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Carbon monoxide


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Carbon Monoxide Poisoning for EMS

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Carbon monoxide

  1. 1. Pathophysiology ofCarbon Monoxide (CO) Poisoning  Frank Dispenza, M.Ed., NREMTP
  2. 2. Carbon MonoxidePoisoning Topics to be covered:  Structure and pathophysiology of Carbon Monoxide Poisoning.  Effects on the human body.  Sources of Carbon Monoxide.  Prevention strategies.  Treatment strategies.
  3. 3. Carbon MonoxidePoisoning1) Carbon Monoxide Facts: a) Colorless, odorless, tasteless. b) A gas, slightly lighter than air. c) Indicated as “CO”. One carbon atom bound to one oxygen atom. d) Also known as „carbonous oxide‟. e) Is a flammable gas. Burns with a blue flame.
  5. 5. How ‘CO’ is Formed1) Carbon Monoxide is formed in a combustion environment that is too „oxygen-starved‟ to make Carbon Dioxide.2) All Carbon Monoxide is „incompletely formed carbon dioxide‟.
  6. 6. How ‘CO’ is Formed1) Examples of „CO‟ producing sources: a) Motor Vehicles, gasoline powered tools. b) Volcanoes. c) Heaters. d) Cooking equipment.
  7. 7. How ‘CO’ enters the Body1) Carbon Monoxide is usually inhaled.2) „CO‟ is toxic to all forms of life that depend on oxygen.3) Poisoning can be „acute‟ (sudden onset) or „chronic‟ (gradual onset)
  8. 8. How ‘CO’ effects the Body1) Common Symptoms: a) Headache / Dizzyness. b) Loss of Judgment Abilities, Delerium. c) Nausea. d) Seizures. e) Tachycardia. f) Loss of Conciousness. g) Death.
  9. 9. How ‘CO’ effectsthe Body
  10. 10. Why ‘CO’ effects the Body1) Hemoglobin: a) The oxygen carrying protein found in blood that distributes oxygen to tissues throughout the body. b) Hemoglobin is found in blood and red blood cells.
  11. 11. Why ‘CO’ effects the Body1) Hemoglobin: a) Oxygen binds with an Iron (Fe) molecule found in the Hemoglobin structure. Oxidized iron is usually red (rust). b) Hemoglobin gives blood it‟s red color.
  13. 13. Why ‘CO’ effects the Body1) Hemoglobin: a) Oxygen binds to the iron molecule. b) Blood carries the oxygen through the body and then drops it off at the cellular level. c) The complex is a little unstable, and O2 leaves it easily.
  14. 14. Why ‘CO’ effects the Body1) Hemoglobin: a) Hemoglobin likes Carbon Monoxide 230 times more than it likes Oxygen. b) Hemoglobin bound to „CO‟ is known as carboxyhemoglobin.
  15. 15. Why ‘CO’ effects the Body1) Carboxyhemoglobin: a) A very stable substance. Does not want to give up it‟s „CO‟. b) This means that it is VERY HARD to get the carbon monoxide out of hemoglobin. c) As long as CO is in hemoglobin, oxygen cannot be there too.
  16. 16. Why ‘CO’ effects the Body1) Carboxyhemoglobin a) The inability of oxygen to get around the body in the blood leads to hypoxia (low-oxygen). b) Symptoms of „CO‟ poisoning are consistent with that of any other disease process that deprives the body of oxygen.
  17. 17. Signs & Symptoms1) Carbon Monoxide is measured in “ppm” or parts per million.2) Here are some symptoms in relation to dosages in „ppm‟…
  18. 18. Signs & Symptoms35 ppm…................…Headache & Dizzyness (6 hrs.)100 ppm…………….………………..Headache (3 hrs.)400 ppm ……………..............… Frontal H/A (1-2 hrs.)800 ppm……...Dizzyness, nausea, seizures (45 min.) …Unconscious in 2 hrs.1600 ppm ….… H/A, tachycardia, dissyness (20 min.) …Death in 2 hrs.3200 ppm……Headache, dizzyness, nausea (5 min.) …Death in 30 mins. 12,800 ppm………..…Unconscious after 2-3 breaths …Death in less than 3 mins.
  19. 19. Acute Poisoning1) Central Nervous System and Heart are most effected.2) Headache, nausea and fatigue can mimic influenza and food poisoning.3) Tachycardia and change in mental status occur later.
  20. 20. Acute Poisoning1) Cardiac Symptoms: a) Tachycardia. b) Hypotension. c) Malaise. d) Fatigue. e) Atrial Fibrillation.
  21. 21. Acute Poisoning1) Central Nervous System: a) Delirium /Psychosis. b) Dizziness. c) Hallucinations. d) Short term memory loss. e) Confusion / Depression f) Hyperglycemia. g) Seizures. h) Respiratory Arrest.
  22. 22. Acute Poisoning1) Think of some other illnesses that have the same signs and symptoms.2) Your Alzheimer‟s patient, suicidal patient, apparent drug overdose patient, CVA patient, may all be actually victims of carbon monoxide poisoning.
  23. 23. Epidemiology1) Most cases go unreported.2) Most often occurs during winter months.3) Faulty ventilation of heat supplying equipment mostly at fault.4) Over 50% of all fatal poisonings of any kind are „CO‟ related.
  24. 24. Epidemiology1) 40,000 people a year seek medical help for CO poisoning.2) 6,000 CO related accidental deaths a year.3) 2,000 suicides a year.4) Even though catalytic converters clean 99% of „CO‟ from car exhaust, running a car in a confined space is still the most usual suicide method.
  25. 25. Epidemiology1) Burning charcoal or fossil fuel in a confined space is fast becoming the new way of committing „CO‟ suicide.2) Dangerous levels of „CO‟ exist in suicide scenes where people have rigged ways to deliver high concentrations of carbon monoxide.3) Always don protective gear!
  26. 26. Treatments1) CPR if needed.2) High-flow Oxygen (via NRB mask).3) Hyperbaric (above level pressure) Oxygen via a hyperbaric chamber. a) Pressure „forces‟ oxygen into hemoglobin.4) Treat seizures with benzodiazapine.5) Treat dysrhythmias with ACLS.
  27. 27. Treatments1) Hyperbaric Chamber:
  28. 28. Treatments1) Hyperbaric Chambers: a) SEHC – Main b) St. Joseph‟s (Warren) c) Trumbull Memorial Hospital (Warren)
  29. 29. Treatments1) Patients need Cardiac Monitor to detect arrhythmias.2) IV Access.3) A good history and physical exam may give you clues to possible „CO‟ poisoning.4) „CO‟ detecting device (like a pulse oximeter).
  30. 30. Detectors1) There are several different technologies for detectors: a) Opto-chemical. b) Biomemetic. c) Electromechanical. d) Semiconductor.
  31. 31. Detectors1) Opto-Chemical a) Cheap. Low tech. b) Treated cloth pad turns dark in the presence of „CO‟. c) Low cost. d) You must look at the pad often. e) Has no alarm device.
  32. 32. Detectors1) Biomemetic (imitates biology). a) Gell cell sensor has a synthetic hemoglobin in it. b) Darkens in presence of „CO‟. c) Can be hooked up to photoelectric light sensor and alarm. d) Lasts about 10 years.
  33. 33. Detectors1) Electromechanical. a) Produces an electrical current that precisely relates to „CO‟. b) Highly accurate. c) Requires minimal power. d) Operates at room temperature. e) Lasts about 5 years on lithium batteries. f) The dominant detector on the market today.
  34. 34. Detectors1) Semiconductor. a) Produces an electrical current that precisely relates to „CO‟. b) Highly accurate. c) Heated Tin Dioxide. d) 752 degrees operational temp. e) Resistance to current in the sensing element can trigger an alarm. f) Uses a lot of power.
  35. 35. DetectorsPlacement can be either on the floor orceiling as „CO‟ has nearly the samedensity as regular air.According to NFPA: All CO detectors“shall be centrally located outside of eachseparate sleeping area in the immediatevicinity of the bedrooms,” and each detector“shall be located on the wall, ceiling or otherlocation as specified in the installationinstructions that accompany the unit.”
  36. 36. DetectorsThe alarm points on carbon monoxidedetectors are not a simple alarm level (as insmoke detectors) but are a concentration-time function. At lower concentrations (eg100 parts per million) the detector will notsound an alarm for many tens of minutes. At400 parts per million (PPM), the alarm willsound within a few minutes. Thisconcentration-time function is intended tomimic the uptake of carbon monoxide in thebody while also preventing false alarms dueto relatively common sources of carbonmonoxide such as cigarette smoke.
  37. 37. Myths and FactsMYTH or FACT ? „CO‟ poisoning patients present with a „cherry red‟ color to their skin.
  38. 38. Myths and Facts MYTHThis is actually a poorindicator as it is usually foundafter death. Patients canhowever have a healthy pinkskin color with highconcentrations of „CO‟.
  39. 39. Myths and FactsMYTH or FACT ? Carbon Monoxide poisoning is thought to play a major role in „haunted houses‟.
  40. 40. Myths and Facts FACTMany people who have complainedof „hauntings‟ have been found tohave high levels of CarbonMonoxide in their blood (usuallyfrom faulty heating equipment).Remember that hallucination,delirium and confusion are allsymptoms of „CO‟ poisoning.
  41. 41. Myths and FactsMYTH or FACT ? Carbon Monoxide can be used as fuel.
  42. 42. Myths and Facts FACTDuring WW II, „CO‟ was used as afuel source for internal combustionengines. Charcoal or wood burnerswere affixed to carburetors and the„CO‟ produced was used in place ofgasoline. Coal gas (used inEngland before the use of naturalgas) is mostly „CO‟.