Broken Freezer

I was on call all night last night and I had several cool patients admitted to my service. There were 3 guys all between 19 and 25 years old who work for a manual labor pool. They report each day to work and take whatever assignments they get and go work for the day. When I was in high school my parents made me work for a labor pool so I am familiar with the miserable nature of this job. These 3 strangers were chosen to work for a large meat warehouse that had a giant walk in freezer break and had tons of spoiled meat to get rid of, I told you these jobs suck. Maybe this is why I stayed in school but I would never admit this because that would only give my parents the sweet feeling of success and I am not ready to relinquish my angst yet. 

These guys reported to the job and worked all day long hauling out thawed, spoiling carcasses out to a dumpster. They had to mop up the blood and clean the freezer inside and out. Several times during the day they all complained of headaches and fatigue and some nausea but they did not think too much of the symptoms, being young macho men they figured it was nothing and continued to work through the symptoms. They finished their job and collected their pay and left to go cash their checks. My patient, a 19 year old male, made it home and had a near syncopal event and fell to the floor. His mother knew something was wrong and forced him to go to the hospital. He worked his way through the ER with some vague symptoms but was ultimately admitted due to his decreased cognitive function. He was having difficulty remembering things and at one point forgot where he was. He was worked up for the flu and some of the more common culprits and then admitted to my service. 

Once I got my hands on him and spoke with his mother in great detail it was not long before we had tied his onset of symptoms to his work activities in the freezer. I spoke with some of my senior residents and we decided to run a carbon monoxide level on him. A normal city/suburban dwelling non-smoker will have an average carbon monoxide level of 2-3%. A person with a chronic lung disease will have a level of 5-9% or so and a smoker will have a level of 10-15%. An average non-smoker will start having symptoms at 15% and get sick at much higher than that and if exposure continues the person can progress to expiration. My patient's carbon monoxide levels came back at 29%. He was lucky that he did not die.  We had been treating him with oxygen therapy and when we confirmed the carbon monoxide poisoning we put him in the hyperbaric treatment that our facility is fortunate enough to have and his symptoms resolved. 

We figured that the motor that was part of the broken freezer was leaking carbon monoxide into the freezer which was a closed space and the workers were exposed to toxic levels. The funny thing is that our facility is one of the few in the area to have a hyperbaric chamber and the other 2 workers had similar symptoms that had progressed and they each separately went to separate hospitals where it was determined that they had carbon monoxide poisoning. They were transfered to our facility to have the hyperbaric treatment. Today it was like a labor pool party as the 3 reunited and complained about their horrible job. We all had some good laughs when I told them some of my war stories from my days on the labor pool circuit. They did not believe that I had worked at a labor pool but when I started in on some of my experiences they soon realized I was the real deal. You can't make this stuff up. 

The good news is that all 3 patients were cured and discharged for home and should do ok but may have some short term cognitive difficulties with memory etc. They will return to base line and it will be nothing more than a funny story. They were fortunate. I have to go now, my car is running in the garage, I am warming it up so I can take a nap in it.....