Twenty-foot fall averts fatality from massive hydrogen sulfide exposure11Selected Topics: Toxicology is coordinated by Kenneth Kulig, MD, of Denver, Colorado

Hydrogen sulfide is a colorless irritant and asphyxiant gas with a noxious odor of “rotten eggs.” Acute hydrogen sulfide exposure may cause, depending on the level and duration of toxicity, symptoms ranging from mild mucous membrane irritation to permanent neurologic impairment and cardiopulmonary arrest. We present a case of an oil refinery worker exposed to a typically fatal concentration of hydrogen sulfide gas (>1000 ppm) while working on top of a 20-foot ladder. The “knockdown” effect of exposure to high concentrations of hydrogen sulfide caused him to lose consciousness and fall from the top of the ladder. He was transported to the Emergency Department as a major trauma victim. Ironically, this 20-foot fall saved his life and possibly those of the rescuers by immediately removing him from the source of the hydrogen sulfide. Treatment of hazardous materials incidents and the pathophysiology and treatment options for hydrogen sulfide poisoning are discussed.