Initial chest radiograph showed bilateral ill-defined air-space consolidations on both perihilar areas, which mimics pulmonary edema but heart and great vessels appeared unremarkable ( Figure 1A). Serum blood urea nitrogen, creatinine, and lactate were 11 mg/dL, 0.8 mg/dL, and 14.0 mmol/L, respectively. Electrocardiography showed sinus tachycardia. Initial blood gas during intubation with 10 L/min oxygen supply showed pH 7.268, PCO 2 34.5 mm Hg, PO 2 77.2 mm Hg, HCO 3 - 15.3 mmol/L, and SaO 2 93.3%. He was immediately intubated because he was cyanotic and in respiratory distress.

There was a bilateral decrease in breathing sounds without wheezing, stridor or crackles on pulmonary auscultation. When he arrived at the ED, his vital signs were as follows: blood pressure, 160/100 mm Hg heart rate, 130 beats/min respiratory rate, 28 breaths/min temperature, 36.2℃ and O 2 saturation measured by pulse oxymeter (SpO 2), 75% of room air. Approximately, 4.5 hours after exposure he was admitted to the ED. Immediately after exposure, he sought refuge in a room inside of the gas supply space and soon lost consciousness. When the methane tank was opened, gas escaped from the tank for about one minute. There was no window and the doors were kept closed in the room.

While opening a methane gas tank, assuming it was a nitrogen tank, he was accidently exposed in a gas supply room, approximately 10×10 m. He had worked without any respiratory protective devices. He had started working at a medical gas supply company 3 months ago. A 21-year-old man, non-smoker, was admitted to the emergency department (ED) in a drowsy mentality after exposure to methane gas.

Fallout 4 med x