Finding needles in a haystack: A case series of carbon monoxide poisoning detected using new technology in the emergency department

2008 ◽  
Vol 46 (5) ◽  
pp. 461-469 ◽  
Author(s):  
Kerlen J. Chee ◽  
Douglas Nilson ◽  
Robert Partridge ◽  
Ashley Hughes ◽  
Selim Suner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
New Technology ◽  
Carbon Monoxide Poisoning ◽  
Case Series

scholarly journals Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

2018 ◽  
Vol 31 (3) ◽  
pp. 146 ◽  
Author(s):  
Luís Ramos dos Santos ◽  
Magna Alves-Correia ◽  
Margarida Câmara ◽  
Manuela Lélis ◽  
Carmo Caldeira ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Hyperbaric Oxygen ◽  
Clinical Symptoms ◽  
Carbon Monoxide Poisoning ◽  
Case Series ◽  
Neurological Syndrome ◽  
High Flow Oxygen ◽  
Lost To Follow Up ◽  
Mean Time

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

Carbon Monoxide Poisoning: Implications for Patient and Family Care in the Emergency Department

2008 ◽  
Vol 1 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Courtney E. Reinisch
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Practice Nurse ◽  
Early Recognition ◽  
Carbon Monoxide Poisoning ◽  
Family Care ◽  
The United States ◽  
Emergency Department Visits ◽  
Advanced Practice ◽  
Co Poisoning

Carbon monoxide (CO) is a colorless, odorless gas that can produce a constellation of noxious symptoms and potentially death when it reaches certain levels. Exposure to CO can be intentional (suicidal) or unintentional (accidental). CO poisoning is responsible for up to 40,000 to 50,000 emergency department visits and 5,000 to 6,000 deaths per year, making it one of the leading causes of poisoning death in the United States. When patients present to the emergency department with a constellation of symptoms, the advanced practice nurse should include environmental exposure in the differential diagnosis. This is especially important when family members present with similar complaints, such as headache or euphoria. Early recognition of CO poisoning is vital to identify individuals in need of prompt treatment and to prevent harmful and potential deadly exposure to others. Since patients often present with constitutional symptoms, including headache (most common), malaise, nausea, and dizziness, providers need to be cautious not to misdiagnose patients as having acute viral syndromes where CO poisoning could be the cause. Vigilance is needed during the winter months in cold climates when unintended poisoning is most common.

scholarly journals COVID-19 morbidity and mortality caused by endogenous carbon monoxide poisoning, with recommendations for testing and treatment

2020 ◽  
Author(s):  
Albert Hamburger Donnay
Keyword(s):  
Carbon Monoxide ◽  
Oxygen Saturation ◽  
Carbon Monoxide Poisoning ◽  
Cardiac Injury ◽  
Case Series ◽  
Body Burden ◽  
Morbidity And Mortality ◽  
Heme Oxygenase 1 ◽  
Co Poisoning ◽  
Blood Tests

To test our hypothesis that abnormal levels of endogenous carbon monoxide (CO) produced naturally by heme oxygenase-1 (HO-1) in response to infections of all kinds may be contributing to the morbidity and mortality associated with COVID-19, we searched PubMed for peer-reviewed literature on carbon monoxide and each of eleven abnormal blood tests, fourteen signs and symptoms, and five fatal complications of COVID-19 infection reported in a case series from a hospital in Wuhan, China: acute respiratory distress syndrome (ARDS), acute kidney injury, acute cardiac injury, arrhythmia, and shock. We found reports of acute exogenous CO poisoning causing all the same signs, symptoms and complications, and all the abnormal blood tests except D-dimer and procalcitonin. Our search also found endogenous HO-1 and CO levels correlated with these complications, independent of any inhaled CO exposure. In sharp contrast to the CO poisoning literature, most studies of endogenous CO interpret its close positive correlation with these acute conditions as protective, with some going so far as to recommend treating ARDS with inhaled CO. We conclude with new recommendations for testing endogenous CO poisoning in COVID-19 cases using devices approved by the US Food and Drug Administration that can distinguish CO coming from the lungs, arteries, veins, and average of all tissues, unlike current protocols for CO poisoning that only measure CO in arteries or veins but not both. Based on these findings, we appeal to clinicians to start testing CO levels in COVID-19 patients and to stop monitoring oxygen saturation with conventional pulse oximeters that overestimate oxygen saturation by the sum of carboxyhemoglobin and methemoglobin. We conclude by reviewing FDA-approved treatments that may help COVID-19 patients with endogenous CO poisoning. These include zinc-based drugs that lower the rate of endogenous CO production by inhibiting HO-1, and drug-free devices and methods that reduce the total body burden of CO after exogenous CO poisoning.

Managing a Mass CO Poisoning: Critical Issues and Solutions From the Field to the Hyperbaric Chamber

2016 ◽  
Vol 11 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Adriano Valerio ◽  
Matteo Verzè ◽  
Francesco Marchiori ◽  
Igor Rucci ◽  
Lucia De Santis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Emergency Services ◽  
Carbon Monoxide Poisoning ◽  
Heating System ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Accidental Poisoning ◽  
Complex Situation ◽  
First Case

AbstractCarbon monoxide acute intoxication is a common cause of accidental poisoning in industrialized countries and sometimes it produces a real mass casualty incident. The incident described here occurred in a church in the province of Verona, when a group of people was exposed to carbon monoxide due to a heating system malfunction. Fifty-seven people went to the Emergency Department. The mean carboxyhemoglobin (COHb) level was 10.1±5.7% (range: 3-25%). The clinicians, after medical examination, decided to move 37 patients to hyperbaric chambers for hyperbaric oxygen (HBO) therapy. This is the first case report that highlights and analyses the logistic difficulties of managing a mass carbon monoxide poisoning in different health care settings, with a high influx of patients in an Emergency Department and a complex liaison between emergency services. This article shows how it is possible to manage a complex situation with good outcome. (Disaster Med Public Health Preparedness. 2017;11:251–255)

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