Carbon Monoxide Inhalation: Difference between revisions

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==== POSSIBLE SIGNS AND SYMPTOMS: ====
==== POSSIBLE SIGNS AND SYMPTOMS: ====
* Headache.
{|
* Dizziness.
|style="width: 30%"|Headache
* Weakness.
|style="width: 30%"|Dizziness
* Nausea, vomiting.
|style="width: 30%"|Weakness
* Cutaneous flush.
|-
* Ringing in the ears.
|Nausea, vomiting
* Coma
|Cutaneous flush
* Parasthesia
|Ringing in the ears
* Anesthesia
|-
|Parasthesia  
|Anesthesia
|Coma
|}


*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|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|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft
**Consider .5 mg [[Atrovent|IPRATROPIUM BROMIDE (ATROVENT)]] via updraft (only one time)
*Differential Diagnosis
**[[Cyanide_Poisoning|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


1. [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM or CPAP device as indicated. (Be aware, Pulse Oximetry may indicate a false positive.)
=== <span style="color: green;">MILD</span> ===
{|
|style="width: 10%"|0 - 3%
|Normal level, no emergent treatment required.  
|-
|style="width: 10%"|3 - 15%
|WITHOUT signs and symptoms, and WITHOUT known history of carbon monoxide exposure continue monitoring and observe for change in condition.  
|}


2. Draw blood tubes, if available. Cover tubes with cold-pack.
=== <span style="color: gold;">MODERATE</span> ===
{|
|style="width: 10%"|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
|}


3. Keep patient as calm as possible to minimize OXYGEN needs.
=== <span style="color: red;">SEVERE</span> ===
{|
|style="width: 10%"|>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.
|}
<span style="color: red;">Pregnancy and any abnormal SpCO treat as severe</span>


4. If wheezing present, [[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft. Monitor heart rate.  After 2 doses of [[Bronchodilators|ALBUTEROL]] 2.5 mg via updraft, consider .5 mg [[Bronchodilators|IPRATROPIUM BROMIDE (ATROVENT)]] via updraft (only one time).
<span style="color: red;">Underlying Conditions, CAD, Pulmonary Disease, Anemia, Children, Geriatrics</span>


5. If the patient is exhibiting altered mental status, the Paramedic should immediately coordinate with the hospital in preparation for the hyperbaric chamber.
===Additional Information===
*Carbon Monoxide is odorless, tasteless
*200-250 times greater affinity for hemoglobin than oxygen


6. If the patient is in cardiac arrest, refer to appropriate Practice Parameters and transport to the closest appropriate receiving facility.
====Sources====
{|class="wikitable"
|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


'''HYPERBARIC CHAMBERS:'''
====Carbon monoxide half-life ====
{|class="wikitable"
|Room air
|4-6 hours
|-
|100% Oxygen
|40 to 60 minutes
|-
|hyperbaric treatment
|20 to 24 minutes
|}


'''Florida Hospital-South, Orlando'''
====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


Shands Hospital, Gainesville.
====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


Holmes Regional Medical Center, Melbourne.
====Children====
*Higher metabolic demand, more susceptible => “canary effect”


[[Category:Respiratory]]
====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

Latest revision as of 14:35, 24 April 2020

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
  • Differential Diagnosis
  • 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

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