Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Diagnosis and treatment will vary depending on the patient's signs and symptoms. Frequently, the symptoms will be mild, the chemical will be well known, and the medical evaluation brief and focused.
Sometimes serious signs and symptoms will need life-saving procedures, such as artificial ventilation, advanced cardiac life support, or complex medical therapy. In most cases, the doctor will consult local poison control experts for advice.
The doctor must first make sure that hospital staff are not at risk for exposure
so the patient may need to undergo decontamination procedures while the
medical staff may need to wear protective garments while treating the
After stabilizing the patient, the next priority is to identify the chemical and consider the effects
the chemical has on the lungs and the rest of the body.
A thorough history will be obtained to include the length of exposure, area of exposure, form and concentration of the chemical, other medical problems, and symptoms. In addition to close inspection of the vital signs (heart rate, blood pressure, respiratory rate, temperature, and how much oxygen
is in the blood), the doctor will evaluate, at a minimum, the eyes, nose, throat, skin, heart, lungs, and abdomen.
Once these steps have been taken, further evaluation may vary depending on the status of the person injured, the type of chemical exposure, and other factors.
In the following sections examples of chemical pneumonia are discussed, and how a doctor might evaluate each case are presented. This is in no way a complete list of all the possible chemical exposures that might result in pneumonia. Thousands of chemicals exist that may result in pneumonia or other serious toxicity.
Example case 1
A 38-year-old oil refinery worker is exposed to a concentrated mist of sulfur dioxide in an enclosed room while repairing a pipe. He immediately complains of burning eyes, nose, and mouth. He also complains of difficulty breathing. He is transported to the nearest
emergency department by EMS personnel. Coworkers contain the gas and alert local authorities.
When the patient arrives in the emergency department, he appears sick. He is having a
difficult time breathing. His heart rate and respiratory rate are very fast and his oxygen level is low. The doctor finds that there was a brief, but intense, exposure and that the patient almost passed out. His coworkers confirm exposure to sulfur dioxide and that no other chemicals were present.
The worker's clothes are removed and he is decontaminated. The doctor notes irritated eyes, fast pulse, and harsh sounds in the lungs. The doctor talks with authorities at the site to confirm the chemical exposure.
The local poison control center is contacted for assistance.
Now the patient is finding breathing even more difficult. Despite an oxygen mask, his lungs have been
severely damaged and are not functioning to receive oxygen to support his vital organs. The patient becomes delirious, and the doctor provides artificial ventilation to
assist him in receiving enough oxygen.
The patient is on a ventilator for a few days and improves. His lungs slowly recover, but never return to normal. Safety personnel at the refinery are able to limit any future hazards.
Example case 2
A young boy is rescued from a house fire. He has no visible burns, but his nasal hairs are singed and there's soot in his mouth. He is breathing well and has stable vital signs.
The doctor notes clear lungs and no swelling in the
mouth or nose. Chest and neck
X-rays are normal. The child is admitted for observation. He develops no problems and is discharged the next day.
Example case 3
A 13-year-old girl attempts suicide by drinking lighter fluid. Her mother sees this and forces her to vomit, then rushes her to the hospital. The doctor notes a fast heart rate and respiratory rate, and that her clothing smells of lighter fluid. The nurse removes the girl's clothes and cleans off the lighter fluid. The patient denies taking any drugs or chemicals other than the lighter fluid.
After decontamination, a chest X-ray shows a mild, diffuse pneumonia. The local poison control center notes that lighter fluid can cause a chemical pneumonia and other problems.
The patient is admitted to the hospital and watched closely. Her pneumonia worsens slightly; however, she does not require artificial ventilation.
After ten days she is discharged to a psychiatric hospital. Her lungs are left with a moderate amount of scarring.
These are only examples. Many chemicals other than these cause chemical pneumonia.