Leenard Michael A. Sajulga, RNCarbon Monoxide Poisoning
Carbon monoxide poisoning• An example of an inhaled poison• The result of the inhalation of the products of incomplete hydrocarbon combustion• May occur as an industrial or household accident or as an attempted suicide
Carbon monoxide• Exerts its toxic effect by binding to circulating hemoglobin to reduce the oxygen-carrying capacity of the blood• Combines with hemoglobin to form carboxyhemoglobin• The affinity between carbon monoxide and hemoglobin is 200-300x that between oxygen and hemoglobin• As a result, tissue anoxia occurs.
• Assess airway and breathing. –Respiratory depression may be present. –If the carbon monoxide poisoning is due to smoke inhalation, stridor (indicative of laryngeal edema due to thermal injury) may be present.
• Provide 100% oxygen by tight-fitting mask• The elimination half-life of carboxyhemoglobin, in serum, for a person breathing room air is 5 hours 20 minutes• If the patient breathes 100% oxygen, the half-life is reduced to 80 minutes
• 100% oxygen in a hyperbaric chamber will reduce the half-life to 23 minutes [treatment of choice• Intubate, if necessary, to protect the airway.
• A thorough history is important: determine the type and length of exposure as well as possible other fumes inhaled• An underlying anemia, cardiac disease, or pulmonary disease may place a person at higher risk.• Determine LOC—the patient may appear intoxicated from cerebral hypoxia; confusion may progress rapidly to coma.
• Assess complaints of headache, muscular weakness, palpitation, dizziness.• Inspect skin: may be pink, cherry red, or cyanotic and pale—skin color is not a reliable sign.• Monitor vital signs: increased respiratory and pulse rates are generally present. Be alert for altered breathing patterns and respiratory failure.
• Listen for rales or wheezes in the lungs (with smoke inhalation, indicates acute respiratory distress syndrome).• Obtain arterial blood samples for carboxyhemoglobin levels. –Normal is less than 12%. –Severe carbon monoxide poisoning is present when levels are greater than 30% to 40%.
• History of exposure to carbon monoxide justifies immediate treatment.• GOALS: to reverse cerebral and myocardial hypoxia and hasten carbon monoxide elimination.• Give 100% oxygen at atmospheric or hyperbaric pressures to reverse hypoxia and accelerate elimination of carbon monoxide
• Patients should receive hyperbaric oxygen for CNS or cardiovascular system dysfunction.• Use continuous ECG monitoring, treat dysrhythmias, and correct acid-base and electrolyte abnormalities.• Observe the patient constantly—psychoses, spastic paralysis, vision disturbances, and deterioration of personality may persist after resuscitation and may be symptoms of permanent CNS damage.