Occupational diseases caused by the impact of physical factors.

Vibration disease is caused by a prolonged (not less than 3-5 years) exposure to vibration in production conditions. Vibrations are divided into local (from hand tools) and general (from machine tools, equipment, moving machines). The impact of vibration is found in many professions.

Pathogenesis: chronic microtraumatism of peripheral vegetative formations, perivasquilary plexuses with subsequent disturbance of blood supply, microcirculation, biochemistry and tissue trophism.

The clinical picture is characterized by a combination of vegetovascular, sensitive and trophic disorders. The most characteristic clinical syndromes are angiodystonic, angiospastic (Raynaud's syndrome), vegetosensory polyneuropathy. The disease develops slowly, after 5-15 years from the beginning of the work associated with vibration, with the continuation of the work the disease grows, after the cessation slow (3-10 years), sometimes incomplete recovery is noted. Conditionally distinguish 3 degrees of the disease: initial manifestations (I degree), moderately expressed (II degree) and expressed (III degree) manifestations. Typical complaints: pain, paresthesia, chilliness of the limbs, whiplash or cyanosis of the fingers when cooling, reducing strength in the hands. With the increase in the disease, headache, fatigue, and sleep disturbance are added. When exposed to general vibration, complaints of pain and paresthesia in the legs, lower back, headache, dizziness prevail.

Objective signs of the disease: hypothermia, hyperhidrosis and swelling of the hands, cyanosis or paleness of the fingers, attacks of "white" fingers, arising during cooling, less often during work. Vascular disorders are manifested in the hypothermia of the hands and feet, spasm or atony of the capillaries of the nail bed, a decrease in the arterial blood flow to the hand. There may be cardialgia. It is mandatory to increase the thresholds of vibration, pain, temperature, less often tactile sensitivity. Disturbance of sensitivity has a polyneuric character. As the disease increases, segmental gipalgesia, gipalgesia on the legs are revealed. Symptoms of the muscles of the limbs, tightness or flabbiness of individual areas are noted.

On the radiographs of brushes, often glandular enlightenment, small islets of compaction or osteoporosis. With prolonged (15-25 years) exposure to general vibration, degenerative-dystrophic changes in the lumbar spine, complicated forms of lumbar osteochondrosis are often detected.

Characteristics of the main syndromes of vibration disease. Peripheral angiodystonic syndrome (I degree); Complaints of pain and paresthesia in the hands, chill fingers. Unclear hypothermia, cyanosis and hyperhidrosis of the hands, spasms and atony of the capillaries of the nail bed, a moderate increase in the thresholds of vibration and pain sensitivity, a decrease in the skin temperature of the hands, a slow recovery of it after a cold sample. Strength, muscle endurance is not changed.

Peripheral angiospastic syndrome (Raynaud's syndrome) (I, II degree) is pathognomonic for the impact of vibration. Disturb attacks of finger whitening, paresthesia. As the disease increases, whitening extends to the fingers of both hands. The clinical picture outside the attacks of whitening of the fingers is close to angiodystonic syndrome. The capillarospasm predominates.

Syndrome of vegetosensory polyneuropathy (II degree) is characterized by diffuse pains and paresthesias in the hands, less often the legs, a decrease in pain sensitivity according to the polyneuric type. Vibration, temperature, tactile sensitivity is reduced. Reduced strength and endurance of muscles. As the disease grows, vegetative and sensitive disorders are revealed on the legs. Attacks and whitening of the fingers become more frequent and lengthen. Developed dystrophic disorders in the muscles of the arms, the shoulder girdle (myopathy). The structure of EMG changes, the rate of excitation is slowed down by motor fibers of the ulnar nerve. Often, asthenia, a vasomotor headache, are revealed. Vibration disease of grade III is rare, leading to the syndrome of sensorimotor polyneuropathy. Usually it is combined with generalized vegetovascular and trophic disorders, expressed by cerebration.

Vibration disease should be differentiated from Reynaud's syndrome of another etiology, syringomyelia, polyneuropathy (alcoholic, diabetic, medicinal, etc.), vertebrogenic pathology of the nervous system. . Treatment. Temporary or permanent cessation of contact with vibration. Effective combination of medicament, physiotherapy and reflex treatment. Ganglion blockers - halidor, bupatol, vasodilators - drugs of nicotinic acid, sympatholytics, drugs that improve trophic and microcirculation system are shown: ATP, phosphadene, compliance, tran-tal, quarantil, injections of B vitamins, injections of humisol. Chamber galvanic baths with the emulsion of naphthalan oil, electrophoresis of novocaine, papain or heparin on the hand, diathermy, UHF or UFO on the cervical sympathetic nodes, diadynamic currents, ultrasound with hydrocortisone, massage, exercise therapy are effective. Hyperbaric oxygenation is indicated. Widely used resort factors: mineral waters (radon, hydrogen sulphide, iodide-bromine, nitrogen thermal), therapeutic mud.

The work ability of patients with vibration disease of the first degree remains for a long time; Preventive treatment is recommended once a year with a temporary transfer (for I -2 months) to work without exposure to vibration. Patients with vibration disease II and especially III degree should be transferred to work without vibration, cooling and overstretching of the hands; They are prescribed repeated courses of treatment. At grade II patients remain able-bodied in a wide range of occupations. At the third degree, the professional and general ability to work of patients is steadily reduced.

Prevention is the use of so-called vibro-safe tools, adherence to optimal working conditions. During interchangeable breaks, self-massage and warming of hands are recommended (dry-air thermal baths). The courses of preventive treatment are shown (1-2 times a year).

Professional hearing loss (cochlear neuritis) - gradual reduction of hearing acuity due to long (many years) exposure to industrial noise (mainly high-frequency noise). A high degree of deafness is found in blacksmiths, boiler-makers, cutters, chasers, copper workers, and airmen. In Russia, the maximum permissible level of industrial noise is 80 dB.

Pathogenesis. Due to chronic microtraumatization, neurovascular and dystrophic changes in spiral (corti) organ and spiral ganglion are formed.

Clinical picture. Complaints about gradually worsening hearing, noise in the ears, while there is a bad audibility of whisper speech (with good perceptual conversations). The lesion is usually bilateral. When examined, the otoscopic picture is not changed. There are three degrees of severity of the disease. For the I degree is characterized by an easy hearing loss (whisper is perceived at a distance of up to 4 m), at grade II there is a moderate hearing loss (whisper perception up to 2 m). III degree differs a significant decrease in hearing (whisper is perceived at a distance of 1 m or less). Prolonged exposure to intense industrial noise when combined with intensive work can be a risk factor in the development of nonspecific reactions of the nervous and cardiovascular systems, which take the form of neurotic disorders, neurocirculatory dystonia.

When diagnosing it is necessary to take into account the work experience and the intensity of the impact noise, the nature of the development of hearing loss, the data of otoscopy and audiometry, the data of preliminary and periodic medical examinations, a differential diagnosis should be made with cochlear neuritis of a different etiology, with otosclerosis.

The treatment is aimed at improving the functional state of the labyrinth receptors. Prescribe drugs that improve cerebral hemodynamics (stegeron, cavinton, komplamin, prodektin, trental), drugs that improve cellular and tissue metabolism (vitamins B1, B6, B12, A, E, ATP), biostimulants (aloe extract, FBS, humisol, apilac ). To improve the conductivity of nerve impulses appoint dibazol, galantamine, proserin; Hopinolytiki (atropine, platifillin). Noise in the ears decreases with the reception of belloid, bellataminal. Assign endoauric electrophoresis of a solution of nicotinic acid, galantamine, proserin; Recommended acupuncture. Contraindicated preparations hundred-toxic action (streptomycin, monomitsin, gentamycin, etc.).

At I and II degrees of hearing loss, work capacity remains intact; Outpatient treatment courses are recommended. With a significant decrease in hearing (grade III) and at grade II, whose work requires good hearing (for example, aircraft engine testers), it is recommended to transfer to work without the influence of intense noise, rational employment.

Prevention. The use of antinoise liners, headphones, helmets. Diseases caused by exposure to non-ionizing radiation. Non-ionizing radiation includes electromagnetic radiation (EMR) of the radio frequency range, permanent and alternating magnetic fields (PMP and PeMP), electromagnetic fields of industrial frequency (EMPH), electrostatic fields (ESP), laser radiation (LI). Often the action of non-ionizing radiation is accompanied by other production factors that contribute to the development of the disease (noise, high temperature, chemicals, emotional-mental stress, light flashes, eye strain).

Clinical picture. Acute impact occurs in extremely rare cases of gross violation of street safety techniques that serve powerful generators or laser installations. Intense EMR causes the thermal effect first of all. Patients complain of malaise, pain in the limbs, muscle weakness, fever, headache, face redness, sweating, thirst, impaired cardiac activity. There may be observed diencephalic disorders in the form of attacks of tachycardia, tremors, paroxysmal headache, vomiting.

In acute exposure to laser radiation, the degree of damage to the eyes and skin (critical organs) depends on the intensity and spectrum of radiation. The laser beam can cause opacification of the cornea, iris burn, lens, followed by the development of cataracts. A retinal burn leads to the formation of a scar, which is accompanied by a decrease in visual acuity. The above lesions of the eyes with laser radiation do not have specific features.

Lesions of the skin by a laser beam depend on the radiation parameters and are of a very diverse nature; From functional shifts in the activity of intradermal enzymes or mild erythema at the site of irradiation to burns reminiscent of electrocoagulation burns in electric shock, or rupture of the skin.

In modern production conditions, occupational diseases caused by exposure to non-ionizing radiation are chronic. The leading place in the clinical picture of the disease is occupied by functional changes in the central nervous system, especially its vegetative divisions, and the cardiovascular system. There are three main syndromes, asthenic, astenovegetative (or neurocirculatory dystonia syndrome of the hypertonic type) and hypothalamic.

Patients complain of headache, fatigue, general weakness, irritability, short temper, reduced efficiency, sleep disturbance, pain in the heart. Characterized by arterial hypotension and bradycardia. In more pronounced cases, vegetative disorders associated with increased excitability of the sympathetic part of the autonomic nervous system and manifested by vascular instability with hypertensive angiospastic reactions (instability of arterial pressure, pulse lability, brady- and tachycardia, general and local hyperhidrosis) are added in more pronounced cases. Possible the formation of various phobias, hypochondriacal reactions. In some cases, a hypothalamic (diencephalic) syndrome develops, characterized by so-called sympathetic-adrenal crises.

Clinically, there is an increase in tendon and periosteal reflexes, tremor of the fingers, a positive symptom of Romberg, oppression or enhancement of dermographism, distal hypoesthesia, acrocyanosis, a decrease in cutaneous temperature. With the action of PMP, polyneuritis can develop, under the influence of electromagnetic fields of microwave cataract.

Changes in peripheral blood are nonspecific. There is a tendency to cytopenia, sometimes mild leukocytosis, lymphocytosis, decreased ESR. There may be an increase in hemoglobin, erythrocytosis, reticulocytosis, leukocytosis (EEPH and ESP); Reduction of hemoglobin (with laser radiation).

Diagnosis of lesions from chronic exposure to non-ionizing radiation is difficult. It should be based on a detailed study of working conditions, an analysis of the dynamics of the process, a comprehensive examination of the patient.

Treatment is symptomatic. The prognosis is favorable. With a decrease in working capacity - a rational job placement, it is possible to go to VTTC.

Prevention: improving technology, compliance with sanitary regulations, safety.

Diseases associated with work in conditions of high atmospheric pressure. Under industrial conditions, exposure to increased atmospheric pressure a person is exposed to diving, caisson work, underwater houses, and working in compression chambers. There are three groups of occupational diseases: the first is associated with the effects on the body of general pressure drops (decompression, or caisson, disease, barotrauma of the lungs, ear); The second is due to the change in the partial pressure of gases (narcotic effect of indifferent gases, oxygen poisoning); The third - nonspecific lesions associated with the peculiarities of human labor in water and other causes (cooling, overheating, poisoning with various substances).

Decompression disease is associated with insufficiently slow decompression, as a result of which there is no release of body fluids from inert gases (nitrogen, helium, etc.); This leads to the formation of free gas bubbles in tissues and liquid media, disruption of metabolic processes and aeroembolism. With a mild form, the first symptoms appear in 2-4 and even after 12-24 hours or more after decompression. There are skin itching, rashes on the skin, muscle and joint pain, general malaise, increased heart rate and breathing. The severe form that developed during the decompression or the first minutes after the end of the period is characterized by a sharp pain in the joints, muscles and bones, a feeling of restraint and pain in the chest, paralysis of the limbs, impaired blood circulation and breathing, loss of consciousness.

The main clinical features distinguish articular, vestibular, neurological and pulmonary forms of the disease. Repeated transfer of mild forms of decompression damage can lead to the formation of chronic lesions in the form of necrotic foci, infarcts, abscesses and other disorders in various organs.

Treatment. Carrying out a therapeutic recompression, before which continuous oxygen inhalation is recommended. Drug therapy - according to the indications.

Barotrauma of the lungs is characterized by rupture of lung tissue, gas entering the bloodstream and development of gas embolism. Perhaps the development of pneumothorax, the penetration of gases into the mediastinal fiber and abdominal cavity. With severe lesions, pleuropulmonary shock. Clinically, pain in the chest, allocation of bloody foam from the mouth, hemoptysis, cough, shortness of breath, tachycardia, speech disorders, convulsions.

Treatment. Conducting therapeutic recompression with the maximum permissible rate of pressure increase. Removal of air from the pleural cavity, analgesic mixtures, cardiac agents. Barotrauma of the middle ear is expressed in the change of the tympanic membrane - from hyperemia to rupture. There is a feeling of pressure on the ears, their stiffness, there are stitching, sometimes unbearable pain, radiating to the temporal region, on the cheek. Tinnitus, deafness and a sense of noise can continue for hours even after the pressure stops.

Treatment. Toilet external auditory canal, analgesics, local heat, instillation in the nose of a solution of ephedrine, antibiotics.

Narcotic effect of indifferent gases. When diving to a depth of more than 40 m with the use of compressed air for breathing, there may come a so-called nitrogen anesthesia (a condition similar to alcohol intoxication), probably due to the high partial nitrogen pressure and the accumulation of carbon dioxide in the body.

First aid with initial signs of narcotic effects of nitrogen - stopping work under pressure and performing decompression.

Oxygen poisoning can occur in two forms. With pulmonary form, shortness of breath, cough, severe chest pain when inhaling, stiff breathing, dry and wet wheezing, inflammation and pulmonary edema, respiratory failure. When the central nervous system is affected, there is a decrease in sensitivity and numbness in the tips of the fingers and toes, drowsiness, apathy, auditory hallucinations, and visual impairment. Cramps are possible by the type of epileptic attack.

Medical measures are reduced to lifting the victim, switching to breathing air; Rest, warmth, symptomatic therapy (anticonvulsant and antibacterial drugs).

The prognosis for mild forms is favorable. Expressed forms and persistent violations of the central nervous system, chronic diseases of the osteoarticular system, as well as the heart and blood vessels lead to a decrease and even a disability. Prevention: strict compliance with the safety requirements of divers, caissons and other professionals associated with work in conditions of increased barometric pressure; Medical selection and re-examination of divers in accordance with instructive and methodological guidelines of the Ministry of Health of the USSR.

When climbing to a height, a pathological condition, called mountain, or altitude sickness, can develop. Its formation is mainly due to a lack of oxygen. The first signs of the disease are dizziness, general weakness, drowsiness, visual impairment, coordination of movements, nausea, vomiting. There are nasal bleeding, tachycardia, tachypnea. The duration of the adaptation period is determined by the height. It takes 1-2 months to fully adapt. However, at an altitude of 3-4 km, even with full adaptation, the performance of heavy physical work causes difficulty.

Treatment. Inhalation of oxygen or its mixture with air. Prevention. Proper professional selection. Gradual training for oxygen starvation, compliance with established instructions. Abundant use of acidified and vitaminized liquid.

Diseases caused by exposure to microclimate hot shops. Among the enterprises that have a high air temperature are hot shops at metallurgical, machine-building and chemical, glass and other plants. As a result of a long supply of a large amount of heat into the body, there is a violation of thermoregulation, the so-called thermal damage.

The pathogenesis of thermal damage includes: vegetative-endocrine disorders, metabolic disorders with the formation of toxic products and the violation of water-salt metabolism-dehydration and hypochloremia.

There are three types of thermal damage: acute, subacute and chronic. Acute lesions of mild degree are characterized by general weakness, lethargy, drowsiness, headache, nausea, increased respiration and pulse, subfebrile temperature; The skin is wet and cool to the touch. At moderate severity, in addition to the noted complaints, there is a brief loss of consciousness. Skin is hyperemic, moist. Pulse and breathing are frequent, the body temperature reaches 40-41 ° C. The severe degree develops gradually or suddenly: loss of consciousness or psychomotor agitation, nausea, vomiting, convulsions, involuntary defecation and urination, paresis, paralysis, coma; Sometimes - stop breathing. Skin hyperemic, moist (sticky sweat), hot. Body temperature 42 g. C and higher; Tachycardia (120-140 in 1 min), tachypnea (30-40 in 1 mip); Hypotension, collapse.

Subacute thermal lesions that occur during prolonged stays in conditions of high external temperature without disturbing the processes of thermoregulation in the body are manifested in dehydration, convulsive and mixed forms. The first is characterized by temperature instability, general weakness, weakness, headache, dizziness, sweating, shortness of breath, tachycardia, oliguria, fainting, vomiting. A characteristic feature of the second form is a convulsive syndrome (periodically arising painful cramps of various muscle groups, more often legs, faces, sometimes turning into general convulsions). The mixed form is more often observed. In severe cases find: sunken eyes, surrounded by dark circles, sunken cheeks, pointed nose, cyanotic lips. Skin pale, dry, cold to the touch. Tachycardia. Hypotension. In the blood - erythrocytosis, leukocytosis, increased amount of hemoglobin, hypochloraemia. Oliguria, hypochloruria.

For chronic heat damage, the following syndromes or their combinations are characteristic: neurasthenic (with a dystonia of the autonomic nervous system); Anemic (with a moderate decrease in the number of erythrocytes, leukocytes, hemoglobin and reticulocytosis); Cardiovascular (tachycardia, pulse lability, shortness of breath, lowering of maximum blood pressure, ECG-signs of myocardial dystrophy); Gastrointestinal (dyspeptic disorders, dull pain in the epigastric region after eating, gastritis, enteritis, colitis).

Treatment. Hydroprocedures. In light cases, a warm shower (26-27 ° C) for 5-8 minutes, with pronounced forms - a bath (29 ° C) for 7-8 minutes followed by a shower (26 ° C). In the absence of showers and baths - wet wraps for 10-15 minutes, cold on the head, plenty of drink until thirst quenched. Full rest. Intravenous introduction of isotonic solution of chloride of nutria, glucose, plasma. Oxygenotherapy. Symptomatic treatment.

The prognosis is favorable in the absence of residual phenomena in the form of disturbances in the functions of the nervous system (paresis, paralysis, mnestico-intellectual disorders, etc.).

Prevention: measures of a sanitary and technical nature aimed at improving microclimate conditions in hot shops, rational mode of work and rest; Means of individual protection, drinking and food regime.