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CARBON MONOXIDE POISONING
What is carbon monoxide poisoning?
Carbon monoxide (CO) is an odorless, colorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air.
Known as ‘the silent killer’, carbon monoxide gas has no smell or taste. Breathing in the gas can make you extremely unwell and can cause injuries to the brain. It can even be fatal.
Sources of CO Poisoning
When power outages occur during emergencies such as hurricanes or winter storms, the use of alternative sources of fuel or electricity for heating, cooling, or cooking can cause CO to build up in a home, garage, or camper and poison the people and animals inside.
Generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices should never be used inside a home, basement, garage, or camper – or even outside near an open window or window air conditioner.
Who is at risk from CO poisoning?
Everyone is at risk for CO poisoning. Infants, the elderly, people with chronic heart disease, anemia, or breathing problems are more likely to get sick from CO.
Each year, more than 400 Americans die from unintentional CO poisoning not linked to fires, more than 20,000 visit the emergency room, and more than 4,000 are hospitalized.
What Are The Symptoms Of Carbon Monoxide Poisoning?
The symptoms and signs of carbon monoxide poisoning are variable and nonspecific. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and altered mental status.
The clinical presentation of CO poisoning is the result of its underlying systemic toxicity. Its effects are caused not only by impaired oxygen delivery but also by disrupting oxygen utilization and respiration at the cellular level, particularly in high-oxygen demand organs (i.e., heart and brain).
Symptoms of severe CO poisoning include malaise, shortness of breath, headache, nausea, chest pain, irritability, ataxia, altered mental status, other neurologic symptoms, loss of consciousness, coma, and death; signs include tachycardia, tachypnea, hypotension, various neurologic findings including impaired memory, cognitive and sensory disturbances; metabolic acidosis, arrhythmias, myocardial ischemia or infarction, and non-cardiogenic pulmonary edema, although any organ system might be involved.
With a focused history, exposure to a Carbon Monoxide source may become apparent. Appropriate and prompt diagnostic testing and treatment is very important.
- Diagnosis is based on a suggestive history and physical findings coupled with confirmatory testing. Patients should be examined for other conditions, including smoke inhalation, trauma, medical illness, or intoxication.
- Neurological exam should include an assessment of cognitive function such as a Mini-Mental Status Exam
- All women of childbearing age who are suspected of having CO poisoning should have a pregnancy test.
Confirmation of diagnosis
- The key to confirming the diagnosis is measuring the patient’s carboxyhemoglobin (COHgb) level.
- COHgb levels can be tested either in whole blood or pulse oximeter.
- It is important to know how much time has elapsed since the patient has left the toxic environment, because that will impact the COHgb level. If the patient has been breathing normal room air for several hours, COHgb testing may be less useful.
- The most common technology available in hospital laboratories for analyzing the blood is the multiple wavelength spectrophotometer, also known as a CO-oximeter. Venous or arterial blood may be used for testing.
- A fingertip pulse CO-oximeter can be used to measure heart rate and oxygen saturation, and COHgb levels. The conventional two-wavelength pulse oximeter is not accurate when COHgb is present.
- COHgb levels do not correlate well with severity of illness, outcomes or response to therapy so it is important to assess clinical symptoms and history of exposure when determining type and intensity of treatment.
- Other testing, such as a fingerstick blood sugar, alcohol and toxicology screen, head CT scan or lumbar puncture may be needed to exclude other causes of altered mental status when the diagnosis of carbon monoxide poisoning is inconclusive.
- Note: carbon monoxide can be produced endogenously as a byproduct of heme metabolism. Patients with sickle cell disease can have an elevated COHgb level as a result of hemolytic anemia or hemolysis.
An elevated COHgb level of 2% for non-smokers and >9% COHgb level for smokers strongly supports a diagnosis of CO poisoning.
Guidance for Management of Confirmed or Suspected CO Poisoning
- Administer 100% oxygen until the patient is symptom-free, usually about 4-5 hours. Serial neurologic exams should be performed to assess progress, and to detect the signs of developing cerebral edema.
- Consider hyperbaric oxygen therapy (HBO) therapy when the patient has a COHgb level of more than 25- 30%, there is evidence of cardiac involvement, severe acidosis, transient or prolonged unconsciousness, neurological impairment, abnormal neuropsychiatric testing, or the patient is ≥36 years in age. HBO is also administered at lower COHgb(<25%) levels if suggested by clinical condition and/history of exposure.
- Hyperbaric oxygen is the treatment of choice for pregnant women, even if they are less severely poisoned. Hyperbaric oxygen is safe to administer and international consensus favors it as part of a more aggressive role in treating pregnant women.
- Cardiac injury during poisoning increases risk of mortality over 10 years following poisoning, so in patients with severe CO poisoning, it may be important to perform an EKG and measurement of troponin and cardiac enzymes.
- Chest radiography is recommended for seriously poisoned patients, especially those with loss of consciousness or cardiopulmonary signs and symptoms. Brain computed tomography or MRI is also recommended in these cases; these tests may show signs of cerebral infarction secondary to hypoxia or ischemia.
- All discharged patients should be warned of possible delayed neurological complications and given instructions on what to do if these occur. Follow-up should include a repeat medical and neurological exam in 2 weeks.
Who Is Responsible For Ensuring My Safety From Carbon Monoxide Poisoning?
Employers, landlords, and other building owners are responsible for ensuring that appliances such as gas fires, central heating systems, water heaters, and stoves are in good working order and conform to health and safety laws.
We can help if you’ve been poisoned by carbon monoxide
We know that it can sometimes be hard to tell whether someone is at fault for your accident, but we can help with that. It could be due to negligence by a residential or business premises landlord or even by your employer.
You may be eligible to seek compensation if your health has been harmed as a result of someone else’s negligence in their duty of care. If you’re not sure where your carbon monoxide exposure occurred or who is to blame, contact our professional team for a free consultation now. We’d be pleased to speak with you about your claim at no cost to you.
Our expert team of serious personal injury solicitors has helped many people affected by carbon monoxide poisoning to secure the best possible compensation. They are dedicated to supporting their clients through the course of their claim and beyond.
CALL US NOW for FREE CONSULTATION at (713) 974-0388.