Lead Paint Removal >> Lead Paint Disclosure Certificate

The physical examination should emphasize the neurological, gastrointestinal, and cardiovascular systems. The worker's weight and blood pressure should be recorded and the oral mucosa checked for pigmentation characteristic of a possible Burtonian or lead line on the gingiva. It should be noted, however, that the lead line may not be present Lead Paint Disclosure Certificate even in severe lead poisoning if good oral hygiene is practiced. 

The presence of pallor on skin examination may indicate an anemia, which if severe might also be associated with a tachycardia. If an anemia is suspected, Lead Paint Disclosure Certificate an active search for blood loss should be undertaken including potential blood loss through the gastrointestinal tract. 

A complete neurological examination Lead Paint Disclosure Certificate should include an adequate mental status evaluation including a search for behavioral and psychological disturbances, memory testing, evaluation for irritability, insomnia, hallucinations, and mental clouding. Gait and coordination should be examined along with close observation for tremor. 

A detailed evaluation of peripheral nerve function including careful sensory and Lead Paint Disclosure Certificate motor function testing is warranted. Strength testing particularly of extensor muscle groups of all extremities is of fundamental importance. Cranial nerve evaluation should also be included in the routine examination. 

The abdominal examination should include auscultation for bowel sounds and abdominal bruits and palpation for organomegaly, masses, and Lead Paint Disclosure Certificate diffuse abdominal tenderness. Cardiovascular examination should evaluate possible early signs of congestive heart failure. Pulmonary status should be addressed particularly if respirator protection is contemplated. 

As part of the medical evaluation, the lead standard requires the following laboratory studies: 1. Blood lead level. 2. Hemoglobin and hematocrit determinations, red cell indices, and Lead Paint Disclosure Certificate examination of the peripheral blood smear to evaluate red blood cell morphology. 3. Blood urea nitrogen. 4. Serum creatinine. 

5. Routine urinalysis with microscopic examination. 6. A zinc protoporphyrin level. In addition to the above, the physician is authorized to order any further laboratory or Lead Paint Disclosure Certificate other tests which he or she deems necessary in accordance with sound medical practice. The evaluation must also include pregnancy testing or laboratory evaluation of male fertility if requested by the employee. 

Additional tests which are probably not warranted on a routine basis but may be appropriate when blood lead and ZPP levels are equivocal include delta-aminolevulinic acid and coproporphyrin concentrations in the urine, and Lead Paint Disclosure Certificate dark-field illumination for detection of basophilic stippling in red blood cells. If an anemia is detected further studies including a careful examination of the peripheral smear.

Reticulocyte count, stool for occult blood, serum iron, total iron binding capacity, bilirubin, and, if appropriate, vitamin B12 and folate may be of value in attempting to identify the cause of the anemia. If a peripheral neuropathy is suspected, Lead Paint Disclosure Certificate nerve conduction studies are warranted both for diagnosis and as a basis to monitor any therapy. 

If renal disease is questioned, a 24-hour urine collection for creatinine clearance, protein, and Lead Paint Disclosure Certificate electrolytes may be indicated. Elevated uric acid levels may result from lead-induced renal disease and a serum uric acid level might be performed. An electrocardiogram and chest X-ray may be obtained as deemed appropriate. 

Sophisticated and highly specialized testing should not be done routinely and where indicated should be under the direction of a specialist. IV. Laboratory Evaluation The blood lead level at present remains the single most important test to monitor lead exposure and Lead Paint Disclosure Certificate is the test used in the medical surveillance program under the lead standard to guide employee medical removal. 

The ZPP has several advantages over the blood lead level, but because of its relatively recent development and Lead Paint Disclosure Certificate the lack of extensive data concerning its interpretation, the ZPP currently remains an ancillary test. This section will discuss the blood lead level and ZPP in detail and will outline their relative advantages and disadvantages. 

Other blood tests currently available to evaluate lead exposure will also be reviewed. The blood lead level is a good index of current or recent lead absorption when there is no anemia present and when the worker has not taken any chelating agents. However, Lead Paint Disclosure Certificate blood lead levels along with urinary lead levels do not necessarily indicate the total body burden of lead and are not adequate measures of past exposure. 

One reason for this is that lead has a high affinity for bone and up to 90% of the body's total lead is deposited there. A very important component of the total lead body burden is lead in soft tissue (liver, kidney, and brain). This fraction of the lead body burden, the biologically active lead, Lead Paint Disclosure Certificate is not entirely reflected by blood lead levels since it is a function of the dynamics of lead absorption, distribution, deposition in bone and excretion. 

Following discontinuation of exposure to lead, the excess body burden is only slowly mobilized from bone and other relatively stable body stores and excreted. Consequently, Lead Paint Disclosure Certificate a high blood lead level may only represent recent heavy exposure to lead without a significant total body excess and likewise a low blood lead level does not exclude an elevated total body burden of lead. 

Also, due to its correlation with recent exposures, the blood lead level may vary considerably over short time intervals. To minimize laboratory error and erroneous results due to contamination, blood specimens must be carefully collected (after thorough cleaning of the skin with appropriate methods) using lead-free blood containers and Lead Paint Disclosure Certificate analyzed by a reliable laboratory. 

Under the standard, samples must be analyzed in laboratories which are approved by the Center of Disease Control (CDC) or Lead Paint Disclosure Certificate which have received satisfactory grades in proficiency testing by the CDC in the previous year. Analysis is to be made using atomic absorption spectrophotometry, anodic stripping voltammetry or any method which meets the accuracy requirements set forth by the standard. 

The determination of lead in urine is generally considered a less reliable Lead Paint Disclosure Certificate monitoring technique than analysis of whole blood primarily due to individual variability in urinary excretion capacity as well as the technical difficulty of obtaining accurate 24-hour urine collections. 

In addition, workers with renal insufficiency, whether due to lead or some other cause, may have decreased lead clearances and Lead Paint Disclosure Certificate consequently urine lead levels may underestimate the true lead burden. Therefore, urine lead levels should not be used as a routine test.

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