scholarly journals Storm-Related Carbon Monoxide Poisoning

2013 ◽  
Vol 19 (3) ◽  
pp. 188-199 ◽  
Author(s):  
Scott A. Damon ◽  
Jon A. Poehlman ◽  
Douglas J. Rupert ◽  
Peyton N. Williams
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
The United States ◽  
Attitudes And Beliefs ◽  
Matrix Approach ◽  
Co Poisoning ◽  
Protective Behaviors ◽  
Home Safety ◽  
Severe Storms ◽  
Summer Storm

Carbon monoxide (CO) poisonings in the United States consistently occur when residents improperly use portable gasoline-powered generators and other tools following severe storms and power outages. However, protective behaviors—such as installing CO alarms and placing generators more than 20 feet away from indoor structures—can prevent these poisonings. This study identified knowledge, attitudes, and beliefs that lead consumers to adopt risk and protective behaviors for storm-related CO poisoning and post-storm generator use. Four focus groups (32 participants in total) were conducted with generator owners in winter and summer storm-prone areas to explore home safety, portable generator use, CO poisoning knowledge, and generator safety messages. Discussions were transcribed, and findings analyzed using an ordered meta-matrix approach. Although most generator owners were aware of CO poisoning, many were unsure what constitutes a safe location for generator operation and incorrectly stated that enclosed areas outside the home—such as attached garages, sheds, and covered porches—were safe. Convenience and access to appliances often dictated generator placement. Participants were receptive to installing CO alarms in their homes but were unsure where to place them. These findings suggest a deficit in understanding how to operate portable generators safely and a need to correct misconceptions around safe placement. In terms of behavioral price, the simple installation and maintenance of inexpensive CO alarms may be the most important strategy for ultimately protecting homes from both storm-related and other CO exposures.

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 Carbon Monoxide Poisoning in the Veterans Health Administration, 2010 - 2016

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Gina Oda ◽  
Russell Ryono ◽  
Cynthia A. Lucero-Obusan ◽  
Patricia Schirmer ◽  
Mark Holodniy
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Veterans Health Administration ◽  
The United States ◽  
Time Frame ◽  
Urgent Care ◽  
Veterans Health ◽  
Co Poisoning ◽  
Health Administration ◽  
Self Harm

ObjectiveTo describe characteristics of Veterans Health Administration(VHA) patients with ICD 9/10 CM inpatient discharge and/oremergency department (ED)/urgent care outpatient encounter codesfor carbon monoxide (CO) poisoning.IntroductionIt is estimated that in the United States (US), unintentional non-firerelated CO poisoning causes an average of 439 deaths annually, and in2007 confirmed CO poisoning cases resulted in 21,304 ED visits and2,302 hospitalizations (71 per million and 8 per million population,respectively)1. Despite the significant risk of morbidity and mortalityassociated with CO poisoning, existing surveillance systems in theUnited States are limited. This study is the first to focus specificallyon CO poisoning trends within the VHA population.MethodsQueries were performed in VA PraedicoTMPublic HealthSurveillance System for inpatient discharges and emergency roomand urgent care outpatient visits with ICD 9/10 CM codes for COpoisoning from 1/1/2010 – 6/30/2016. A dataset of unique patientencounters with CO poisoning was compiled and further classified asaccidental, self-harm or unspecified. Patients with carboxyhemoglobin(COHb) blood level measurements≥10%2for the same timeframewere extracted and merged with the CO poisoning dataset.We analyzed for demographic, geographic and seasonal variables.Rates were calculated using total unique users of VHA care formatching time frame and geographic area as denominators.ResultsThere were a total of 671 unique VHA patients identified with COpoisoning. Of these, 298 (44%) were classified as accidental, 104(15%) self-harm, and 269 (40%) unspecified. A total of 6 patientsdied within 30 days of their coded diagnosis, however only 1 ofthese was directly attributable to CO poisoning. The overall rate ofCO poisoning over the study time frame was 18 per million uniqueusers of VHA care. CO poisoning diagnoses were obtained from396 (59%) outpatients, 216 (32%) inpatients, and 59 (9%) patientswith both and outpatient visit and inpatient admission. Patientswith self-harm classification were less likely to be seen in the ED(only 24 (6%) unique patients compared to 190 (48%) accidental and182 (46%) unspecified classifications). Of patients seen in the ED andsubsequently admitted, patients with the classification of accidentalpoisoning made up the largest percentage with 36 unique patients(61%). There were 71 (11%) females compared to 600 (89%) males.The highest represented age group was 45-64 with 342 unique patients(51%). Rates by US Census Region were highest in the Midwestand Northeast (27 and 23 per million unique users, respectively)compared to the West and South (15 and 13 per million uniqueusers, respectively) (Figure 1). Accidental CO poisonings showed aseasonal pattern with peaks occurring in late fall, winter, and earlyspring months (Figure 2). CO poisonings classified as unspecifiedhad a similar but less pronounced pattern, while those classified asself-harm were too few to observe any pattern over time. COHb bloodlevels≥10% were present in 111 (17%) of patients with CO poisoningcodes. Of patients with COHb measures≥10%, those with self-harmclassification were least represented with only 7 unique patients (6%).Accidental and unspecified classifications were equally representedwith 53 (48%) and 51 (46%) unique patients, respectively.ConclusionsThe impact of CO poisoning on the VHA patient population hasnot been well studied. The geographic distribution of the majorityof cases in the Midwest and Northeast, and the seasonal distributionof accidental cases in colder months seems to be appropriate withrespect to what is known of unintentional CO poisoning as oftenassociated with heat-generating sources3. Opportunities for furtherinvestigation include how potential CO poisoning cases are evaluatedin VHA given the low percentage of cases with COHb blood levelmeasurements.

Carbon monoxide poisoning can act as a stress test to reveal underlying coronary artery disease: case report

2020 ◽  
pp. 151-169
Author(s):  
Lindell K. Weaver ◽  
◽  
Keyword(s):  
Carbon Monoxide ◽  
Hyperbaric Oxygen ◽  
Carbon Monoxide Poisoning ◽  
Stress Test ◽  
The United States ◽  
Brain Inflammation ◽  
Smoke Inhalation ◽  
Co Poisoning ◽  
Exposure Limits ◽  
Disease Case

Despite established exposure limits and safety standards as well as the availability of carbon monoxide (CO) alarms, each year 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO or from longer exposures to lower levels. Common symptoms can include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath, and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often develop brain injury manifested by neurological problems, including cognitive sequelae, anxiety and depression, persistent headaches, dizziness, sleep problems, motor weakness, vestibular and balance problems, gaze abnormalities, peripheral neuropathies, hearing loss, tinnitus, Parkinsonian-like syndrome, and other problems. In addition, some will have cardiac issues or other ailments. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO2) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by the CO-induced adduct formation of myelin basic protein. Based upon three supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO2 should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.

Carbon monoxide poisoning from devices used in disaster recovery

2007 ◽  
Vol 5 (3) ◽  
pp. 25
Author(s):  
Rosalyn Lemak, MPH
Keyword(s):  
United States ◽  
Carbon Monoxide ◽  
Natural Disasters ◽  
Disaster Recovery ◽  
Carbon Monoxide Poisoning ◽  
The United States ◽  
Recovery Phase ◽  
Co Poisoning ◽  
Power Outages ◽  
Ice Storms

Carbon monoxide (CO) is responsible for more fatalities in the United States each year than any other toxicant. While CO exposure is a year-round problem, fatal and nonfatal CO exposures occurred more often during the fall and winter months, and the majority of nonfatal CO exposures were reported to occur in the home. Postdisaster CO poisoning is an emerging hazard. Unintentional CO poisonings have been documented after natural disasters like hurricanes, floods, ice storms, and power outages. Overwhelmingly, CO exposure results from common sources such as portable generators, gas grills, kerosene and propane heaters, pressure washers, and charcoal briquettes. Although disaster events are thought to create victims immediately and in great numbers during the initial impact, some disasters are more deadly to people during the recovery phase, when people are thinking the disaster is over. More are injured during the cleanup phase than from the storm itself.

Pediatric Carbon Monoxide Poisoning

2010 ◽  
Author(s):  
Ramona O. Hopkins
Keyword(s):  
United States ◽  
Carbon Monoxide ◽  
Internal Combustion Engines ◽  
Methylene Chloride ◽  
Carbon Monoxide Poisoning ◽  
The United States ◽  
Emergency Department Visits ◽  
Co Poisoning ◽  
Vehicle Exhaust ◽  
Pediatric Populations

Carbon monoxide (CO) exposure has been described ever since humans developed products of combustion (e.g. fire, burning charcoal). The Romans realized that CO poisoning leads to death (Penney 2000). Coal fumes were used in ancient times for execution, and the deaths of two Byzantine emperors are attributed to CO poisoning (Lascaratos and Marketos 1998). Admiral Richard E. Byrd developed CO poisoning during the winter he spent alone in a weather station deep in the Antarctic interior (Byrd 1938). Further, CO poisoning took the life of tennis player Vitas Gerulaitis (“Died, Vitas Gerulaitis,” 1994; Lascaratos and Marketos 1998) and may have contributed to Princess Diana’s accidental death in 1997 (Sancton and Macleod 1998). Carbon monoxide is a colorless, tasteless, odorless gas by-product of the combustion of carbon-containing compounds such as natural gas, gasoline, kerosene, propane, and charcoal. The most common sources of CO poisoning are internal combustion engines and faulty gas appliances (Weaver 1999). Carbon monoxide poisoning can also occur from space heaters, methylene chloride in paint removers, and fire (Weaver 1999). The most frequent causes of pediatric CO poisoning are vehicle exhaust, dysfunctional gas appliances and heaters, and charcoal briquettes (Kind 2005; Mendoza and Hampson 2006). Less common sources of CO poisoning include riding in the back of pickup trucks, and while swimming and recreational boating (Hampson and Norkool 1992; Silvers and Hampson 1995). Among pediatric populations, minorities are disproportionately affected by CO poisoning compared to Caucasians, and Latinos and non-Latino blacks were more commonly poisoned by charcoal briquettes used for cooking or heating (Mendoza and Hampson 2006). Carbon monoxide is the leading cause of poisoning injury and death worldwide (Raub et al. 2000) and accidental and intentional poisoning in the United States. In the United States carbon monoxide poisoning results in approximately 40,000 emergency department visits (Hampson 1999) and 800 deaths per year (Piantadosi 2002). Children are particularly venerable to CO poisoning. The Center for Disease Control reports children younger than 4 years have the highest incidence of unintentional CO poisoning but the lowest death rates (2005).

scholarly journals Predictive Role of QTc Prolongation in Carbon Monoxide Poisoning-Related Delayed Neuropsychiatric Sequelae

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Shu-Chen Liao ◽  
Yan-Chiao Mao ◽  
Yao-Min Hung ◽  
Ching-Hsing Lee ◽  
Chen-Chang Yang
Keyword(s):  
Carbon Monoxide ◽  
Roc Curve ◽  
Carbon Monoxide Poisoning ◽  
Chang Gung Memorial Hospital ◽  
Qtc Interval ◽  
Continuous Variables ◽  
Co Poisoning ◽  
Qtc Prolongation ◽  
Roc Curve Analysis ◽  
Delayed Neuropsychiatric Sequelae

Objective. Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients’ quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. Methods. This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. Results. A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21–6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31–9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03–1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21–5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660–0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. Conclusions. We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning.

Brain stem and spinal cord demyelination due to acute carbon monoxide poisoning

2021 ◽  
pp. 247-253
Author(s):  
Yan Lv ◽  
Yv Zhang ◽  
Shuyi Pam ◽  
Keyword(s):  
Spinal Cord ◽  
Carbon Monoxide ◽  
Brain Stem ◽  
Carbon Monoxide Poisoning ◽  
Recovery Period ◽  
Extended Period ◽  
Severe Case ◽  
Co Poisoning ◽  
Secondary Demyelination ◽  
The Brain

Demyelination throughout the brain stem and spinal cord caused by acute carbon monoxide (CO) poisoning has not been previously reported. Magnetic resonance imaging (MRI) has revealed that acute CO poisoning primarily affects the subcortical white matter of the bilateral cerebral hemispheres and basal ganglia. Here we report the case of a patient with delayed neuropsychological sequelae (DNS) due to acute CO poisoning. A 28-year-old man was admitted to our department following a suicide attempt by acute CO poisoning. After a six-month pseudo-recovery period, he was diagnosed with DNS, with MRI evidence of demyelinating change of the bilateral cerebral peduncles. Demyelination was identified throughout the brain stem, expanding from the bilateral cerebral peduncles to the medulla oblongata, occurring approximately six months after poisoning. One and a half years after acute CO poisoning, demyelination of the cervical and thoracic spine was observed, most notable in the lateral and posterior cords. It is evident that previously published research on this topic is extremely limited. Perhaps in severe cases of acute CO poisoning the fatality rate is higher, leading to fewer surviving cases for possible study. This may be because a more severe case of acute CO poisoning would result in the higher likelihood of secondary demyelination. This research indicates that clinicians should be aware of the risk of secondary demyelination and take increased precautions such as vitamin B supplementation and administration of low-dose corticosteroids for an extended period of time in order to reduce the extent and severity of demyelination.

Epidemiological aspects and a current approach to the problem of carbon monoxide poisoning

2020 ◽  
Vol 6 (4) ◽  
pp. 4-9
Author(s):  
Sayit I. Indiaminov ◽  
Antonina A. Kim
Keyword(s):  
Carbon Monoxide ◽  
World Literature ◽  
Carbon Monoxide Poisoning ◽  
Epidemiological Data ◽  
Current Approach ◽  
Co Poisoning ◽  
Fatal Poisoning ◽  
Young Males ◽  
Causes Of Mortality ◽  
Mechanical Asphyxia

Background: Carbon monoxide (CO) poisoning is the leading cause of death from poisoning (accidental and intentional). The number of cases of CO poisoning is increasing day by day. Aims: The aim of the study was to analyze the epidemiological situation of CO poisoning and identify the urgent aspects of this problem. In the article, the author provided a retrospective analysis of 117 cases of CO poisoning, registered in a number of regional branches of the Republican Scientific and Practical Center of the Forensic Medical Examination of Uzbekistan, after he studied and analyzed the world literature on the epidemiology of CO poisoning. It has been revealed that fatal poisoning ranks third after mechanical injuries and mechanical asphyxia and constitutes 6.3% (513 cases) in the range of deaths by violence (8078 cases). Therefore, CO poisoning is considered as one of the most prevailing (51%) causes of mortality. Conclusion: This is a global problem, with young males at risk. Further studies on the current clinical and forensic aspects of CO poisoning are required, and the necessity for regular analysis of epidemiological data for taking comprehensive measures to prevent CO poisoning is emphasized.

scholarly journals Carbon Monoxide Poisoning Effectively Treated with High-flow Nasal Cannula

2019 ◽  
Vol 4 (1) ◽  
pp. 42-45
Author(s):  
Patrick Lee ◽  
Steven Salhanick
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
High Flow ◽  
Nasal Cannula ◽  
The Novel ◽  
Co Poisoning ◽  
High Flow Nasal Cannula ◽  
Disease States ◽  
Cohb Level ◽  
Potential Option

Carbon monoxide (CO) poisoning is typically treated by administration of oxygen via non-rebreather mask (NRB). High-flow nasal cannula (HFNC) is an alternative to NRB in a variety of disease states. We report a case of the novel use of HFNC in the treatment of acute CO poisoning. A 29-year-old man presented with a carboxyhemoglobin (COHb) level of 29.8%. He was treated with HFNC, and COHb levels declined to 5.4% in 230 minutes. Given several theoretical advantages of HFNC relative to NRB, HFNC is a potential option for use in the treatment of CO poisoning.

Evaluation of oxidative stress and antioxidant parameters in children with carbon monoxide poisoning

2019 ◽  
Vol 38 (11) ◽  
pp. 1235-1243
Author(s):  
O Teksam ◽  
S Sabuncuoğlu ◽  
G Girgin ◽  
H Özgüneş
Keyword(s):  
Oxidative Stress ◽  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Venous Blood ◽  
Treatment Modalities ◽  
Control Group ◽  
Co Poisoning ◽  
Erythrocyte Catalase ◽  
Significant Difference ◽  
Before And After

Objective: In this study, we aimed to investigate oxidative stress and antioxidant parameter levels in patients with carbon monoxide (CO) poisoning. Methods: The study was conducted prospectively between March 1, 2015 and April 30, 2016 in the pediatric emergency department. Eligible patients included children aged 0–18 years old with a diagnosis of CO poisoning. To determination of oxidative stress and antioxidant parameter levels, venous blood with heparinized and urine samples were drawn during the admission and after normobaric oxygen (NBO) and hyperbaric oxygen (HBO) treatment. Results: Forty-seven children with CO poisoning for study group and 29 patients as control group were included to the study. Sixteen patients treated with HBO. Basal plasma malondialdehyde levels were found to be significantly higher in the CO poisoning group when compared with the control group ( p = 0.019). There is no significant difference in oxidative stress and antioxidant parameter levels except erythrocyte catalase enzyme levels in patients treated with NBO when comparing before and after NBO treatment ( p > 0.05). Decreasing of basal erythrocyte catalase enzyme levels were found statistically significant after NBO treatment ( p = 0.04). There was no significant difference in oxidative stress and antioxidant parameter levels in patients treated with HBO before and after therapy ( p > 0.05). Conclusions: CO poisoning is associated with increased lipid peroxidation in children immediately after the poisoning. However, both treatment modalities including NBO or HBO do not have a significant effect on oxidative stress or antioxidant parameter levels.

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