CO poisoning

[12R34Y]

Had 6 CO poisonings yesterday in the ED. One family of 4 and another old couple. Highest CO level was 28 and he got dived. Tis' the season when people turn on their old furnaces due to cold weather.

Anyone else seeing a bunch of these yet due to the cold weather?

later

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[spyderdoc]

Sure is the season, I already picked up a couple of CO detectors at Costco. only $25 each. They're nice in that they plug in, so no battery maint...Well worth it.....

 

[deleted59964]

Sure is the season, I already picked up a couple of CO detectors at Costco. only $25 each. They're nice in that they plug in, so no battery maint...Well worth it.....

Do you guys treat it with hyperbaric O2 or just 100%.
Go easy on me - I'm just an MS2

 

[12R34Y]

Do you guys treat it with hyperbaric O2 or just 100%.
Go easy on me - I'm just an MS2

There are varying thoughts on this from what I can tell. You can knock the half-life of CO in the body down to 60-90 minutes with high-flow Oxygen via Non-rebreather mask. Hyperbarics will knock it down to about 20-30 minute half-life thus clearing it more quickly. We dive people for 2 hours at 2.5 atms typically.

The family of 4 all had classic signs and symptoms of CO inhalation. Nausea/vomiting, headaches, fatigue etc....They were placed on high-flow O2 in the field and by the time they had arrived and their blood gases were drawn they had probably been on it for 30-40 minutes.

None of their CO levels were higher than 11. They all ultimately went home without hyperbarics.

The elderly couple both had levels above 25% which is typically the indication for hyperbarics.

The other indication is anytime someone has a loss of conciousness due to CO poisoning regardless of their level at the time of their ABG.

Every doc has kind of different hard and fast rules. Both board certified hyperbaric EM docs at the my institution differ on when they dive.

later

 

[DropkickMurphy]

Damn.....guess it is that time of the year. I just picked a guy up today for the funeral home at the county medical examiner's office who had died from CO poisoning. Unfortunately it was too late for him by the time anyone got to him and the only thing he was put into was a cardboard box and a crematorium retort. Be safe guys, have your furnaces checked and get some CO detectors.

 

[bartleby]

The direct effects of CO (i.e. tissue hypoxia) are only half the story. Some feel that the delayed effects of CO poisoning such as defecits in memory and executive function are related to lipid peroxidation in the brain caused by free radicals. HBO is felt to halt this process and prevent these complications.

There are varying thoughts on this from what I can tell. You can knock the half-life of CO in the body down to 60-90 minutes with high-flow Oxygen via Non-rebreather mask. Hyperbarics will knock it down to about 20-30 minute half-life thus clearing it more quickly. We dive people for 2 hours at 2.5 atms typically.

 

[AzMichelle]

Bartleby...

This is off topic but I have to tell you that I adore your sig picture. That's a great photo!

 

[bartleby]

Thanks! To think... I was just a puppy a few short years ago...

Bartleby...

This is off topic but I have to tell you that I adore your sig picture. That's a great photo!

 

[tennik]

Make sure to notify authorities/families when you have a CO poisoned patient. Tragic story here a few years ago when a man died unexpectedly and was termed likely cadiac death. His family came in for the funeral and stayed at his house. Five of the Six people staying there died the night before the funeral.....CO!

 

[DropkickMurphy]

Better advice, during this time of year, when you order an ABG on any patient (especially codes and altered mental status cases) be sure to ask for the co-oximetry results as well. It could well prevent such a tragedy.