Carbon Monoxide Inhalation

Section 3 - RESPIRATORY

3.02 CARBON MONOXIDE INHALATION

POSSIBLE SIGNS AND SYMPTOMS:

Headache	Dizziness	Weakness
Nausea, vomiting	Cutaneous flush	Ringing in the ears
Parasthesia	Anesthesia	Coma

• INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with BVM or CPAP device as indicated.
• Pulse Oximetry may indicate a false positive.
• Draw blood tubes, if available. Cover tubes with cold-pack
• Keep patient as calm as possible to minimize OXYGEN needs.
• If wheezing is present
  • ALBUTEROL (PROVENTIL) 2.5 mg via updraft
  • Consider .5 mg IPRATROPIUM BROMIDE (ATROVENT) via updraft (only one time)
• Differential Diagnosis
  • CYANIDE POISONING 5.19
• If SpCO measurement in the field is not available any symptomatic patient with suspected exposure should be treated with 100% OXYGEN via NRB and transported to closest facility
• If carboxyhemoglobin (SpCO) measurement in the field is possible the following guidelines can be used as a baseline for determining treatment and transport

MILD

0 - 3%	Normal level, no emergent treatment required.
3 - 15%	WITHOUT signs and symptoms, and WITHOUT known history of carbon monoxide exposure continue monitoring and observe for change in condition.

MODERATE

3 - 15%

WITH signs and symptoms, or WITH known history of carbon monoxide exposure provide treatment as needed and transport to facility capable of emergency hyperbaric treatment

SEVERE

>15%

WITH signs and symptoms, regardless of known history of exposure, treat with 100% oxygen by non re-breather mask and transport to facility capable of emergency hyperbaric treatment. Contact the receiving facility as early as possible and advise them of the SpCO measurement and the need for emergent hyperbaric treatment.

Pregnancy and any abnormal SpCO treat as severe

Underlying Conditions, CAD, Pulmonary Disease, Anemia, Children, Geriatrics

Additional Information

• Carbon Monoxide is odorless, tasteless
• 200-250 times greater affinity for hemoglobin than oxygen

Sources

motor vehicles	generators	fires	methyl chloride	paint remover (by-product)
furnaces	space heaters	auto exhausts	smokers (15% CO)

Epidemiology

leading cause of death from poisoning

Carbon monoxide half-life

Room air	4-6 hours
100% Oxygen	40 to 60 minutes
hyperbaric treatment	20 to 24 minutes

Pathophysiology

• Inhalation
• Diffusion across membranes
• Reversible binding with hemoglobin=> carboxyhemaglobin
• Decrease in oxygen delivery
• Also binds to myoglobin (muscle weakness)
• Shifts oxygen delivery curve to the left

Signs and Symptoms

• History of multiple exposures/ family members affected
• Headache (earliest and most common symptom)
• Dizziness, mental status change, weakness, fatigue, nausea, vomiting
• Tachycardia, tachypnea, syncope, coma
• Cherry red mucous membranes (uncommon, 10%)
• Myocardial infarction

Children

• Higher metabolic demand, more susceptible => “canary effect”

Pregnancy

• Fetus is especially vulnerable
• Decreased oxygen delivery
• HgF binds CO more readily
• Longer elimination of CO

Following acute exposure to carbon monoxide long term sequelae can result therefore it is important for carbon monoxide to be removed from the system as quickly as possible.

Hyperbaric Chambers Advent Health Orlando (407) 303 1549

Resources Divers Alert Network Emergency Hotline at (919) 684-9111