Case files of the university of cincinnati fellowship in medical toxicology: Two patients with acute lethal occupational exposure to hydrogen sulfide

Abstract

We are presenting cases of 2 employees of a chemical plasticsmanufacturing plant who experienced acute, brief, inhalationalexposure to lethal concentrations of hydrogen sulfide in a con-fined space. Eight other coworkers not present in the immediateexposure area also presented to local health care facilities withmild complaints of headache, nausea, and dizziness, but they suf-fered no significant sequelae.Patient #1 was a 55-year-old man who, while working in a con-fined space, uncoupled a nozzle from a steam pipe, collapsedwithin one minute, and suffered cardiopulmonary arrest. He had aprior history of asthma, hyperlipidemia, coronary artery disease,and was taking lisinopril, aspirin, and lipitor. Following chest com-pressions and rescue breathing, both by on-scene responders andEMS, the patient’s blood pressure was 210/110 mmHg, the pulsewas 100 bpm, and ventilation was assisted at 14/minute. On exam-ination, the patient was minimally combative, with a Glasgowcoma score of 6 (E1, V1, M4), with pupils 3mm bilaterally and reac-tive to light. The patient had a small partial-thickness burn to theright chest, presumed to be a thermal burn from steam or the hotpipe. No cyanosis or pulmonary crackles were noted. Because of res-piratory distress, the patient was intubated on-scene using fentanyl,diazepam, and vecuronium by the combined nurse-physician Air EMS flight team. Post-intubation vital signs were as follows:blood pressure 130/69 mmHg, pulse 95 bpm, respirations 14/min(assisted), and oxygen saturation 98% on 100% FiO