Learning about a new toxic inhalation

It’s been quite a while since Yale

Some of my knowledge went stale

For I’ve never been tried

On chlorine dioxide

When it comes to the stuff you inhale.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

This town depends on forest products and, to a lesser extent, mining.   Felled trees get trucked or floated to the industrial area just outside of town, to get sawn at the lumber mill or chopped and bleached at the pulp mill.  The wood useful for neither process gets burned as biofuel at an electric plant.

The pulp mill operates 50 weeks per year, with a two-week shut down at the end of each summer for preventive maintenance and cleaning. The usual work force gets supplemented by short-term workers and contractors with their crews.

The cadre of workers may have experience, but all change involves chaos, and from chaos comes hurt.

Today, I saw a patient who had inhaled chlorine dioxide, ClO2, referred to by its local name, clowtwo (rhymes with crow brew) the day before, and gave me permission to write a good deal more than I have.

Decades ago, I worked in a town that relied on the meat-packing business. That industry requires a lot of refrigeration, which in turn depends on ammonia.  We did a lot of workman’s compensation medicine at the time, and one day I had four workers brought in simultaneously for ammonia inhalation, from a refrigerant leak.

Had I been asked, I would have diverted all 4 patients to the Emergency Room, but I hadn’t had the chance. I immediately had one nurse start oxygen, another nurse call for 2 ambulances, and a third nurse inject steroids.

When I called the ER to request a transfer, I could say, honestly, that they were breathing just fine and wondering why I was so worried. By the time they arrived at the emergency room, all 4 were starting to drown in their own fluids.  They all survived, after close to a week in the ICU.

I dealt effectively with a tough situation because I had read up on the effects of ammonia on the lungs beforehand, and I knew how dangerous it could be.

In this case, I knew a good deal more about chlorine inhalation, because of its use in WWI, but I didn’t know about chlorine dioxide and I hadn’t read up on it. The patient helped me along as I clicked my way through the Net, giving me the benefit of his experience.



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