| Carbon Monoxide Poisoning Review Christina Cruz Dominguez Staff Writer Fall is in the air…..yes, this refers to the song, and also to the dangers associated with the change of seasons. As the temperature drops, and furnaces and fireplaces are lit, the dangers of carbon monoxide poisoning escalate. Every year we hear of some unfortunate individuals who either burned or brought into their home, charcoal briquettes for warmth, and either died or were severely injured. With today's recession and the cost of heating a home rising, let us be aware and inform our friends and family of the dangers of Carbon Monoxide Poisoning. A brief review of the presentation of carbon monoxide poisoning. • Carbon Monoxide (CO) is a colorless, odorless, and deadly gas produced by any combustion of carbon products. • CO produces toxicity by three mechanisms: Hypoxemia, Ischemia, and Cellular Asphyxia. • CO binds to hemoglobin with 250 times the affinity of oxygen; thus, decreasing the blood’s oxygen carrying capacity. • CO shifts the oxygen-hemoglobin curve to the left; resulting in further decreased intracellular oxygen concentrations. • CO decreases cardiac output and causes hypotension; producing ischemic organ damage. • CO binds with myoglobin and intracellular cytochromes; hence further decreasing the heart’s inotropic effect and diminished intracellular oxygen utilization. • .1% CO (1000ppm) may produce a fatal 50% saturation of the hemoglobin. • The maximum OSHA permissible standard is 50ppm as an eight hour weighted average. • Infants and fetuses are at higher risk to CO toxicity since their fetal hemoglobin has an even higher affinity for CO. • CO has a rapid absorption with a slow release from tissues in room air. The half life of CO is 4-5 hours in room air. Toxic doses and effects of CO are variable and dependent on the age of the patient, their underlying health condition, and the time lapse from exposure to evaluation. In general, low levels produce headache, nausea, vomiting, diarrhea, and dizzyness. Moderate levels produce an alteration in mental status (confusion to syncope), shortness of breath, and angina. Severe levels produce seizure, coma, acute myocardial infarction, hypotension, cardiac arrhythmias, and death. Survivors of severe intoxications may suffer from chronic disabilities such as blindness, deafness, seizures, parkinsonism, memory loss, or personality changes. CO Hemoglobin Level (%) Signs and Symptoms 0-10 Usually none 10-20 Headache, DOE, Angina 20-30 Headache, dyspnea, N/V, dizzyness 30-40 Headache, N/V, AMS (judgment) 40-50 AMS (confusion), Syncope, Tachy:cardia/pnea 50-60 Syncope, Seizures, Coma 60-70 Coma, Hypotension, Arrythmias, Death >70 Rapidly Fatal As you can see, even at significantly toxic levels, the clinical presentation is not straight forward. Do not attempt to rely upon the dictum of the “Cherry Red Tongue,” it may not be there when you need it. Call 911. What to Expect from 911 and the ER Pulse oximetry will typically read a falsely high normal although the patient is severely hypoxic. Remember to look for signs of acute myocardial ischemia, rhabdomyolysis, and pancreatitis in addition to an Altered Mental Status. The differential diagnosis for these patients presenting with acute Altered Mental Status changes should include Hypoglycemia, Head Trauma, CVA, Meningitis, and Drug/Alcohol ingestion. Suicidal gesture should be considered in those patients with a history of depression or a recent life crisis. Management of the CO intoxicated patient should be dependent upon the clinical presentation, i.e., supplemental O2 to ACLS measures. The mainstay of treatment is OXYGEN with as close to an FiO2 of 100% as feasible; i.e., nonrebreather mask to intubation. An FiO2 of 100% reduces the half-life of CO to 40-80 minutes. Hyperbaric chambers reduce the half-life to 20 minutes. Do attempt to correct the metabolic acidosis (pH 7.2-7.3) since this mild to moderate acidosis moves the oxygen dissociation curve to the right; hence delivering more O2 to the tissues. Disposition is dependent on the clinical presentation and course of the patient. The Bottom Line Clean your furnace, your chimney flutes, and do not burn or use charcoal briquettes in your home. IF YOU HAVE A HEADACHE OR CONFUSION...CALL 911 |
| Aesthetic Medicine Today |
 | |  | |  | |  | |  | |  |
 | |  | |  | |  | |  | |  |
 | |  | |  |