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Case Study #5 Truck Driver with a Cough

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Presentation on theme: "Case Study #5 Truck Driver with a Cough"— Presentation transcript:

1 Case Study #5 Truck Driver with a Cough

2 Onset  Randy is a 35 year old male who you are seeing in urgent care for a worsening cough 724.260.5504

3 History  Smokes ½ pack a day of cigarettes.  Works as a driver hauling sand for fracking operations, and spends a good deal of the day loading and unloading “proppant”.  He notices that his clothes get very dusty at the end of the day.  His supervisor handed out some masks for several weeks, but then was apparently told to stop by higher management.  No history of childhood asthma 724.260.5504

4 History (continued)  He has been doing this work for about 18 months, and thinks that his cough started several months after starting this job.  He has taken several courses of antibiotics, but the cough persists.  He had been working extra shifts recently and noticed that he was both coughing and feeling a little short of breath. 724.260.5504

5 Exam  Slight conjunctival irritation noted  Occasional wheezes heard 724.260.5504

6 Questions  As Randy’s physician, what other aspects of the history should be gathered?  What are the steps that providers should take when seeing a worker with a possible work-related condition? 724.260.5504

7 Occupational History for Gas Extraction Workers Screening questions:  What is your job in the gas extraction industry?  When did you start working at this job?  Are you exposed to chemicals, dusts, or other hazards in your work?  Do you think your health problems are related to your work?  If you have left this job, when did you leave? 724.260.5504

8 Follow-up Questions:  Do/did you have symptoms that are/were worse at work and that improve/d away from work? If so, describe  Have any coworkers noticed similar problems?  Describe the tasks you do/did and the hazards that you encounter/ed in each of these tasks. Also describe any personal protective equipment that you wear routinely.  Dates that you have worked at this job  Have you sought medical attention for this problem before?  Have you had previous jobs that have exposed you to potentially harmful chemicals, dusts, or other hazards? If so, describe briefly, with approximate dates (years). 724.260.5504

9 Steps Providers Need to Take When Evaluating Possible Work-Related Illness and Injury  1) Confirm the diagnosis (consider non- occupational conditions)  2) Assess exposures  3) Consider adverse effects of exposure and determine work-relatedness (referral to occupational medicine specialist if necessary) 724.260.5504

10 1) Confirm the Diagnosis  Many occupational illnesses resemble common medical problems  Consider non-occupational medical causes of condition in differential diagnosis  Diagnostic aids in this case: spirometry, peak flow diary, review of medical records 724.260.5504

11 2) Assess Exposures  Occupational history  Gather additional information: MSDS sheets, ask permission to speak with supervisor  OSHA/NIOSH Hazard alert on silica exposure in hydraulic fracturing 724.260.5504

12 3) Determine work-relatedness  Consider steps 1 and 2  On more likely than not basis, is condition related to work exposures?  Documentation important 724.260.5504

13 4) Management  Reduce exposures  Consider referral to occupational medicine specialist  Reporting 724.260.5504

14 Exposure Reduction Hierarchy of Controls:  Exposure reduction: best if possible  Administrative controls: work restriction  Personal protective equipment  And counsel to stop smoking! 724.260.5504

15 Resources:  Taiwo et al: Recognizing Occupational Illness and Injuries American Family Physician 2011, available at  OSHA-NIOSH Hazard Alert for Worker Exposure to Silica During Hydraulic Fracturing: Available at : ulic_frac_hazard_alert.html ulic_frac_hazard_alert.html 724.260.5504

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