Carbon Monoxide Toxicity

Carbon Monoxide is a colorless, odorless, tasteless gas which results from incomplete combustion of carbon containing fuel.  Here’s some quick tips for managing this deadly condition.

Toward the bottom of this post, I’ve linked some good resources about CO toxicity, and would encourage you to check them out.  Here are the fast facts that you need to know:

Carbon monoxide is produced by incomplete combustion of carbon compounds.  Charcoal grills, gas grills, generators, heaters, boats, planes, trains, automobiles, and anything that burns fossil fuels will produce it.  Carbon monoxide has about 210 times the affinity for hemoglobin than does oxygen, making it easy to hitch a ride in a patients circulatory system.  Since the “seat’s taken”, oxygen will be denied from joining with the hemoglobin, and thus, cannot perfuse systemic tissue.

Symptoms

The symptoms of CO toxicity may appear very similar to a viral illness, and this often results in misdiagnosis.  Below are some, but not all of the possible symptoms.

  • Dyspnea on exertion
  • Memory disturbances
  • Headache
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Abdominal pain
  • Blurry vision

Signs

  • Elevated SpCO reading (usually this value is 0% in nonsmokers and 3-5% in smokers, but can be higher.  Values higher than 15% are cause for serious concern and require immediate treatment.
  • Tachycardia
  • Tachypnea
  • Hyperthermia

With exception to firefighters (who are actively fighting a fire) and patients suffering the effects of smoke inhalation, CO toxicity rarely makes it on my differential list.  If you have access to an SpCO analysis device, it would be a very good idea to place it on any patient with nonspecific complaints of “flu like” symptoms who is tachypnic,  especially in the colder months of the year.

Management 

  • If the patient is still in the environment where they developed the symptoms, get them (any yourself) out ASAP.
  • Avoid unnecessary exertion by the patient
  • High flow O2 via NRB
  • Cardiac Monitoring

If you are a prehospital provider, contact medical control immediately upon suspicion of CO toxicity, as direct transport to a hyperbaric chamber may be indicated.


In closing, I feel obligated mention how I picked this topic.  While listening to Episode 98 of the FlightBridgeED Podcast , I learned about some recent research that may lead to the development of a CO toxicity reversal agent.  This would be a phenomenal advance in the management of patients with CO toxicity, given the current treatment methods.  To keep Eric Bauer and Mike Verkest from ordering a hit on me, I won’t steal their thunder.  I’m kidding of course, but seriously, if you aren’t listening to their podcasts you are missing a lot of great content.  You can check it out at FlightBridgeED.com, or click the link above.

Here’s some further reading on CO Toxicity:

Thanks for reading!  Please take a moment to follow my blog via e-mail so that you never miss a post.  You can also follow me on Facebook and Twitter by clicking the links on the top or side of the page.  Also, I have posted the answer regarding which EKG tracing was made using field expedient electrodes.  You can find that article here.  Until next time be safe and stay focused!

-Owen

 

References

Bauer E, Verkest M. The Neuroglobin Scavenger. FlightBridgeED. [accessed 2017 Jan 20]. www.flightbridgeed.com

Fernando J. Carbon Monoxide Poisoning. LITFL: Life in the Fast Lane Medical Blog. [accessed 2017 Jan 20]. http://lifeinthefastlane.com/ccc/carbon-monoxide-poisoning/

Shochat GN. Carbon Monoxide Toxicity. Carbon Monoxide Toxicity: Background, Pathophysiology, Epidemiology. [accessed 2017 Jan 20]. http://emedicine.medscape.com/article/819987-overview#a4

 

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