The pesticide-exposed worker: an approach to the office evaluation

Pesticide exposures have clinical, epidemiological, legal, and political ramifications that go beyond the confines of a physician's office. The examination of the employee who has been exposed to a pesticide should be undertaken in an organized and methodical manner so that specific questions of causality can be answered and treatment can be initiated.

Five representative case studies illustrate different circumstances in which a pesticide injury can be seen in the office setting.

A wide range of pesticides is used in business and home, and the dangers of misdiagnosis, maldiagnosis, underdiagnosis, and overdiagnosis are especially common given the variety of chemicals used. The exposed employee must be removed from the source of exposure. Complete decontamination is a primary concern, and patients with unstable vital signs will need to be hospitalized. A methodical office examination, however, can be carried out on many exposed employees. A detailed description of the circumstances of the exposure should be elicited, and the chemical implicated in the exposure should be researched. A pesticide exposure is a sentinel event in the life of a patient and also suggests that other employees can be exposed. Such an exposure needs to be carefully assessed and documented, and proper treatment must be rendered. Further, the exposure can represent the first of many other exposures that might or might not be reported. Proper notification of authorities can limit exposures before they become severe.