A power-point on Carbon monoxide poisoning. Reference: Pillai textbook of Forensic medicine, Wikipedia

1. POOJA SANTHOSH
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2.  Odourless
 Colourless
 Non-irritating
 Lighter than air
Plasma level : 1-5%
Smokers : 7-8%

3.  Incomplete combustion –wood/charcoal
 Automobile exhaust
 Fire
 Tobacco smoke
 Endogenous CO from haeme degradation (non-toxic
on its own)

5.  Plasma concentration > 50-60%

6.  Lungs absorb CO combines with Hb(85%) +
myoglobin (15%) eliminated through lungs

7.  Affinity to Hb: 230-270 times
 Leftward shift of Oxyhaemoglobin dissociation curve
 Decreased ability of carrying and releasing Oxygen

8.  Acute Poisoning
 Early: Non-specific
 2 classical features (rare):
Cherry red colour – blood + tissues
Cutaneous bullae/blisters
 Based on severity:
Mild (COHb <30%)
Moderate (30-40%)
Severe (>40%)

10.  Mild Severity
 Headache
 Nausea
 Vomiting
 Dizziness
 Exertional Dyspnea

11.  Moderate
 Chest pain
 Blurred vision
 Confusion
 Weakness
 Increasing dyspnea
 Tachycardia
 Tachypnea
 Ataxia

12.  Severe
 Trismus
 Muscle Spasms
 Convulsions
 Palpitations
 Disorientation
 Vent arrhythmias
 Hypotension
 MI
 Resp failure
 Coma

13.  Headache, dizziness, confusion
 Weakness, nausea, vomiting, abdominal pain
 Paraesthesias
 Visual disturbances
 Hypertension
 Hyperthermia
 Cherry red skin
 Palpitations
 Aggravation of Angina

15.  Estimation of COHb level
 Pulse oximetry
 Arterial blood gases
 ECG
 Chest X-ray
 Bedside tests

17.  Alcoholic intoxication
 Hyperventilation syndrome
 Cerebrovascular accident
 Meningitis/encephalitis
 Migraine
 Epilepsy
 Food poisoning

18.  Imm removal from contaminated env
 100% O2 -endotracheal tube
 Monitor C&D
 Neurologic exam + CAT scan + fundoscopic exam
 If ICT increased
 Hyperventilation
 Head elevation
 Mannitol

20.  NaHCO3 not given – Metabolic Acidosis
 Convulsions – Diazepam iv
Antidote : Hyperbaric Oxygen

21.  Cherry red colour of skin, blood, tissue
 Cutaneous bullae
 Pulmonary, cerebral edema
 Necrosis and cavitation of Basal ganglia
Collect blood from peripheral vein. Preservative: Sodium
fluoride.

23.  Suicidal
 Increased suicide in western countries earlier by
‘Putting the head in the gas oven’
 Now, suicide via inhaling exhaust fumes
 Accidental
 Incomplete combustion of natural gas (ill-ventilated)
 Defective exhaust system of automobile
 Conglagration – large building in flames
• Homicidal (rare)