Health Hazards of SolventsCase Study #2

James E. Cone MD, MPH and

Karen Packard, RDH, MSThis presentation is made possible by a grant from the

Association of Occupational and Environmental Clinics and the National Institute for Occupational Safety & Health.

Case 2 24 year old male

electrical parts manufacturing plant worker entered a vapor degreasing tank to clean, noted dizziness and fell unconscious to bottom of tank.

Co-worker tried to lift him out of tank. He also began feeling dizzy and climbed out of the tank.

Case 2 5-8 minutes delay until paramedics arrived

Paramedics in SCBA and protective clothing lifted patient out of tank.

Initial examination at scene of index case: cyanotic, pulseless, no spontaneous respirations

MSDS revealed 1,1,1-trichloroethane

1,1,1-trichloroethane levels measured in the bottom of tank = 20,000 ppm.

Measured oxygen levels in tank were low due to displacement by solvent vapor.

Case 2 Intubated, and CPR initiated. Initial electrocardiogram is shown next:

Laboratory: O2 Saturation reducedAST 36 (0-35), ALT 44 (0-35)CPK, CPK-MB and troponin all normal

Case 2 Ongoing symptoms reported in follow-up clinic visit:

– lightheadedness– trouble with speech, memory and sleep

disturbance. – Shortness of breath on exertion, wheezing.

Nightmares about the incident.

Physical Examination: - Normal except wheezing on forced expiration,

abnormal mental status (Digit span forward = 6, reverse=4).

Case 2

Neuropsychological testing. Decreased grip strength on left. Otherwise normal.

PFTs : FVC 5.48 (116% of predicted), FEV1 4.48 (114%), FEV1/FVC 84%.

Methacholine challenge: Increased responsiveness to methacholine.

Psychiatric evaluation: Fear, tension, anxiety, recurrent ruminations and dreams about incident, with anger and depression.

Case 2

What diagnoses does this suggest?

Is the patient disabled?

His vocation rehabilitation counselor asks whether he would be a good candidate to be a floor refinisher? What do you say?

What recommendations would you give to the employer?

Case 2 His diagnosis includes:(1) s/p cardiopulmonary arrest due to solvent

intoxication and likely acute asphyxiation in degreasing tank

(2) reactive airways disease most likely due to acute solvent overexposure

(3) post-traumatic stress disorder (PTSD)

He is unlikely to be able to return to his prior employment as a vapor degreaser. He should avoid future exposures to respiratory irritants or solvents. Thus, he would not be a good candidate to be a floor refinisher.

Recommendations to employer: Confined space program.