Cable G G, Doherty S
Emergency Department, Tamworth Base Hospital, New South Wales, Australia.
Aviat Space Environ Med. 1999 Jan;70(1):68-72.
Agricultural pilots are involved in a particularly hazardous occupation with a high occupational mortality rate. They face many risks, not least of which is exposure to the agricultural chemicals that they spray. Many accidents and illnesses have been reported previously in the literature, attributable to the acute and chronic effects of chemical exposure, most notably the organophosphate family of insecticides. There are few reports of post-crash exposure to carbamate and organochlorine insecticides. This report documents the case of a professional agricultural pilot who, following an emergency landing, was soaked with Methomyl (a carbamate) and Endosulfan (an organochlorine) leaking from his aircraft. He developed cholinergic symptoms within an hour of the accident, which settled spontaneously, but suffered a tonic-clonic seizure some 6 h later while in the hospital. The seizure was attributed to exposure to the organochlorine, however, subsequent EEG recordings demonstrated a non-specific epileptiform focus in the frontal lobes. The pilot made a full recovery and has remained seizure-free without treatment. The pathophysiology of carbamate and organochlorine poisoning is reviewed, and the differential diagnoses of seizures in this pilot discussed. The difficulty facing a licensing authority in determining the aeromedical disposition of a pilot who has suffered a provoked seizure is also highlighted.
农业飞行员从事的是一种特别危险的职业，职业死亡率很高。他们面临许多风险，其中尤其包括接触他们所喷洒的农用化学品。此前文献中已报道了许多事故和疾病，归因于化学物质接触的急性和慢性影响，最显著的是有机磷类杀虫剂。关于坠机后接触氨基甲酸酯类和有机氯类杀虫剂的报道很少。本报告记录了一名职业农业飞行员的案例，他在紧急迫降后，被从其飞机泄漏的灭多威（一种氨基甲酸酯）和硫丹（一种有机氯）浸湿。事故发生后一小时内他出现了胆碱能症状，这些症状自行缓解，但约6小时后在医院时发生了强直阵挛性癫痫发作。癫痫发作归因于有机氯接触，然而，随后的脑电图记录显示额叶有非特异性癫痫样病灶。该飞行员完全康复，未经治疗也未再发作癫痫。本文回顾了氨基甲酸酯类和有机氯类中毒的病理生理学，并讨论了该飞行员癫痫发作的鉴别诊断。还强调了执照颁发机构在确定患有诱发性癫痫发作的飞行员的航空医学处置时所面临的困难。
