Name
CARBON MONOXIDE POISONING
DESCRIPTION
DETAIL
D.D. : - CYANIDE TOXICITY* HISTORY IN IMPORTANT * CARBOXYHEMAGLOBIN LEVELS - HIGH
TYPENOTES
RISK FACTORS : Cigarette smokers, Smoke inhalation, Closed space with faulty furnaces or stoves, Coal miners, Mechanics (inhalation of car exhaust), Paint strippers, Solvent manufacturingGENERAL MEASURES : β’ Removal from offending source β’ Rapid reduction in tissue hypoxia with 100% oxygen to reduce the half-time of elimination of carbon monoxide to 40 minutes β’ Supportive care as necessary β’ Intubation and mechanical ventilation may be necessary for severe intoxication β’ Volume resuscitation DRUG(S) OF CHOICE : . 100% Oxygen by tight fitting non-rebreathing mask . Hyperbaric oxygen for severe poisoning 1. Mild poisoning: carboxyhemoglobin levels < 30% . No signs or symptoms of cardiovascular or neurologic dysfunction . TREATMENT - admission if carboxyhemoglobin > 25% . Symptomatic medication - acetaminophen for headache etc. . 100% Oxygen by nonrebreather until carboxyhemoglobin < 5% . Patients with underlying heart disease should be admitted regardless of level of carboxyhemoglobin 2 . Moderate poisoning: carboxyhemoglobin 30-40% . No signs or symptoms of cardiovascular or neurologic dysfunction . Treatment - admission . Cardiovascular status should be followed closely even in the absence of clear cardiac effects . Determination of acid-base status - corrected by oxygen . 100% Oxygen by nonrebreather until carboxyhemoglobin < 5% 3 . Severe poisoning: carboxyhemoglobin > 40% . Cardiovascular or neurologic functional impairment at any carboxyhemoglobin . Treatment - admission . Cardiovascular function monitoring . Acid-base status monitoring . 100% Oxygen by nonrebreather until carboxyhemoglobin < 5% . Hyperbaric oxygen immediately if available, if unavailable then treat as in moderate poisoning . No improvement in cardiovascular or neurologic function within 4 hours - transport to nearest facility with hyperbaric oxygen, regardless of distance PATIENT MONITORING: . Measurement of carboxyhemoglobin levels . Arterial blood gases . Psychiatric evaluation and follow up for intentional exposure PREVENTION/AVOIDANCE : . Maintenance of furnaces and stoves to avoid faulty combustion . Adequate ventilation in high risk occupations POSSIBLE COMPLICATIONS: . Myocardial infarction . Long term neuropsychiatric complications . Intellectual deterioration . Memory impairment . Personality changes . Irritability . Aggressiveness . Violence . Moodiness EXPECTED COURSE/PROGNOSIS : Most survivors recover completely with only a minority developing chronic neuropsychiatric impairment
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, CARBOXYHAEMOGLOBIN ( CARBON MONOXIDE )
[CARBON MONOXIDE POISONING]