Inhalation Risks from Phosphide Fumigants

A 48 year old male acutely develops symptoms of chest pain, shortness of breath, dizziness, and nausea with an episode of vomiting. The symptoms develop acutely at the workplace, where he is employed as a production worker at an aluminum phosphide manufacturing facility. He is brought to the company physician and is noted to be alert and responsive with a normal respiratory rate, but appearing pale, sweaty, and acutely ill. He has no prior history of heart disease, and a recent exercise stress test that was normal. On initial examination, the heart rate is slow with distant heart sounds. The initial blood pressure is 78/58, and a rhythm strip indicates a junctional bradycardia (rate 58). He is transported via ambulance to an emergency room, with suspicion that he is having a myocardial infarction.