Emergency Medicine Book

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Carbon Monoxide Poisoning

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  1. Epidemiology
    1. Leading cause of toxin related death in United States
  2. Sources of Carbon Monoxide
    1. Gas powered engine
      1. Propane fueled forklifts
      2. Ice skating rink Zamboni
      3. Indoor tractor pulls
    2. Home
      1. Furnace
      2. Indoor Heaters
        1. Home water heaters
        2. Gas heaters
        3. Pool heaters
        4. Kerosene heaters
      3. Indoor Flames
        1. Wood stoves
        2. Indoor charcoal fires
        3. Sterno fuel
      4. Tobacco smoke
        1. Smokers
          1. Carboxyhemoglobin levels may reach 9-20%
        2. Nonsmokers exposed to passive smoke
          1. Cigarette tip 2.5 fold greater CO than inhaled
    3. Industrial or Occupational
      1. Steel foundry
      2. Pulp paper mill
      3. Formaldehyde and coke producing plants
      4. Fire fighters
    4. Fire
      1. Building or structure fire
      2. Wilderness fire
  3. Pathophysiology
    1. Carbon Monoxide Properties
      1. Colorless
      2. Odorless
      3. Non-irritating gas
    2. Carbon monoxide inhalation
      1. High affinity for Hemoglobin
      2. Displaces Oxygen and produces carboxyhemoglobin
    3. Results in excessive carboxyhemoglobin
  4. Symptoms
    1. Headache (88%)
    2. Dizziness (83%)
    3. Nausea (75%)
    4. Drowsiness (75%)
    5. Dry Mouth (44%)
  5. Signs
    1. Cherry-red skin and mucosa
    2. Bounding Pulse
    3. Hypertension
    4. Muscular fasciculations
    5. Stertorous breathing
    6. Dilated pupils
    7. Convulsions
    8. Altered mental state to coma
  6. Symptoms and Signs per Carboxyhemoglobin level
    1. Carboxyhemoglobin: 10%
      1. Frontal Headache
    2. Carboxyhemoglobin: 20%
      1. Throbbing Headache
      2. Dyspnea on exertion
    3. Carboxyhemoglobin: 30%
      1. Impaired judgment
      2. Nausea or Vomiting
      3. Dizziness
      4. Visual disturbance
      5. Fatigue
    4. Carboxyhemoglobin: 40%
      1. Confusion
      2. Syncope
    5. Carboxyhemoglobin: 50%
      1. Coma
      2. Seizures
    6. Carboxyhemoglobin: 60%
      1. Hypotension
      2. Respiratory failure
    7. Carboxyhemoglobin: 70%
      1. Death
  7. Labs
    1. Blood grossly appears abnormal red color
    2. Carboxyhemoglobin elevated
    3. Leukocytosis
  8. Management: Mild Poisoning
    1. Criteria
      1. Carboxyhemoglobin <30%
      2. No Neurologic or Cardiovascular Impairment
    2. Management
      1. Oxygen 100% Non-Rebreathing Mask
        1. Continue until carboxyhemoglobin <5%
      2. Admission criteria
        1. All patients with Carboxyhemoglobin >25%
        2. Underlying heart disease
  9. Management: Moderate Poisoning
    1. Criteria
      1. Carboxyhemoglobin: 30-40%
      2. No Neurologic Impairment
    2. Management
      1. Oxygen 100% Non-Rebreathing Mask
        1. Continue until carboxyhemoglobin <5%
      2. Admission to telemetry (cardiovascular monitor)
      3. Arterial Blood Gas
        1. Determine acid-base status
  10. Management: Severe Poisoning
    1. Criteria
      1. Carboxyhemoglobin: >40%
      2. Neurologic Impairment
    2. Management
      1. Oxygen 100% Non-Rebreathing Mask
        1. Continue until carboxyhemoglobin <5%
      2. Admission to telemetry (cardiovascular monitor)
      3. Arterial Blood Gas
        1. Follow acid-base status
      4. Hyperbaric oxygen chamber
        1. Efficacy
          1. Better short-term and long-term cognitive outcome
          2. Weaver (2002) N Engl J Med 347:1057
        2. Criteria
          1. Chamber immediately available OR
          2. No improvement in 4 hours
            1. Cardiovascular status
            2. Neurologic status
  11. Preventive Measures
    1. Adequate Ventilation
    2. Carbon monoxide detectors
  12. Resources
    1. Consumer Products Safety= 800-638-2772)
  13. References
    1. Reisdorf (1996) in Tintinelli (1996)
    2. (1995) MMWR Morb Mortal Wkly Rep 44:765

Carbon Monoxide Poisoning (C0007020)

Definition (MSH)Toxic asphyxiation due to the displacement of oxygen from oxyhemoglobin by carbon monoxide.
Definition (CSP)toxic asphyxiation due to the displacement of oxygen from oxyhemoglobin by carbon monoxide.
ConceptsInjury or Poisoning (T037)
EnglishCARBON MONOXIDE POIS, Carbon Monoxide Poisoning, Carbon Monoxide Poisonings, POIS CARBON MONOXIDE
Spanishintoxicación por monóxido de carbono, intoxicacion por monoxido de carbono
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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