Carbon Monoxide Poisoning
- Thread starter BrentB
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Smuttynose
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Can the info you wanted to share be posted in another way. Copy and 'Paste' or just your basic stealing it.
Sorry for the delay. Today it made the top of the my non-work related to-do list during my lunch
NEJM article was about a 39yr female and found semi comatose by a friend who called 911. The patient recovered after treatment.
Take home message
Carbon monoxide (CO) poisoning is the silent killer and results in more than 50,000 emergency department visits and 3800 deaths from fires or other sources of carbon monoxide per year in the US (CDC) and roughly 500 from non-fire, unintentional deaths a year. Carbon monoxide is a colorless, odorless gas and produced by faulty furnaces, inadequate ventilation of heating sources and exposure to engine exhaust.
The symptoms of CO poisoning are nonspecific. Mild exposures result in headache, muscle pain, dizziness or mental and neuron-related impairment. Severe CO poisoning result in confusion, loss of consciousness or death. Patients with subclinical exposures who did not seek medical evaluation and treatment may recognize poisoning only after an severe event or coincidental discovery of a carbon monoxide leak.
As CO exposure increases, poisoning results. CO’s affinity for hemoglobin in blood is more than 200 times that of oxygen. When CO binds to hemoglobin, it produces carboxyhemoglobin, which inhibits the transport, delivery, and utilization of oxygen. The levels of oxygen normally released to the tissues are decreased and blood oxygen content is decreased, resulting in tissue hypoxic injury and cascading set of events leading to cell injury and death in the brain and blood cells, and cardiac distress and related set of adverse events. (sorry very brief overview)
During the medical evaluation, the key element is confirming the diagnosis by measuring the patient’s carboxyhemoglobin level using a multiple wavelength spectrophotometer, also known as a CO-oximeter. Not all hospitals will have this instrument and testing needs to be performed quickly. If testing is unavailable, the patient should be transferred to another facility with better testing and treatment capabilities and oxygen started as soon as possible. Hyperbaric oxygen therapy is the recommended treatment in cases of individuals with the greatest mortality and morbidity risks.
The vast majority of carbon monoxide poisoning cases are nonfatal. Even when appropriately treated, however, carbon monoxide poisoning may result in significant sequelae. Therefore, prevention is extremely important.
I recommend the CDC web site for additional information
http://www.cdc.gov/co/default.htm
NEJM article was about a 39yr female and found semi comatose by a friend who called 911. The patient recovered after treatment.
Take home message
Carbon monoxide (CO) poisoning is the silent killer and results in more than 50,000 emergency department visits and 3800 deaths from fires or other sources of carbon monoxide per year in the US (CDC) and roughly 500 from non-fire, unintentional deaths a year. Carbon monoxide is a colorless, odorless gas and produced by faulty furnaces, inadequate ventilation of heating sources and exposure to engine exhaust.
The symptoms of CO poisoning are nonspecific. Mild exposures result in headache, muscle pain, dizziness or mental and neuron-related impairment. Severe CO poisoning result in confusion, loss of consciousness or death. Patients with subclinical exposures who did not seek medical evaluation and treatment may recognize poisoning only after an severe event or coincidental discovery of a carbon monoxide leak.
As CO exposure increases, poisoning results. CO’s affinity for hemoglobin in blood is more than 200 times that of oxygen. When CO binds to hemoglobin, it produces carboxyhemoglobin, which inhibits the transport, delivery, and utilization of oxygen. The levels of oxygen normally released to the tissues are decreased and blood oxygen content is decreased, resulting in tissue hypoxic injury and cascading set of events leading to cell injury and death in the brain and blood cells, and cardiac distress and related set of adverse events. (sorry very brief overview)
During the medical evaluation, the key element is confirming the diagnosis by measuring the patient’s carboxyhemoglobin level using a multiple wavelength spectrophotometer, also known as a CO-oximeter. Not all hospitals will have this instrument and testing needs to be performed quickly. If testing is unavailable, the patient should be transferred to another facility with better testing and treatment capabilities and oxygen started as soon as possible. Hyperbaric oxygen therapy is the recommended treatment in cases of individuals with the greatest mortality and morbidity risks.
The vast majority of carbon monoxide poisoning cases are nonfatal. Even when appropriately treated, however, carbon monoxide poisoning may result in significant sequelae. Therefore, prevention is extremely important.
I recommend the CDC web site for additional information
http://www.cdc.gov/co/default.htm
We have had a number of discussions about carbon monoxide poisoning on this (and other boating forums). I suspect that this case was chosen for publication in the clinical section of NEJM, is in the prologue: A patient who has several month history of Fatigue, headache and memory loss is found unconscious. One major problem--which is illlustrated in this case is the cummulative effect of carbon monoxide. It is bound with the hemoglobin (which normally transports oxygen in the blood stream/via the red blood cells). The bound carbon monoxide prevents oxygen from reaching the tissues. The carbon monoxide dis-associates very slowly from the hemoglobin, and thus chronic carbon monoxide poisoning is a much bigger problem than is realized because the carbon monoxide accumulates over a long peroid of time and causes occult symptoms.
I studied a group of my own patients who complained of fatigue, malaise, headache etc. This group all drove the LA freeways for at least half an hour a day, and they lived near the freeways. They had various degrees of elevation of carbon monoxide--small, but clinically significant. These happened to be non smokers--but heaver smokers often have chonically elevated CO levels.
The normal CO detectors do not measure these low levels. The house hold detectors were dumbed down, because of "false" alarms to the paramedics in the 90's. There are some: such as the Kiddie KN-COPP-B which are battery operated and have a digital read out. Far better is the CO experts units--I believe that the 1070 is the latest model. These are more expensive, but far more accurate. Some have been labeled "not for marine use"--realted to lack of being splash proof and may not be quite so accurate in the high humidity. they are normally used in airplanes.
Also remember than any of the CO detectors is only good for a few years--best to replace after 2 years--at least every 5 years.
There is a good, but slightly dated article at: http://www.avweb.com/news/aeromed/186016-1.html
Brent's stastics seem a little high, even when reviewing the most recent CDC data. What I read is about 2700 cases a year where CO may be a contributing factor in the death, and 439 (give or take) as a direct death from CO, but not related to a fire event. In any case, CO is a serious death threat. I have seen a number of cases when I was in practice, including unknown cause of coma and resultant death.
Be safe.
I studied a group of my own patients who complained of fatigue, malaise, headache etc. This group all drove the LA freeways for at least half an hour a day, and they lived near the freeways. They had various degrees of elevation of carbon monoxide--small, but clinically significant. These happened to be non smokers--but heaver smokers often have chonically elevated CO levels.
The normal CO detectors do not measure these low levels. The house hold detectors were dumbed down, because of "false" alarms to the paramedics in the 90's. There are some: such as the Kiddie KN-COPP-B which are battery operated and have a digital read out. Far better is the CO experts units--I believe that the 1070 is the latest model. These are more expensive, but far more accurate. Some have been labeled "not for marine use"--realted to lack of being splash proof and may not be quite so accurate in the high humidity. they are normally used in airplanes.
Also remember than any of the CO detectors is only good for a few years--best to replace after 2 years--at least every 5 years.
There is a good, but slightly dated article at: http://www.avweb.com/news/aeromed/186016-1.html
Brent's stastics seem a little high, even when reviewing the most recent CDC data. What I read is about 2700 cases a year where CO may be a contributing factor in the death, and 439 (give or take) as a direct death from CO, but not related to a fire event. In any case, CO is a serious death threat. I have seen a number of cases when I was in practice, including unknown cause of coma and resultant death.
Be safe.
The NEJM article was intended for physicians and other HCWs and a full page flow diagram from mild to severe poisoning showing the the major interactions and some interesting imaging scans. I wish it had open access. The article and CDC had different numbers and like many other items, it is under-reported.
Stay Safe and Prevent the Preventable
Stay Safe and Prevent the Preventable
Had a guy a while back that tried to commit suicide by sitting in his running car in an enclosed garage, his wife found him and called 911. When we arrived he was completely fine physically............he was sitting in one of those new "F.D." electric cars with his eyes closed sleeping. :roll:
("There's Your Sign").... :lol:
("There's Your Sign").... :lol:
Yes Brent, it was fully charged :wink .
Actually the above is not a true story. The other day at work we were talking about how things have changed electronically in today's EMS and Fire service....e.g. when there is a vehicle in a ditch, numerous folks will call 911 on their cell phones to report it, the conveniences of the "help alert" devices that elderly folks that live alone wear in order to summon assistance, and the "on star" devices in automobiles to alert a dispatcher about a vehicle collision. About that time someone mentioned that we won't be having to go on calls for suicide by carbon monoxide from vehicles due to the "electric automobiles". So that discussion at work, prompted me to fabricate the above fictious story.
(Just a little fire department humor... :wink ).
Actually the above is not a true story. The other day at work we were talking about how things have changed electronically in today's EMS and Fire service....e.g. when there is a vehicle in a ditch, numerous folks will call 911 on their cell phones to report it, the conveniences of the "help alert" devices that elderly folks that live alone wear in order to summon assistance, and the "on star" devices in automobiles to alert a dispatcher about a vehicle collision. About that time someone mentioned that we won't be having to go on calls for suicide by carbon monoxide from vehicles due to the "electric automobiles". So that discussion at work, prompted me to fabricate the above fictious story.
(Just a little fire department humor... :wink ).Down here in the trenches I see at least several CO significant exposures and at least one with partial poisoning every year... Given my statistics, one can multiply by, 1 X the number of working docs in the USA, and come up with a far different number than the CDC...
In all fairness to the CDC and the NEJM I have never reported an exposure or partial poisoning, only those that needed hospitalization, which is where the CDC gets the 2700 from...
CO is a deadly gas and exposure is far too prevalent... Those of us who have open flame stoves in our homes, boats, and RVs, are being exposed to toxic levels of CO every time we cook... It is only that the exposure time is short enough not to lead to toxic blood levels that saves us... But deciding to heat the boat at night with the propane stove, thinking that leaving a hatch cracked open will sweep out the CO, is playing russian roulette...
This years big case for me was deer hunting over the weekend and they used a back packer's, single burner propane camping stove on the floor of the pickup camper for heat... He came in the office on Tuesday complaining of headache, dizzy, and being forgetful... His carboxyhemoglobin was still 18%, 48 hours after the exposure... It was a near thing...
denny-o
In all fairness to the CDC and the NEJM I have never reported an exposure or partial poisoning, only those that needed hospitalization, which is where the CDC gets the 2700 from...
CO is a deadly gas and exposure is far too prevalent... Those of us who have open flame stoves in our homes, boats, and RVs, are being exposed to toxic levels of CO every time we cook... It is only that the exposure time is short enough not to lead to toxic blood levels that saves us... But deciding to heat the boat at night with the propane stove, thinking that leaving a hatch cracked open will sweep out the CO, is playing russian roulette...
This years big case for me was deer hunting over the weekend and they used a back packer's, single burner propane camping stove on the floor of the pickup camper for heat... He came in the office on Tuesday complaining of headache, dizzy, and being forgetful... His carboxyhemoglobin was still 18%, 48 hours after the exposure... It was a near thing...
denny-o
After reading Dr Bob's last post it peaked my curiousity. My home detector has a digital readout & memory. I pressed it and it had read 14ppm as the high reading at SOME point. Broke out the manual and it stated that anything less than 30 ppm is "normal" and could be attributed to various causes. The alarm never activated audibly and doesn't for such a low readout. Anyone know if using a propane heater (construction type that looks like a jet engine) produces CO2? I use one in my garage during the winter months, if/when I'm working on my car. Since the garage is NOT air tight I assuemed it'd be safe.