Case History: Outdoor CO Poisoning from Tractor Exhaust2

A 37-year old tobacco farmer in Kentucky was hospitalized for carbon monoxide (CO) poisoning while planting tobacco. The farmer rode a two-seat tobacco setter that was pulled behind a tractor. The tractor's exhaust pipe was beneath the tractor and vented toward the setter. The farmer occupied the seat closest to the exhaust.

The farmer began work at 1:00 p.m. on the day of admission. By 4:00 p.m., the farmer and a co-worker sitting in the adjacent seat developed headaches. The farmer had additional complaints of dizziness and fatigue. The co-worker quit work at 4:30 p.m. and was replaced by a family member.

The farmer continued working in spite of increased severity of symptoms. The co-worker and tractor driver both observed reduced hand-eye coordination in the farmer who refused to stop working. At 6:30 p.m. the farmer collapsed and was transported to the ER.

The farmer's arterial carboxyhemoglobin level was 23.3% (normal = <2%). This confirmed CO poisoning.

2Outdoor carbon monoxide poisoning attributed to tractor exhaust. MMWR 1997;46(51):1224-1227.

DEPARTMENT OF FAMILY MEDICINE – DIVISION OF PUBLIC HEALTH AND PUBLIC SERVICE

MEDICAL UNIVERSITY OF SOUTH CAROLINA, 171 ASHLEY AVENUE, CHARLESTON, SC 29425-2217