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THE HIDDEN DANGER OF CARBON MONOXIDE POISONING
SIGNS AND SYMPTOMS
Commonly, lower-level carbon monoxide patients describe their symptoms as those of a "flu-type" syndrome. They frequently complain of malaise (tiredness), headache, visual disturbances, "runny nose", and may not associate or recognize the symptoms as being the result of CO poisoning. A one month retroactive study of patients reporting to a hospital emergency room with "flu-like" symptoms revealed that almost one quarter of them (23.6%) had a CO level greater than 10% (a diagnosis of carbon monoxide poisoning is generally confirmed by a CO level greater than 10%).
Often, several members of the same family or those in a given building will complain of the same symptoms. Children are thought to be more susceptible to carbon monoxide poisoning than adults. Some people may not suspect that CO poisoning is occurring until major symptoms appear. Carbon Monoxide poisoning can mimic gastroenteritis (nausea and vomiting). Other manifestations may cause the appearance of what may appear to be a neurological or psychiatric disorder. High risk groups include infants, the elderly, pregnant women, and anyone with a previous history of cardiac insufficiency or chronic obstructive lung disease.
MEDICAL CONSEQUENCES
Carbon monoxide acts to cause tissue hypoxia by displacing oxygen with carboxyhemoglobin. This inhibits the transference of oxygen to the organs. Particularly affected are the heart, central nervous system and brain. The heart responds to hypoxia from CO poisoning by beating rapidly, irregularly, and with a decrease in blood pressure. Cardiac arrhythmia's (irregularities) frequently occur in the face of CO, causing heart blocks and ventricular ectopic beats (P.V.C.- Premature Ventricular Contraction). This cardiac irregularity may lead to heart attack and even death.
Cerebral edema (swelling of the brain) is also a common result of severe carbon monoxide poisoning. This life threatening condition entails the destruction of brain cells by compressing them into themselves within the cranial compartment. Drugs that are normally used for the treatment of cerebral edema, like Dexamethasone and Mannitol, do not seem to be of assistance in the treatment of CO induced cerebral edema. Studies have shown that cerebral edema caused by CO poisoning can cause delayed neurological problems that involve the "higher" or cognitive functions, and may cause a Parkinsonian-like brain syndrome.
CAUSATIVE FACTORS
Frequently, carbon monoxide is produced by the incomplete combustion of wood or hydrocarbon products. It will be produced as a byproduct of the burning of almost anything. Many carbon monoxide victims are stricken by gases that are insufficiently vented by heating equipment or furnaces. Several incidents occur each year in homes with fireplaces or wood-burning stoves/heaters.
Other incidents have been reported in apartments where gas stoves are being used for heat. In at least one case, carbon monoxide poisoning was caused by the use of a charcoal grill within an apartment's bathtub. More than fifty percent (50%) of all carbon monoxide incidents occur within homes. Twenty percent (20%) of all incidents occur in businesses of various types.
TREATMENT
One of the most important considerations in the treatment of Carbon Monoxide exposure patients is the immediate recognition of the problem. Once detected or suspected, the following action can be taken be taken by anyone;
1. Move the victim(s) to fresh air
2. Activate the Fire/Emergency Medical Service System, if victim(s) are experiencing any symptoms
3. Monitor for respiratory problems
4. Ventilate the affected area
Upon arrival, it is recommended that Basic Life Support (BLS) (e.g. EMT) personnel should;
1. Evaluate for respiratory tract irritation, bronchitis, or pneumonitis.
2. Administer humidified 100% oxygen by tight- fitting face mask. Assist ventilations as needed
3. Monitor Vital Signs
4. Monitor level of consciousness
5. Consider early transport to a Hyperbaric Oxygen Chamber for severely poisoned patients
5. Place the patient in a position of comfort and keep them warm
It is recommended that Advanced Life Support (A.L.S.) (e.g. Paramedic) personnel should;
1. Further evaluate the respiratory tract for dysfunction or possible compromise - intubate and assist ventilation as needed
2. Draw a blood sample for Carboxyhemoglobin analysis
3. Provide 100% humidified oxygen, do not delay administration of oxygen while performing blood sampling
4. Administer normal saline or other crystalline parental fluids at 2/3 to 3/4 of normal maintenance rates
5. Prepare for the possibility of generalized seizures in severe cases. Give diazepam (Valium) in 2-10 mg. doses (as needed) to terminate and control seizure activity
6. Perform electrocardiogram monitoring of the patient, be especially aware of ventricular ectopic beats and heart blocks. EKG changes seen most commonly in CO patients are ST segment depression, T-wave abnormalities, atrial fibrillation, and PVCs.
7. Any patient found unconscious, seizing, or with EKG changes and with an associated history should be treated as a severe carbon monoxide poisoning until proven otherwise
8. Consider direct transport to a Hyperbaric Oxygen therapy facility, with Oxygen being administered enroute, for severely poisoned patients
9. If the patient's history suggests any possibility of CO Poisoning, treat him/her as though they were exposed
PREVENTION AND CONCLUSIONS
Many lives could be saved and much disability prevented if citizens could learn to recognize and prevent the dangers of carbon monoxide poisoning. Preventive efforts such as checking furnace flues, chimneys, and vents could help to alleviate the hazard. The use of good common sense in not using open flames, ovens and other appliances not intended for heating, could reduce the number of carbon monoxide related incidents. It is also recommended that homeowners have their complete heating systems checked before every heating season.
Only by being aware of the peril, and understanding the nature of the hazard, can we help to prevent unnecessary exposures to deadly carbon monoxide. By understanding the mechanism of injury, we can be better prepared to treat the effects of this toxic product. In this way, it is expected that the number of people who succumb to carbon monoxide's "deadly clutches" can be reduced.
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