carbon monoxide and hydrogen sulfide. Other harmful gases that may be produced should be detected at the site to exclude or determine poisoning events caused by mixed gases such as hydrogen sulfide and carbon monoxide.
2.5 On-site medical rescue
The primary measure for on-site medical rescue is to quickly move the patient away from the poisoning site to fresh air, take off contaminated clothes, loosen collars, and keep the respiratory tract open. , and keep warm. When a large number of poisoned patients appear, injury classification should be carried out first, and red label patients should be treated first.
2.5.1 On-site injury classification
a) Red mark, one of the following indicators: disorder of consciousness; convulsions; cyanosis.
b) Green label, those with the following indicators: headache, dizziness, fatigue, palpitation, chest tightness, etc.
c) Black mark, those with the following indicators at the same time: loss of consciousness, no spontaneous breathing, disappearance of aortic pulse, and dilated pupils.
2.5.2 On-site medical rescue
For red label patients, it is necessary to maintain resuscitation, inhale oxygen, and immediately establish intravenous access. When repeated convulsions occur, promptly take symptomatic support measures. After green label patients leave the environment, no special treatment will be given temporarily and changes in condition will be observed.
2.5.3 Patient transfer
After on-site first aid treatment, poisoned patients should be transferred to the local general hospital or poisoning treatment center as soon as possible.
4 3 Collection and detection of poisoning samples
3.1 Selection of samples to be collected
At the scene of a poisoning emergency, air samples are the first choice to collect. In addition, other types of samples that should be collected can be determined based on the results of on-site investigations of poisoning incidents.
3.2 Sample collection method
3.2.1 Sample collection for on-site rapid testing
On-site oxygen and methane rapid detection equipment in the air are equipped with gas collection devices , can be measured directly on site. See the instrument manual for sampling methods.
On-site measurement of carbon dioxide: According to the instructions, directly take the air sample into the non-dispersive infrared analyzer for measurement.
3.2.2 Method for collecting carbon dioxide laboratory testing samples
Use a double-connected rubber ball to pour the on-site air sample into an aluminum-plastic gas collection bag with a volume of 0.5L to 1L. After letting it go, pump in the on-site air again, repeat this 5 to 6 times, then fill the air sampling bag with the air sample, seal the gas sampling port and bring it back to the laboratory for measurement.
3.3 Laboratory Recommended Methods
Determination of carbon dioxide in the air by non-spectral infrared gas analysis of carbon monoxide and carbon dioxide. (See GBZ/T160.28.32004) 5 4 Treatment in the hospital
4.1 Patient handover
After the poisoned patient is sent to the hospital, the reception of the poisoned patient and the transfer personnel will be responsible for the relationship between the poisoned patient and the hospital. Transfer the information and sign for confirmation.
4.2 Diagnosis and diagnostic grading
The treating doctor will inquire about the history of the poisoned patient or his attendants, conduct a physical examination and laboratory examination on the poisoned patient, confirm the diagnosis of the poisoned patient, and conduct Diagnostic grading.
Diagnostic grading
a) Observation object
Symptoms such as headache, dizziness, palpitations, nausea, and fatigue may disappear after inhaling fresh air.
b) Mild poisoning, one of the following:
i Obvious headache, dizziness, excitement, irritability, chest tightness, difficulty breathing, cyanosis;
ii Mild to moderate impairment of consciousness.
c) Severe poisoning, one of the following:
i coma;
ii ??convulsions;
iii sudden death.
4.3 Treatment
After the receiving hospital confirms the diagnosis and grades the poisoning patients received, the patients will be sent to different departments for further treatment according to the severity of the condition. Observation objects can be kept under observation, patients with mild poisoning can be hospitalized, and patients with severe poisoning can be given immediate monitoring and rescue treatment.
4.3.1 Reasonable oxygen therapy
Poisoned patients should be given reasonable oxygen therapy as soon as possible. Generally, nasal cannula or mask can be used to provide oxygen. Severe patients can undergo hyperbaric oxygen therapy if conditions permit.
4.3.2 Prevent and treat cerebral edema
a) Dehydrating agent: rapid intravenous infusion of mannitol can be given. If renal insufficiency occurs, glycerol-fructose can be intravenously infused together with mannitol. Use alternately.
b) Diuretics: Furosemide (furosemide) is generally given, and the dosage and course of treatment are determined according to the condition.
c) Adrenal glucocorticoids: should be used early, in appropriate amounts, and for short periods of time.
4.3.3 Other symptomatic and supportive treatment
Strengthen nutrition, reasonable diet, pay attention to water, electrolyte and acid balance, prevent and treat secondary infections, improve cell metabolism, and promote brain cell function recovery , closely monitor the functions of the heart, lungs, brain and other organs, and provide corresponding treatment measures in a timely manner. 6 5 Termination of emergency response
The risk sources of the poisoning incident and related risk factors have been eliminated or effectively controlled, no new poisoning patients have appeared, and the condition of the original patients has been stable for more than 24 hours.
7 Appendix 1. Qualitative and semi-quantitative determination of oxygen in the air by tracheal tube method
1 Scope of application
This method is suitable for detection using the corresponding detection range when oxygen deficiency is suspected. tube to detect oxygen concentration in gas samples. The methods are qualitative and semi-quantitative determination.
2 Principle
It is made by filling a porous granular carrier soaked with appropriate reagents in a glass tube. When the measured gas passes through the tube at a certain flow rate, the measured group A color reaction occurs with the reagent, and the concentration of the gas to be measured is determined based on the color depth of the colored compound or the discoloration length of the packed column. The color changes of gas tubes with different reaction principles are different. Please refer to the manual of the gas tube.
3 Important parameters of the method
3.1 Measurement range: 1~21.
3.2 Accuracy: When tested with a test gas with a concentration below 1/3 of the measurement range, the relative error of the measured value is within ±35; when tested with a test gas with a concentration above 1/3 of the measurement range , the relative error of the measured value is within ±25.
3.3 Precision: RSD≤10.
3.3 Detection limit: 0.1.
3.4 Full measurement time: 15s to 3min.
3.5 Working temperature: 20℃～50℃.
3.6 Environmental humidity (RH): ≤85.
4 Reagents and instruments
Tracheal tube and sampler.
5 Operation steps
5.1 When using a gas rapid detection tube, you must use the matching means to sample. A gas detection tube has multiple detection tubes with different measurement concentration ranges. During application, detection tubes with different measurement concentration ranges can be selected according to on-site conditions.
5.2 Cut off the two ends of the detection tube and seal them.
5.3 Insert the detection tube into the air inlet of the sampler, paying attention to the air inlet direction.
5.4 Pull the sampler to collect 100ml of gas. When the color change indicated in the detection tube stops, the data can be read from the scale indicated on the color column.
6 Quality Control
6.1 The gas detection tube must be used in strict accordance with the instruction manual, especially the sampling time and the validity period of the gas detection tube.
6.2 When observing the detection tube, the light should be sufficient, use a light-colored background, and compare with the unused detection tube.
6.3 When collecting gas, pull the sampler with even force to ensure that the reaction interface of the gas detection tube is clear and uniform, and the reaction interface is linear. 8 Appendix 2. Portable oxygen detector to quantitatively measure oxygen in the air
1 Scope of application
This method is suitable for detecting gas samples in the presence of oxygen using sensors with corresponding ranges. Medium oxygen concentration. The method is quantitative determination.
2 Principle
Built-in sampling pump and plug-in electrochemical sensor. The gas undergoes an oxidation-reduction reaction on the electrochemical sensor to generate a corresponding electronic signal, and the oxygen concentration is estimated by recording the intensity of the electrical signal.
3 Necessary performance and parameter conditions of the instrument
3.1 Measuring range: 0~30.
3.2 Instrument error: ≤5 (full scale).
3.3 Response time: ≤30s.
3.4 Real-time display of concentration.
3.5 high contrast digital display, high brightness LED indicator light and buzzer alarm.
3.6 Sensor life: ≥2 years.
3.7 Automatic calibration and zeroing.
3.8 Fully functional automatic self-test after booting.
3.9 Safety: The whole machine is explosion-proof.
3.10 Power supply: Rechargeable battery, can work continuously for more than 10 hours.
3.11 Battery life: ≥18 months.
3.12 Working temperature: 20℃～50℃.
3.13 Ambient humidity (RH): 15~99, no condensation.
3.14 has data output function.
4 Optional performance and parameter conditions of the instrument
4.1 A variety of gas sensors can be used.
4.2 Audio and visual alarm, optional vibration alarm.
4.3 Programmable to automatically send out alarms.
4.4 It has a built-in sampling pump and a gas sampler to collect on-site samples and bring them back to the laboratory for further analysis.
4.5 Equipped with data collector for continuous monitoring.
5 Measurement
Follow the instructions.
Calibration and zeroing.
6 Precautions
6.1 The electrochemical sensor has a certain validity period and should be replaced regularly even if it is not used.
6.2 Pay attention to the battery life and charge it in time.
6.3 Strictly follow the instructions and use standard gas for calibration regularly.
6.4 Pay attention to the response time and zero return time of the instrument. 9 Appendix 3. Quantitative determination of methane in the air with portable methane detector
1 Scope of application
This method is suitable for the determination of methane in ambient air. The method is quantitative determination.
2 Principle
Using infrared sensor technology.
3 Main parameters
3.1 Built-in sampling pump.
3.2 Measuring range: (0~100) Combustible gas concentration of methane gas.
3.3 Instrument resolution: 0.1 methane.
3.4 Sensor life: ≥5 years.
3.5 Response time: ≤30s.
3.6 Real-time display of concentration, time statistical weighted average, and short-term exposure average.
3.7 High contrast digital display, high brightness LED indicator light and buzzer alarm.
3.8 Automatic calibration and zeroing.
3.9 Fully functional automatic self-test after booting.
3.10 Power supply: It can work continuously for more than 12 hours on a single charge.
3.11 Battery life: ≥18 months.
3.12 Working temperature: 20℃～50℃.
3.13 Environmental humidity (RH): 5~90.
3.14 The whole machine is explosion-proof.
3.15 has data output function.
124 Optional performance and parameter conditions of the instrument
4.1 A variety of gas sensors can be used.
4.2 Audio and visual alarm, optional vibration alarm.
4.3 Programmable to automatically send out alarms.
4.4 It has a built-in sampling pump and a gas sampler to collect on-site samples and bring them back to the laboratory for further analysis.
4.5 Equipped with data collector for continuous monitoring.
5 Measurement
Follow the instructions.
Calibration and zeroing.
6 Precautions
6.1 The electrochemical sensor has a certain validity period and should be replaced regularly even if it is not used.
6.2 Pay attention to the battery life and charge it in time.
6.3 Strictly follow the instructions and use standard gas for calibration regularly.