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A: Taking an Exposure History
Pages 61-96

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From page 61...
... A Taking an Exposure History 61
From page 62...
... U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES '~ Public Health Service z AJAR Agency for Toxic Substances and Disease Registry - ~~ in conjunction with "~ Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health ENVIRONMENTAL MEDICINE
From page 63...
... Taking an Exposure History 1 63 ENVIRONMENTAL MEDICINE
From page 64...
... An exposure history form, completed by the patient in each scenario, provides clues that prompt the clinician to investigate the possibility of toxic exposure. Scenario 1: This patient is an accountant who has had the same job and residence for many years.
From page 65...
... . With practice using the exposure history form and a network of referrals, the primary care clinician can play an important role in detecting, treating, and preventing disease resulting from toxic exposures.
From page 66...
... Other skin disorders with exposure etiologies include pigment alerations, chbracne, urticana, and malignant neoplasrns. Alcohol abuse is a potential confounding factor in the evaluation of patients with suspected toxic exposure.
From page 67...
... Taking an Exposure History 5 67 ENVIRONMENTAL MEDICINE
From page 68...
... . (For further information on the health hazards of asbestos exposure, consult Case Studies in Environmental Medicine: Asbestos Toxicity, ATSDR, June 1990.)
From page 69...
... Taking an Exposure History 7 69 ENVIRONMENTAL MEDICINE
From page 70...
... Nitrates, a common contaminant of rural shallow wells, pose a risk of methemoglobinemia, especially to infants.(See ATSDR series Case Studies in Environmental Medicine: Asbestos Toxicity, June 1990; Arsenic Toxicity, June 1990; Lead Toxicity, Revised September 1992; Nitrates/Nitrites Toxicity, October 1991; Trichloroethylene Toxicity, January 1992; Methylene Chloride Toxicity, June 1990; Tetrachloroethylene Toxicity, June 1990.) Soil Contamination Ingestion of contaminated soil poses a risk of toxicity, especially to children under the age of six because of natural mouthing behaviors.
From page 71...
... Ex~sum Survey A Exposures Curmnl and past exposure ~ meals, dust, fleers, fumes, Emits, biologic _^.~_ Opal wow day gob asks, lemon, materials, agents used)
From page 72...
... The questions investigate the following: known exposure to metals, dust, fibers, fumes, chemicals, physical agents, and biologic hazards; details about known toxicant exposure; other persons affected; temporal patterns and activities, changes in routines and worksite characteristics, and protective equipment use. If the patient answers yes to one or more questions on Part 1, the clinician must follow up by asking the patient progressively more detailed questions about the possible exposure.
From page 73...
... For the past year I've had my film and prints processed commercially. Taking an Exposure History 11 73 ENVIRONMENTAL MEDICINE
From page 74...
... The patient's symptoms, including his angina attack, would be consistent with carbon monoxide poisoning. Although the patientts symptoms could be associated with his preexisting disease, evidence is strong enough at this point to investigate the possibility of environmental exposure.
From page 75...
... The exposure historyform may also alert the clinician to past exposures. Most often, neither the job title nor the patient's initial description of job duties reveals clues of exposure.
From page 76...
... Clinician: Did you use any protective equipment? Masks, respirators?
From page 77...
... , which needs follow-up. Had the clinician failed to pursue an exposure history, the patient's current illness might have been misdiagnosed, treatment might have been inappropriate, or measures might not have been implemented to prevent further carbon monoxide exposure leading to a risk of continued progression of the angina, as well as coma and death involving other household occupants.
From page 78...
... . Part 2 of the exposure history is a comprehensive inventory of the patient's occupations, employers, and current and potential exposures in the workplace.
From page 79...
... _ ., Taking an Exposure History 17 ENVIRONMENTAL MEDICINE 79
From page 80...
... We went to bed fairly early, about 10 PM. On Sunday morning, I had the attack.
From page 81...
... At the suggestion of the clinician, the safety manager at the mill instructs the employees in proper safety practices and no further incidents occur. Taking an Exposure History 19 81 ENVIRONMENTAL MEDICINE
From page 82...
... EnvironmentalHistory Part 3 of the exposure history form contains questions regarding the home and surrounding environment of the patient. Dialogue with the patient should include queries about the location of the house, water supply, and changes in air quality.
From page 83...
... Many factors can influence body burden, including exposure level and duration, route of exposure, physical activity, and amount of body fat. A conference call with the emergency response coordinator, a toxicologist, an industrial hygienist, and a physician to Taking an Exposure History 21 83 ENVIRONMENTAL MEDICINE
From page 84...
... contact, who recommends a specialist who will provide follow-up care for this patient. Results of the health department's tests of ambient air reveal no immediate crisis in the vicinity, although the levels are high; test results of water samples from private wells in the area are pending.
From page 85...
... Exposure History Form Name: Date: Birthdate: Sex: M F 1. Are you currently exposed to any of the following?
From page 86...
... no yes 16. Are family members experiencing similar or unusual symptoms?
From page 87...
... Protective Equipment : ~ * Iist the chemicals, dusts.
From page 88...
... no yes 9. Does your drinking water come from a private well, city water supply, or grocery store?
From page 89...
... A complete reference including epidemiology, principles of management and evaluation of Taking an Exposure History 27 89 ENVIRONMENTAL MEDICINE
From page 90...
... Clinical occupational medicine. Philadelphia: WB Saunders, 1986.
From page 91...
... Conditions to Avoid: Exposure to ignition sources and contact with incompatibles. Hazardous Products of Decomposition: Thermal oxidative decomposition of carbon disulfide can produce carbon monoxide (CO)
From page 92...
... Engineering Contras: To reduce potential health hazards, use sufficient dilution or local exhaust ventilation to control airborne contaminants and to maintain concentrations at the lowest practical level. To prevent static sparks, electrically ground all system parts including piping, valves, and moveable containers.
From page 93...
... Taking an Exposure History 31 93 ENVIRONMENTAL MEDICINE
From page 94...
... Third edition due for release in April 1993. Sources of information More information on taking an exposure history can be obtained from ATSDR, your state and local health departments, and university medical centers.
From page 95...
... l Taking an Exposure History 33 95 ENVIRONMENTAL MEDICINE


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