Another perspective on ACEP policy on critical issues in carbon monoxide poisoning: Invited commentary (original) (raw)

Carbon monoxide poisoning: assessment, treatment, and outcomes

International Journal Of Community Medicine And Public Health, 2021

Many complications can occur secondary to carbon monoxide (CO), including serious complications to the cardiovascular system and neurological complications that might even end up with death. It has been estimated that around 30-40% of patients suffering from CO poisoning usually die before presenting at the emergency department. Accordingly, management of these patients is a critical approach to enhance the outcomes and prognosis of the affected patients. In the present literature review, we have discussed the current evidence regarding the assessment, treatment, and outcomes of patients with CO poisoning. Our results indicate that attending clinicians should adequately assess the suspected patients with their clinical manifestations, laboratory parameters, and history of exposure to CO. Besides, imaging techniques can also be indicated in some cases with a suspected brain injury. After the diagnosis has been successfully established, management of symptoms and administration of the...

Carbon monoxide poisoning: a review for clinicians

The Journal of Emergency Medicine, 1999

e Abstract-Carbon monoxide (CO) poisoning continues to be a significant health problem both in the United States and in many other countries. CO poisoning is associated with a high incidence of severe morbidity and mortality. Epidemics of CO poisoning commonly occur during winter months and sources include: smoke from fires, fumes from heating systems burning fuels, and exhaust fumes from motor vehicles. The history of exposure and carboxyhemoglobin levels should alert the physician to this diagnosis. In the absence of exposure history, CO poisoning should be considered when two or more patients are simultaneously sick. The clinical presentation is non-specific and may range from nausea and headache to profound central nervous system dysfunction. The mainstay of therapy for CO poisoning is supplemental oxygen, ventilatory support, and monitoring for cardiac dysrhythmias. This article reviews up-to-date information of this potentially devastating exposure.

The Diversity of Carbon Monoxide Intoxication: Medical Courses Can Differ Extremely—A Case Report

Inhalation Toxicology, 2008

Intoxications of carbon monoxide are frequent and may affect systems of lung, heart, and brain, leading to coma or death in severe cases. In this case report, we present two adults who were exposed to the same source of carbon monoxide for a nearly equal period of time. The first patient, a 28-yr-old female, developed massive symptoms including loss of consciousness, respiratory insufficiency, and lung complications resulting in severe lung edema. She was intubated and ventilated for 43 h before she recovered and could be extubated. The other patient, a 22-yr-old male, recovered immediately and was fully orientated after applying an oxygen mask at the scene of incident. After admission to the intensive care unit, both patients showed an equally high serum level of COHb and received hyperbaric oxygen therapy. The male patient was discharged from hospital the following day, whereas the female remained in intensive care for 4 days. A satisfactory explanation could not be found for the difference in the clinical progression in these two cases. However, this case report shows that, in spite of almost equal serum levels of carboxyhemoglobin (COHb), the individual symptoms can vary extremely. Therefore, a detailed medical history, physical examination, supporting diagnostic measures, and the continuous monitoring of vital parameters in a specialized clinic are essential.

Pilot study of risks and long-term effects of carbon monoxide poisoning

2011

BACKGROUND There are a number of cases each year of fatal and non-fatal carbon monoxide (CO) poisoning. In non-fatal cases, immediate consequences can include loss of consciousness and irreversible tissue damage in the brain or heart. Poisoning insufficient to cause coma may still lead to symptoms, but the cause may not be recognised, and it is likely that mild CO poisoning is under-reported.

S2k guideline diagnosis and treatment of carbon monoxide poisoning

GMS German Medical Science, 2021

Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke, indoor fireplaces, silos containing large quantities of wood pellets, engine exhaust fumes, and when using hookahs. Symptoms of CO poisoning are nonspecific and can range from dizziness, headache, and angina pectoris to unconsciousness and death. This guideline presents the current state of knowledge and national recommendations on the diagnosis and treatment of patients with CO poisoning. The diagnosis of CO poisoning is based on clinical symptoms and proven or probable exposure to CO. Negative carboxyhemoglobin (COHb) levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon. Reduced oxygen-carrying capacity, impairment of the cellular respiratory chain, and immunomodulatory processes may result in myocardial and central nervous tissue damage even after a reduction in COHb. If CO poisoning is suspected, 100% oxygen breathing should be imme...

A 5-year assessment on carbon monoxide poisoning in a referral center in Tehran-Iran

International Journal of Preventive Medicine, 2019

Background: Carbon monoxide (CO) poisoning results in hundreds of deaths and thousands of emergency department visits all over Iran annually. In this study, we aim to provide an epidemiologic analysis of this poisoning in different consciousness levels. Methods: This single-center retrospective study was conducted at a referral poison center from March 21, 2007 to March 19, 2012 in Tehran, Iran. All CO poisoned children and adults who hospitalized were evaluated based on their on-arrival consciousness level. Results: Two-hundred-sixty patients with pure CO poisoning were enrolled with the majority of males (55.4%). CO exposure was unintentional in 99.6% of cases. The average period between CO exposure and the patients' hospital admission was 6.4 hours (SD = 11.2). Most of the toxicities had occurred at home (73.5%). On arrival acid-base status revealed respiratory acidosis cases in 11.9% of cases. Central nervous system imaging revealed 6.2% abnormal finding. Typically, patients presented with vomiting (25.8%), nausea (22.7%), and dizziness (11.3%). Twenty-nine patients (11.2%) needed intubation and mechanical ventilation. Thirty-six patients admitted to ICU with a median [IQR] hospital stay of 6 [2, 18] days. Ultimately, 202 (78.6%) patients discharged and 47 (18.3%) left the hospital against medical advice, 5 (1.9%) died, and 10 (3.8%) experienced sequellae. Two patients (0.8%), were transferred to other hospitals for specialized care. Conclusions: The incidence and mortality rate of CO poisoning in the current study are still higher than many other parts of the world. Ongoing health prevention strategies are not efficiently working. Hence, constant public education and warning about CO toxicity should be highlighted.

Acute Carbon Monoxide Poisoning: Experience of Eight Years

Journal of Academic Emergency Medicine, 2014

Aim: This study aims to evaluate the general characteristics of patients with acute carbon monoxide poisoning in childhood. Materials and Methods: Medical reports of 240 patients with carbon monoxide poisoning who were admitted to the Pediatric Emergency Department between January 2005 and 2013 (mean age, 82.5±56 months; 115 boys, 125 girls) were retrospectively analyzed. Demographic features of patients, sources of exposure, clinical signs, blood carboxyhemoglobin levels, laboratory findings, and treatment methods were evaluated. Results: Approximately half of the poisonings were observed in winter (December and January). Among the sources of exposure to carbon monoxide gas, the stove was found to be the most common source. Majority of patients suffered from fainting and headaches, whereas 16% of patients had no active complaints. The average of the initial blood carboxyhemoglobin level was 14.9±10%, and 14.2% of patients had a level of >25%. All patients underwent normobaric oxygen therapy, and 21.7% of them underwent hyperbaric oxygen treatment. Conclusion: Unexpected deaths because of carbon monoxide poisoning gradually increase, particularly in winter. Carbon monoxide poisoning should be considered in the patients presenting with suspicious findings, particularly in winter. Blood carboxyhemoglobin levels are useful for diagnosis.