FEDERAL SERVICE FOR SUPERVISION IN THE FIELD OF PROTECTION
CONSUMER RIGHTS AND HUMAN WELL-BEING

In order to implement clause 1.6 of Appendix N 6 to the order of the Ministry of Health of the Russian Federation of May 28, 2001 N 176 "On improving the system for investigating and recording occupational diseases in the Russian Federation" (registered with the Ministry of Justice Russian Federation July 27, 2001, registration N 2828), as well as in order to improve the system of investigation and accounting occupational diseases

I order:

1. Approve the instructions for compiling the sanitary and hygienic characteristics of the working conditions of an employee if he is suspected of having an occupational disease (Appendix).

2. Heads of departments Federal Service on supervision in the field of consumer protection and human well-being in the constituent entities of the Russian Federation, for railway transport:

2.1. Inform the institutions of Rospotrebnadzor, medical and preventive organizations, other interested organizations about the implementation of the instructions;

2.2. Use the instructions when compiling the sanitary and hygienic characteristics of the working conditions of an employee if he is suspected of having an occupational disease.

3. To impose control over the execution of this order on the Deputy Head of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare L.P. Gulchenko.

Supervisor
G. Onishchenko

Registered
at the Ministry of Justice
Russian Federation
April 22, 2008
registration N 11577

Application. Instructions for compiling a sanitary and hygienic characteristic of the working conditions of an employee if he is suspected of having an occupational disease

Application

APPROVED
order of the Federal Service
on supervision in the field of protection of rights
consumers and human well-being
dated March 31, 2008 N 103

1. This instruction defines the procedure for collecting information and drawing up a sanitary and hygienic characteristic of the working conditions of an employee if he is suspected of having an occupational disease (hereinafter referred to as the sanitary and hygienic characteristic).

2. The sanitary and hygienic characteristics of working conditions are compiled by the Office of Rospotrebnadzor for the constituent entity of the Russian Federation or its structural divisions(hereinafter - management), as a rule, within 7 days, but no later than 2 weeks from the date of receipt of a notice of an acute disease (poisoning), and within 2 weeks from the date of receipt of a notice of a chronic disease.

3. The sanitary and hygienic characteristic is compiled in 4 copies in the form N 362-1 / y-01, signed by management specialists, approved by the chief state sanitary doctor subject of the Russian Federation and certified by a seal.

One copy of the sanitary and hygienic characteristic is sent (issued) to the medical organization that sent the notice, one copy - to the employer, one - to the employee or his representative against signature; one copy is kept in management.

4. If necessary (lack of information, laboratory and instrumental data, contact with similar harmful factors at other places of work, etc.), the department that assesses working conditions for compiling a sanitary and hygienic characteristic requests additional documents or a sanitary and hygienic characteristic ( sanitary and epidemiological conclusion) at a different place (places) of work.

5. In the case of establishing a preliminary diagnosis of an occupational disease (poisoning) in an employee after cessation of contact with harmful factors production environment(late silicosis, tuberculosis, malignant tumors, etc.) and the inability to provide data on working conditions (liquidation of a workshop, site, organization, reconstruction, lack of documents on the quantitative characteristics of harmful factors), other documents are used (extract from work book, briefing magazines, links to literary reference materials according to the quantitative characteristics of the factors of the production environment and the labor process for similar industries, professions, etc.), confirming the presence of harmful production factors and their quantitative characteristics.

During the liquidation of the workplace, workshop, site, organization, it is possible to model the working conditions of an employee, reference to literary reference materials on the quantitative characteristics of the factors of the working environment and the labor process for similar industries, and other information.

6. The description of the working conditions of the employee (clause 4 of the characteristics) is drawn up on the basis of job duties and the sanitary and epidemiological characteristics of working conditions (sanitary and epidemiological conclusion for production) directly at the workplace, information received from the employer (or his representative) and the employee, other.

The sanitary and hygienic characteristic is compiled taking into account the preliminary diagnosis of an occupational disease (poisoning).

AT without fail the characteristics of the leading and all concomitant harmful factors of the working environment and the labor process, work regimes that could lead to occupational disease (poisoning) are indicated.

Concentrations and levels of harmful production factors (qualitative and quantitative indicators) are indicated on the basis of documents of bodies and organizations authorized to carry out state control(supervision) in the field of ensuring sanitary and epidemiological well-being obtained in the course of state sanitary and epidemiological supervision, protocols of laboratory and instrumental studies when issuing a sanitary and epidemiological conclusion for production, products, incl. conducted by research institutes and testing centers accredited in the prescribed manner.

Quantitative characteristic harmful factor the working environment should be presented in dynamics for the maximum possible period of work in this profession.

7. In the absence of data from laboratory and instrumental studies, the department instructs the Federal State Health Institution - the Center for Hygiene and Epidemiology of Rospotrebnadzor to conduct such studies at the workplace.

8. The results of physiological studies are presented in the form of annexes to the sanitary and hygienic characteristics compiled in accordance with the current hygienic classification of factors in the working environment and the labor process.

The sanitary-hygienic characteristics list the means used personal protection, the presence of sanitary and epidemiological conclusions and note their actual use.

9. Items of the sanitary and hygienic characteristics of the working conditions of an employee in case of suspicion of an occupational disease (poisoning) from to are drawn up in accordance with the protocols of laboratory and instrumental studies and measurements of working environment factors and the provisions of the current sanitary legislation.

Paragraph 18 of the sanitary and hygienic characteristics is drawn up in accordance with the current hygienic classification of factors in the working environment and the labor process.

Paragraphs 19-23 of the sanitary and hygienic characteristics are drawn up in accordance with the actual data obtained as a result of the sanitary and hygienic examination and the available information.

Paragraph 24 of the sanitary and hygienic characteristic gives an opinion on the working conditions of the employee on the basis of a general hygienic assessment of working conditions in accordance with the current sanitary legislation and taking into account the provisions of the current hygienic classification of factors in the working environment and the labor process. Reference is made to the attached additional documents and the results of studies, tests, assessments (protocols, acts, etc.).

10. Opinions, testimonies of the employee, witnesses, employer, which are drawn up on separate sheets indicating the identity document of these persons, may be attached to the sanitary and hygienic characteristic.



Electronic text of the document
prepared by CJSC "Kodeks" and verified according to.

Sanitary and hygienic characteristics of working conditions is one of the documents on the basis of which the issue of the relationship of the disease with professional work is decided.

The requirements for compiling a sanitary and hygienic characteristic of labor are regulated by the Instruction for compiling a sanitary and hygienic characteristic of the working conditions of a worker who is suspected of having an occupational disease (Resolution of the Ministry of Health of the Republic of Belarus dated 08.08.2000 No. 33 “On the procedure for conducting mandatory medical examinations workers"). They boil down to the following.

The sanitary-hygienic characteristic is compiled by the territorial center of hygiene and epidemiology at the request of medical institutions.

The following have the right to request a sanitary and hygienic characteristic: the medical unit of the enterprise where the sick person worked; a medical institution providing medical care to a sick person; republican and regional centers of occupational pathology.

The sanitary and hygienic characteristic is compiled within 30 calendar days from the date of receipt of the request and is issued in 3 copies on the letterhead of the TsGiE. The first copy of the characteristic is issued to the requesting institution, the second - to the personnel department of the enterprise, the third - is stored in the CGIE file.

The sanitary and hygienic characteristic is prepared on the basis of a detailed act of examining working conditions with the involvement of the enterprise administration. The refusal of the administration to participate in the compilation of the characteristics must be specified in the act. The worker on whom the characteristic is drawn up, at his request, can be acquainted with it.

When compiling the sanitary and hygienic characteristics, materials from research, medical institutes, laboratories of the Central Geological and Environmental Engineering are used, industrial enterprises and other organizations. In the event of liquidation, re-profiling of the enterprise where the sick person worked, other documents are provided confirming belonging to a profession associated with harmful working conditions (extract from the work book, etc.). The state of the working conditions of the sick person and other information are described for similar industries with reference to literature data on the quantitative characteristics of the factors of the working environment and the labor process and are drawn up in the form of an "Information note".

The sanitary and hygienic characteristics consistently provide the following information:

Surname, name, patronymic of the employee; year of birth; profession, position; institution, enterprise; departmental affiliation;

Workshop (site, workshop); total work experience, in a given profession, in a given workshop (section, department, workshop);

Characteristics of the factors of the labor process; quantitative characteristics of the leading factor;

Quantitative characteristics of concomitant harmful factors of the production environment; description labor activity;

List of harmful factors of the working environment and the labor process;

With what harmful factors of the production environment did you have contact before: a list of factors, at which enterprise, the duration of contact (according to the worker, other materials);

Chronometric data (the duration of the factor during the shift); personal protective equipment and their use.

The description of the work activity of the employee is given on the basis of familiarization of the hygienist with official duties and the nature of the worker's work directly at the workplace and takes into account information received from the administration and the worker himself.

A list of harmful production factors and their quantitative characteristics are given. The results of laboratory-instrumental studies of sanitary and hygienic laboratories of the Center for Geological and Environmental Evolution, enterprises and other organizations are used.

The results of the research should be given with reference to the institution that measured the level of the harmful factor, indicating the timing of the research. Additionally, other materials may be involved, including acts of investigation of cases of occupational diseases working in the surveyed area, information reported by the sick, which are confirmed by representatives of the administration or working in this area.

The quantitative characteristic of the harmful factor of the working environment should be presented in dynamics for the maximum possible period of this profession.

The leading factor of the working environment and the labor process is the one that poses the greatest danger to the health of the worker. Its description is given in full. Contributing factors are listed and, if possible, quantified.

In the absence or insufficiency of the results of laboratory and instrumental studies, the Center for Geological and Epidemiological Studies conducts additional measurements at the workplace of the sick person.

Chronometric data are presented in the form of the time of action of a harmful factor on a worker during a shift. If the work performed is unequal in different shifts, a different time period is chosen - a month, a year.

representative body to replace one type of PPE, provided for by established standards, with another, equivalent in terms of protective properties. For example, a cotton overall can be replaced by a cotton suit or dressing gown and vice versa, a cotton suit can be replaced by semi-overalls with a shirt (blouse) or sundress with a blouse and vice versa, etc.

In cases where such PPE as a safety belt, dielectric galoshes and gloves, goggles and shields, a respirator, a gas mask, a protective helmet, a balaclava, a mosquito net, a helmet, shoulder pads, elbow pads, self-rescuers, antiphons, plugs, noise-protective helmets, light filters, vibration protection gloves, etc.,

not included in industry or model norms(further

norms), they are issued to employees to ensure their safety, depending on the nature of the work performed on the basis of the requirements of regulatory legal acts on labor protection (rules, standards, etc.) with a wear period - until worn out or on duty.

tenant on account own funds may provide for collective agreement, employment contract issuance of PPE to employees in excess of the established norms.

The procedure for issuing and storing personal protective equipment. PPE issued to employees should be appropriate to the nature and conditions of their work and ensure labor safety.

In accordance with the resolution State Committee Republic of Belarus on standardization, metrology and certification dated July 30, 2004 No. 35 “On expanding the range of products subject to mandatory certification” it is not allowed to purchase PPE for issuance to employees without a certificate of conformity.

Acceptance from suppliers of each batch of PPE should be carried out with a check of their quality and compliance with the requirements of standards, specifications, others normative documents on labor protection. In case of non-compliance with the requirements of regulatory documentation, PPE must be returned with the presentation of appropriate claims in the prescribed manner.

PPE is the property of a business entity and is subject to return: upon dismissal of an employee before the end of the wear period, upon transfer at the same enterprise to another job for which the issued personal protective equipment is not provided for by the norms.

The terms for wearing personal protective equipment are set on a calendar basis and are calculated from the day they are actually issued to employees, and for special clothing and special footwear from low temperatures, the specified time period also includes the time of its storage in the warm season.

The issuance and delivery of PPE by employees is noted in a personal card of the established form.

Used PPE is issued to other workers only after it has been washed, dry-cleaned, disinfected and repaired. The term of their socks is set depending on the degree of wear and is entered in a personal card. Employees are prohibited from taking out PPE outside the territory of a business entity at the end of work.

The employer is obliged not to allow the performance of work without the use of the necessary PPE by the employees; organize proper care of PPE (timely dry-clean, wash, repair, decontaminate, decontaminate, neutralize and dedust); replace or repair PPE that has become unusable before the expiration of the established wearing period for reasons beyond the control of the employee (such replacement is carried out on the basis of an appropriate act drawn up with the participation of a representative of the trade union or an authorized labor collective); provide regular, in accordance with deadlines, testing and checking the serviceability of PPE (respirators, gas masks, self-rescuers, safety belts, dielectric gloves, etc.), as well as the timely replacement of filters, glasses and other parts with reduced protective properties, when issuing such personal protective equipment, instruct on the rules of use and the simplest ways to check the serviceability of these tools, if necessary, training workers in their use.

After the PPE test, a mark (stamp, stamp) should be made on the timing of the next test.

Dry cleaning, washing, repair, decontamination, decontamination, neutralization and dedusting of PPE are carried out by the employer.

Control over the fulfillment by the employer of the requirements of these Rules is carried out by the Department state inspection labor under the Ministry of Labor and Social Protection of the Republic of Belarus, other bodies of state supervision and control. Public control is carried out by trade unions.

Scroll: Decree of the Ministry of Health of the Republic of Belarus dated April 11, 2012 No. 34 On the establishment of the form "Sanitary and hygienic characteristics of working conditions"

On the establishment of the form "Sanitary and hygienic
characteristics of working conditions "

On the basis of paragraph 2 of the Resolution of the Council of Ministers of the Republic of Belarus dated March 1, 2012 No. 200 "On amendments and additions to the Resolution of the Council of Ministers of the Republic of Belarus dated January 15, 2004 No. 30" and subparagraph 8.32 of paragraph 8 of the Regulations on the Ministry of Health of the Republic of Belarus, approved Decree of the Council of Ministers of the Republic of Belarus dated October 28, 2011 No. 1446 “On certain issues of the Ministry of Health and measures to implement the Decree of the President of the Republic of Belarus dated August 11, 2011 No. 360”, Ministry of Health of the Republic of Belarus
DECIDES:
1. Set the form "Sanitary and hygienic characteristics of working conditions" in accordance with the appendix.
2. This resolution comes into force after its official publication.

Minister V.I. Zharko

Application
to the decision
Ministry of Health
The Republic of Belarus
11.04.2012 № 34

Sanitary and hygienic characteristics of working conditions*
No. _________ from ______________

Chief physician of the territorial CGE __________________________
(signature, full name)

________________
* The sanitary and hygienic characteristics of working conditions are drawn up by the territorial center of hygiene and epidemiology at the written request of a healthcare organization. To establish an acute occupational disease, items 1, 2, 3, 4, 5.1, 6, 11, 13 are filled in.
** Indicate information about the organizations that conducted the tests, the date and number of the protocols. If archival or literary data are used, indicate the source, year. In the absence or insufficiency of the results of laboratory and instrumental studies of factors in the working environment, the territorial center of hygiene and epidemiology conducts additional measurements at the workplace of the sick person. Additionally, other materials can be used, incl. acts of investigation of cases of occupational diseases of workers in the surveyed area, information reported by the sick person himself, which is confirmed by representatives of the administration or working in this area, including data on working conditions for the previous working period, and in the absence of such, data on working conditions at similar workplaces at present time.

In bases it is referred to non-normative documents.

SANITARY AND HYGIENIC CHARACTERISTICS OF WORKING CONDITIONS.

Currently, he is a disabled person of the 3rd group. In the past, he worked as a sinker in a mine for 22 years, where he had constant contact with vibration, heavy physical exertion, hypothermia, and noise. He worked with the SCL apparatus, weighing 19 kg (as well as an installation frame of 20 kg). He had constant contact with dust (sand), fan installations did not always work and not enough. Overalls were not provided. Working day 7 hours. Leave of 24 working days, always provided, usually in summer time. Work week 5 days. Category one. Currently works as a loading equipment operator (at the control panel). Wage 300 thousand rubles.

PROFESSIONAL ROUTE. After graduating from the 8th grade of a secondary school, he worked as a welder at a factory for 2 years (1968-1970). Then he served in the ranks of the Soviet Army (1970-74). After the army he worked for 22 years as a tunneller in a mine. Since February 1996, the 3rd group of disability has been registered for an occupational disease. From that time to the present, he has been working as a loading unit operator.

COMPLAINTS: pain in the hands, aching, increasing in the evening, numbness and decreased sensitivity of the fingers (pain, temperature, tactile), stiffness in the joints of the hands and toes, ankle joints. On the "goosebumps", cramps in the arms and legs (calf muscles). For a headache in the back of the head and crown of a permanent nature. On lumbar, aching pain, which intensifies after physical exertion. For hearing loss.

Complains of a feeling of heaviness in the epigastric region, belching and heartburn that occur 1-1.5 hours after eating.

Complains of a persistent cough, with discharge of mucopurulent sputum, a feeling of soreness and pain behind the sternum.

Complains of pain behind the sternum, compressive nature with irradiation to the left shoulder blade, and shortness of breath that occurs after physical exertion (rise to the 3rd floor), and is stopped by sublingual application of nitroglycerin.

ANAMNESIS OF THE PRESENT DISEASE. Considers himself ill since 1986, when he first noticed numbness, "goosebumps" of the fingers. On this occasion, he turned to the clinic at the place of work, where he was diagnosed with vegetative-vascular dystonia of the hypotonic type. Received sick leave for 3 days. Outpatient treatment was carried out (which he does not remember), the effect of which was not. Over the next 10 years, he noted a deterioration in his condition: numbness of the hands increased, pains appeared in the joints (elbows, shoulders), stiffness in the joints appeared; began to notice cramps in the calf muscles that occur at night. On this occasion, he regularly consulted a neuropathologist, where he was diagnosed with widespread osteochondrosis of the spine. In 1996 he was sent to the clinic of occupational diseases of the St. Petersburg State Medical Academy for a consultation due to the deterioration of his condition. The clinic was diagnosed with vibration disease (according to the patient). Treatment was carried out (what he does not remember), he noted a slight improvement in his condition. The 3rd group of disability was issued. He was transferred to another job with the payment of disability interest (60%). Over the past year, he has noted a deterioration in his condition: pain in the hands and headaches have intensified; notes an increase in blood pressure to 130/90 mm Hg. (up to a maximum of 180/110), lost 5 kg.

ANAMNESIS OF LIFE.

Education - secondary incomplete. Material and living conditions are unsatisfactory (there is no hot water in the house, heating is irregular in winter).

Habitual intoxication: smokes 10-15 cigarettes a day since the age of 22. Doesn't drink alcohol.

Allergic history: intolerance medicines and does not note household substances.

Epidemiological history: tuberculosis, sexually transmitted diseases, hepatitis, typhus and typhoid denies. Blood transfusions in 1992. There were no intramuscular, subcutaneous, intravenous injections in the last 6 months. Arrived from the city of Slantsy.

Past diseases: gastric ulcer, subtotal resection of the stomach according to Billroth 1 in 1992 (perforation of the stomach ulcer).

OBJECTIVE STUDY.

The patient's condition is satisfactory. The position is active. The physique is correct, there are no skeletal deformities. Height 175 cm, weight 60 kg. Subcutaneous fat is not expressed. The skin is of normal color, clean. Skin turgor is preserved, the skin is dry, elasticity is not reduced. Visible mucous membranes are pale pink.

SANITARY AND HYGIENIC CHARACTERISTICS OF WORKING CONDITIONS.

Currently, he is a disabled person of the 3rd group. In the past, he worked as a sinker in a mine for 22 years, where he had constant contact with vibration, heavy physical exertion, hypothermia, and noise. He worked with the SCL apparatus, weighing 19 kg (as well as an installation frame of 20 kg). He had constant contact with dust (sand), fan installations did not always work and not enough. Overalls were not provided. Working day 7 hours. Vacation 24 working days, always provided, usually in the summer. Working week 5 days. Category one. Currently works as a loading equipment operator (at the control panel). Salary 300 thousand rubles.

PROFESSIONAL ROUTE. After graduating from the 8th grade of a secondary school, he worked as a welder at a factory for 2 years (1968-1970). Then he served in the ranks of the Soviet Army (1970-74). After the army he worked for 22 years as a tunneller in a mine. Since February 1996, the 3rd group of disability has been registered for an occupational disease. From that time to the present, he has been working as a loading unit operator.

COMPLAINTS: pain in the hands, aching, increasing in the evening, numbness and decreased sensitivity of the fingers (pain, temperature, tactile), stiffness in the joints of the hands and toes, ankle joints. On the "goosebumps", cramps in the arms and legs (calf muscles). For a headache in the back of the head and crown of a permanent nature. On lumbar, aching pain, which intensifies after physical exertion. For hearing loss.

Complains of a feeling of heaviness in the epigastric region, belching and heartburn that occur 1-1.5 hours after eating.

Complains of a persistent cough, with discharge of mucopurulent sputum, a feeling of soreness and pain behind the sternum.

Complains of pain behind the sternum, compressive nature with irradiation to the left shoulder blade, and shortness of breath that occurs after physical exertion (rise to the 3rd floor), and is stopped by sublingual application of nitroglycerin.

ANAMNESIS OF THE PRESENT DISEASE. Considers himself ill since 1986, when he first noticed numbness, "goosebumps" of the fingers. On this occasion, he turned to the clinic at the place of work, where he was diagnosed with vegetative-vascular dystonia of the hypotonic type. Received sick leave for 3 days. Outpatient treatment was carried out (which he does not remember), the effect of which was not. Over the next 10 years, he noted a deterioration in his condition: numbness of the hands increased, pains appeared in the joints (elbows, shoulders), stiffness in the joints appeared; began to notice cramps in the calf muscles that occur at night. On this occasion, he regularly consulted a neuropathologist, where he was diagnosed with widespread osteochondrosis of the spine. In 1996 he was sent to the clinic of occupational diseases of the St. Petersburg State Medical Academy for a consultation due to the deterioration of his condition. The clinic was diagnosed with vibration disease (according to the patient). Treatment was carried out (what he does not remember), he noted a slight improvement in his condition. The 3rd group of disability was issued. He was transferred to another job with the payment of disability interest (60%). Over the past year, he has noted a deterioration in his condition: pain in the hands and headaches have intensified; notes an increase in blood pressure to 130/90 mm Hg. (up to a maximum of 180/110), lost 5 kg.

ANAMNESIS OF LIFE.

Education - secondary incomplete. Material and living conditions are unsatisfactory (there is no hot water in the house, heating is irregular in winter).

Habitual intoxication: smokes 10-15 cigarettes a day since the age of 22. Doesn't drink alcohol.

Allergological history: no intolerance to medicines and household substances.

Epidemiological history: tuberculosis, sexually transmitted diseases, hepatitis, typhus and typhoid denies. Blood transfusions in 1992. There were no intramuscular, subcutaneous, intravenous injections in the last 6 months. Arrived from the city of Slantsy.

Past diseases: gastric ulcer, subtotal resection of the stomach according to Billroth 1 in 1992 (perforation of the stomach ulcer).

OBJECTIVE STUDY.

The patient's condition is satisfactory. The position is active. The physique is correct, there are no skeletal deformities. Height 175 cm, weight 60 kg. Subcutaneous fat is not expressed. The skin is of normal color, clean. Skin turgor is preserved, the skin is dry, elasticity is not reduced. Visible mucous membranes are pale pink.

Musculoskeletal system. The general development of the muscular system is good, there is no pain when feeling the muscles. There are no bone deformities, no pain when feeling the joints. Joints of the usual configuration. Active and passive mobility in the joints in full. The shape of the skull is mesocephalic. The shape of the chest is correct.

The mammary glands are not enlarged, the nipple is without features. The pectoralis major muscle is palpable.

Lymph nodes: occipital, anterior and posterior cervical, submandibular, axillary, elbow, inguinal, popliteal, not palpable.

Thyroid not enlarged, soft elastic consistency. There are no symptoms of thyrotoxicosis.

The cardiovascular system. Pulse 80 beats per minute, rhythmic, relaxed, satisfactory filling. Same for right and left hand.

Palpation of the vessels of the extremities and neck: the pulse on the main arteries of the upper and lower extremities (on the brachial, femoral, popliteal, dorsal arteries of the foot, as well as on the neck (external carotid artery) and head (temporal artery) is not weakened. BP 130/100 mm. Hg St.

Palpation of the heart area: left apex beat 3 cm away from the midclavicular line in the fifth intercostal space, diffuse, increased length (about 3.5 cm).

Percussion of the heart: the limits of relative cardiac dullness

Percussion limits of absolute cardiac dullness

Auscultation of the heart: heart sounds are muffled, the ratio of tones is preserved at all points of auscultation. Weakened at the top, rhythmic. Systolic murmur is well audible at the apex and Botkin's point. It is not carried out on the vessels of the neck and in the axillary region.

Auscultation of large arteries revealed no murmurs. The pulse is palpated on the large arteries of the upper and lower extremities, as well as in the projections of the temporal and carotid arteries.

Respiratory system. The shape of the chest is correct, both halves are evenly involved in breathing. Breathing is rhythmic. Respiration rate 18 per minute.

Palpation of the chest: the chest is painless, inelastic, voice trembling is weakened over the entire surface of the lungs.

Percussion of the lungs: with comparative percussion of the lungs over the entire surface of the lung fields, a pulmonary sound with a box shade is determined.

Topographic percussion of the lungs:

The height of the tops of the lungs:

Mobility of the lung edges

right 4 cm

left 4 cm

Auscultation of the lungs: hard breathing, weakened in the lower parts of the lungs. Buzzing rales in lower parts.

With bronchophony, a weakening of the conduction of the voice in the lower parts of the lung fields was revealed.

Digestive system.

Examination of the oral cavity: the lips are dry, the red border of the lips is pale, the dry transition to the mucous part of the lip is pronounced, the tongue is moist, lined with a grayish coating. The gums are pink, do not bleed, without inflammation. The tonsils do not protrude beyond the palatine arches. The mucous membrane of the pharynx is moist, pink, clean.

STOMACH. Inspection of the abdomen: the abdomen is symmetrical on both sides, the abdominal wall does not participate in the act of breathing. On superficial palpation, the abdominal wall is soft, painless, and relaxed.

With deep palpation in the left iliac region, a painless, even, densely elastic consistency of the sigmoid colon is determined. The blind and transverse colon are not palpable. With approximate percussion, free gas and fluid in the abdominal cavity are not determined. Auscultation: normal intestinal peristalsis.

Stomach: the boundaries are not defined, there is a splash noise of visible peristalsis is not noted. There is pain on palpation in the epigastric region. Intestines. Feeling along the colon is painless, splashing noise is not detected.

Liver and gallbladder. The lower edge of the liver from under the costal arch goes 2 cm. The borders of the liver according to Kurlov 12.9.8. The gallbladder is not palpable. Symptoms of Mussy, Murphy, Ortner are negative. Frenicus symptom is negative. The pancreas is not palpable.

The spleen is not palpable, the percussion borders of the spleen are: upper in the 9th and lower in the 11th intercostal space along the midaxillary line.

genitourinary system. The kidneys and the projection area of ​​the ureters are not palpable, tingling in the lumbar region is painless. The external genital organs are developed correctly, the testicles are palpable in the scrotum, of a dense elastic consistency.

Neuropsychic status. Consciousness is clear, speech is intelligible. The patient is oriented in place, space and time. Sleep and memory preserved. Hearing loss, whispering speech from 2 meters. There is a decrease in pain and tactile sensitivity of the hands, similar to "short gloves". On the part of the motor sphere, no pathology was detected. Gait without features. Tendon reflexes are brisk. Shell symptoms are negative. The pupils are dilated and react to light.

STATUS LOCALIS: cold, dry hands. Distal hypoalgesia is revealed by the type of short gloves. Decreased temperature, tactile sensitivity. The muscle strength of the arms is significantly reduced. There is a symptom of a white spot.

PRELIMINARY DIAGNOSIS:

Vibration disease stage 2 from exposure to local vibration (vegetosensory polyneuropathy of the upper limbs of a professional nature from the complex impact of adverse production factors - vibration, physical stress, hypothermia).

Sensorineural hearing loss?

SURVEY PLAN.

1. clinical blood test

2. urinalysis

3. analysis of feces for worm eggs

4. Blood test F-50 and RW

5. biochemical analysis of urine: ALT, AST, CPK, LDH5, cholesterol, lipoproteins, creatinine, bilirubin, sodium, chlorine, potassium.

6. electrocardiography

7. echocardiography

8. X-ray of the chest in two projections (frontal and lateral)

9. Ultrasound of the abdominal organs (carefully the kidneys, liver)

10. Fibrogastroduodenoscopy and surgeon's consultation.

11. Consultation with a neurologist

12. ENT doctor's consultation

DATA OF INSTRUMENTAL AND LABORATORY STUDIES.

Data from laboratory studies :

Clinical blood test from 03/22/97

hemoglobin 146 g/l

erythrocytes 4.7 x 10 12 /l

color index 0.96

white blood cell count 3 x 10 9 / l

eosinophils 1

segmented 56

lymphocytes 35

monocytes 4

ESR 7 mm/h

Urinalysis 22.03.97.

color light yellow

acid reaction

specific gravity 1012

protein 0.033 g/l

leukocytes 1-2 in the field of view

fresh erythrocytes 0-2 in the field of view

squamous epithelium 1-3 in the field of view

Blood chemistry:

urea 6.4 - norm

creatinine 0.07 - norm

cholesterol 8.3 normal

bilirubin 10.88 - normal

ALT - 0.4 - normal

Electrocardiography from 22.03.97. RR=0.80,PQ=0.16, HR 0.34 QT 0.33, QRS 0.064

Conclusion: sinus rhythm with a frequency of 75 per minute. Indirect signs of initial hypertrophy of the left ventricle. Deterioration of coronary blood supply in the region of the posterior wall.

Ultrasound dated 03/23/97. The kidneys are of normal shape, the pelvicalyceal system is not dilated. Adrenals are normal.

Chest x-ray: on a chest x-ray in two projections (plain and left lateral x-ray), fresh focal and infiltrative changes in the lungs are not determined. The walls of the bronchi of medium caliber are thickened. The roots of the lungs are structured, not dilated, with petrificates. Pleural layers in the anterior sinus. The heart is not enlarged. The aorta is not changed.

ENT doctor's consultation: conclusion: deviated septum. Hearing loss was not found.

FINAL DIAGNOSIS.

Given the nature professional activity patient: had constant contact with vibration, physical overstrain, hypothermia for 22 years, one can suspect a vibration disease from exposure to local vibration. The presence of this pathology is also indicated by the characteristic complaints of the patient (pain in the hands, aching, increasing in the evening, numbness and decreased sensitivity of the fingers (pain, temperature, tactile), stiffness in the joints of the hands and toes, ankle joints. On "goosebumps", cramps in the arms and legs (calf muscles)), the dynamics of the disease (the disease developed after 10 years of work in these conditions, the symptoms steadily progressed), objective examination data (decrease in all vibration, tactile and temperature sensitivity and also pain sensitivity polyneuritic type). Based on these data, Raynaud's syndrome can be excluded, since there are no polyneuritic type sensory disturbances in it (especially a decrease in pain sensitivity). It is also possible to exclude the diagnosis of syringomyelia, which does not depend on the profession, there are no attacks of whitening of the fingers, there are no disorders of vibration and tactile sensitivity, with an isolated decrease in pain sensitivity according to the segmental type, there are also no changes in the internal organs.

The diagnosis of widespread osteochondrosis of the spine was made on the basis of the patient's complaints about: lumbar, aching pains that worsen after physical exertion. Pain in the cervical spine. Based on the data of an objective study: a decrease in active and passive mobility in the joints of the spine, pain on palpation of the spinous processes.

Diagnosis - peptic ulcer of the stomach, peptic ulcer of the anastomosis. Placed on the basis of the patient's complaints of aching pain in the epigastric region that occurs after eating, belching and heartburn, anamnesis data (suffers from gastric ulcer since 1986, in 1992 operated on for perforation of the gastric ulcer - subtotal resection of the stomach was performed, according to Billroth 1) , as well as an objective study: the tongue is coated with a grayish coating, local pain is detected on palpation in the epigastric region.

The diagnosis of coronary heart disease, angina pectoris FC 1 was made on the basis of the patient's complaints of pain behind the sternum, a compressive nature with irradiation to the left shoulder blade, and shortness of breath that occurs after exercise (ascent to the 3rd floor), and is stopped by sublingual use of nitroglycerin, based on an objective research - auscultation reveals muffled tones, systolic murmur at the apex and at the Botkin point.

The diagnosis of hypertension, stage 1, was made on the basis of the patient's complaints of headaches in the temporal region that occur after emotional stress, disappear after taking one tablet of Adelfan, and also on the basis of objective examination data - BP 130/100, during a headache attack 170 / 110.

FINAL DIAGNOSIS:

Vibration disease stage 2 from exposure to local vibration (vegetosensory polyneuropathy of the upper limbs of a professional nature from the complex impact of adverse production factors - vibration, physical stress, hypothermia).

Widespread osteochondrosis of the spine.

Stomach ulcer. Subtotal resection of the stomach according to Billroth 1 (in 1992). Peptic ulcer anastomosis.

Cardiac ischemia. Angina pectoris, 1 functional class.

Hypertension, 1 tbsp.

• Trental 1 tablet 3 times a day
• Pyridoxine 1 tablet 2 times a day
• UHF on the region of the cervical sympathetic nodes.
• Almagel 1 spoon before and after meals.

EXPERT SOLUTION.

Persistent, partial disability. Persistent disability, since vibration disease is not curable, and with continued contact with vibration, it tends to progress. Partial disability, because all work associated with vibration, heavy physical exertion, hypothermia is excluded. Also, the patient is contraindicated work in underground conditions. Can work as a locksmith, storekeeper, janitor.

STAGE EPICRISIS.

Patient Lytkin Mikhail Alekseevich was admitted to the Clinic of Occupational Diseases on March 20, 1997, due to the deterioration of his condition: increased pain in the hands, headaches; notes an increase in blood pressure to 130/90 mm Hg. (up to a maximum of 180/110), lost 5 kg. In the clinic, on the basis of complaints, objective examination, laboratory data, the diagnosis was made: Vibration disease stage 2 from exposure to local vibration (vegetosensory polyneuropathy of the upper extremities of a professional nature from the complex effects of adverse production factors - vibration, physical stress, hypothermia). Widespread osteochondorosis of the spine. Stomach ulcer. Subtotal resection of the stomach according to Billroth 1 (in 1992). Peptic ulcer anastomosis. Cardiac ischemia. Angina pectoris, 1 functional class. Hypertension, 1 tbsp.