Leikin J B, Kaufman D, Lipscomb J W, Burda A M, Hryhorczuk D O
Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
Am J Emerg Med. 1990 Nov;8(6):534-7. doi: 10.1016/0735-6757(90)90158-v.
Five patients presented to the emergency department (ED) following exposure in an enclosed space to methylene chloride (dichloromethane), used for removing paint. Two workers and three rescuers were involved. Two rescuers complained only of dizziness and mild nausea, and were subsequently discharged from the ED. One rescuer was asymptomatic. Worker no. 1 arrived in cardiac arrest and eventually died in the ED despite resuscitation efforts. Worker no. 2 also presented to the ED in cardiac arrest, and was successfully resuscitated to pulse and blood pressure. However, he never regained consciousness or spontaneous respirations, and died on the fourth day. Of interest is that worker no. 2's carboxyhemoglobin level increased from 2% to 8% over the 9 hours following admission, despite administration of 40% to 50% oxygen by endotracheal tube. Among the conclusions that can be drawn are (1) the cause of death in these patients was not carbon monoxide poisoning, but solvent-induced narcosis; (2) carboxyhemoglobin levels may continue to rise following cessation of exposure, despite administration of high flow oxygen; (3) rescuers can easily become victims if proper protective clothing and respirators are not worn.
五名患者在封闭空间接触用于去除油漆的二氯甲烷后被送往急诊科。涉及两名工人和三名救援人员。两名救援人员仅抱怨头晕和轻度恶心，随后从急诊科出院。一名救援人员无症状。1号工人到达时心脏骤停，尽管进行了复苏努力，最终仍在急诊科死亡。2号工人也在心脏骤停的情况下来到急诊科，并成功复苏至有脉搏和血压。然而，他从未恢复意识或自主呼吸，于第四天死亡。有趣的是，2号工人入院后的9小时内，尽管通过气管插管给予了40%至50%的氧气，其碳氧血红蛋白水平仍从2%升至8%。可以得出的结论包括：（1）这些患者的死因不是一氧化碳中毒，而是溶剂引起的麻醉；（2）尽管给予高流量氧气，接触停止后碳氧血红蛋白水平可能继续上升；（3）如果不穿戴适当的防护服和呼吸器，救援人员很容易成为受害者。
