CARBON MONOXIDE (CO) POISONING EPIDEMIC * prevention – WARNING – CAUSES – SYMPTOMS – THERAPY – GOAL – LONG TERM EFFECTS – **mandatory reporting effort by Washington State Public Health and Washington Posion Center

 

 

Preventing Carbon Monoxide Poisoning   *  Emergency

 

(fires photos from:  nifc.gov)
(product photos from:  web general sites)
(house photo from: kltv, texas)

 

Generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices should never be used inside a home, basement, garage, or camper – or even outside near an open window. 

Every home should have at least one working carbon monoxide detector. The detector’s batteries should be checked twice annually, at the same time smoke detector batteries are checked.

Carbon monoxide (CO) is an odorless, colorless gas that can cause sudden illness and death if inhaled.
When power outages occur during emergencies such as hurricanes or winter storms, the use of alternative sources of fuel or electricity for heating, cooling, or cooking can cause CO to build up in a home, garage, or camper and to poison the people and animals inside.

Every year, more than 500 people die in the U. S. from accidental CO poisoning.
CO is found in combustion fumes, such as those produced by small gasoline engines, stoves, generators, lanterns, and gas ranges, or by burning charcoal and wood. CO from these sources can build up in enclosed or partially enclosed spaces. People and animals in these spaces can be poisoned and can die from breathing CO.

How to Recognize CO Poisoning
Exposure to CO can cause loss of consciousness and death. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. People who are sleeping or who have been drinking alcohol can die from CO poisoning before ever having symptoms.

Important CO Poisoning Prevention Tips

  • Never use a gas range or oven to heat a home.
  • Never use a charcoal grill, hibachi, lantern, or portable camping stove inside a home, tent, or camper.
  • Never run a generator, pressure washer, or any gasoline-powered engine inside a basement, garage, or other enclosed structure, even if the doors or windows are open, unless the equipment is professionally installed and vented. Keep vents and flues free of debris, especially if winds are high. Flying debris can block ventilation lines.
  • Never run a motor vehicle, generator, pressure washer, or any gasoline-powered engine outside an open window, door, or vent where exhaust can vent into an enclosed area.
  • Never leave the motor running in a vehicle parked in an enclosed or partially enclosed space, such as a garage.
  • If conditions are too hot or too cold, seek shelter with friends or at a community shelter.
  • If CO poisoning is suspected, consult a health care professional right away.

 

Educational materials

 

(adapted from CDC website)

 

Indications for Hyperbaric Oxygen

Hyperbaric oxygen therapy is a specialized medical treatment in which the patient breathes 100 per cent oxygen while inside a chamber at increased atmospheric pressure. HBO is used for specific medical conditions. HBO has long been (PHOTO: hcmc hbo ctr) recognized as vital in the resolution of critical medical conditions such as gas gangrene, carbon monoxide poisoning, air embolism due to diving, trauma, or surgical procedures, and decompression sickness. It is also an important adjunct for specific wound healing conditions.

 

The Hyperbaric Oxygen Committee of the Undersea and Hyperbaric Medical Society (UHMS) lists the following indications: approved uses for Hyperbaric Oxygen therapy:

  • Air or gas embolism
  • Carbon monoxide poisoning and smoke inhalation
  • Clostridial myonecrosis (gas gangrene)
  • Crush injury, compartment syndrome, and other acute traumatic ischemias
  • Decompression sickness
  • Enhancement of selected problem wounds
  • Exceptional blood loss anemia
  • Necrotizing soft tissue infections
  • Chronic refractory osteomyelitis
  • Radiation tissue damage (Osteoradionecrosis)
  • Skin grafts and flaps (compromised)
  • Thermal burns
  • Adjunctive HBO in intracranial abscess

 

 (adapted from:  HCMC HBO Ctr)

 

 

Carbon monoxide poisoning: Reporting required

Due to the ongoing severe cold weather conditions and associated increase in carbon monoxide (CO) poisoning among King County (PHOTO: hcmc hbo ctr)  residents, Public Health is making suspected CO poisoning immediately reportable to Public Health by hospitals and healthcare provi
ders for seven days from today, through Dec. 24, 2006
. This period will be extended if necessary.

The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. Inhalation of carbon monoxide gas typically leads to headache, dizziness, and confusion, which might progress to dyspnea, tachypnea, syncope, and metabolic acidosis.  Laboratory criteria for diagnosis: A case in which carboxyhemoglobin concentration exists >5% in venous or arterial blood in nonsmokers and >10% in smokers, as determined by hospital or commercial laboratory tests. The typical range of carboxyhemoglobin concentrations in smokers is 6%-10%.

 

Advice regarding diagnosis and treatment management of CO intoxication is available 24/7 through Washington State Poison Center at 1-800-222-1222.

This health order impacts primarily emergency departments (ED) and the information should be disseminated to all ED staff in King County hospitals immediately. A designated person on each shift should be identified to report cases of CO poisoning to Public Health.

 (adapted from the Seattle/King County Public Health Announcement) 

THE CONTROVERSY CONTINUES:  DOES THE HYPERBARIC OXYGEN HELP?

Current assessment and treatment of CO poisoning in the
emergency department is grossly inadequate to prevent serious
neurologic complications. HBOT speeds removal of CO from
tissues and counters a number of its deleterious effects. Past studies
have demonstrated efficacy of HBOT for reducing the incidence of
neurologic sequelae, even though only three sessions of HBOT
were used. Clinical experience such as that reported here shows that
HBOTtreatment late in the course of established impairments from
CO can lead to clinical improvements. Improvement is documented
by evidence of increased brain metabolism on functional brain
imaging by SPECT after HBOT. Further study as well as wider
availability of HBOT, particularly for persons such as firefighters
who are at high occupational risk of CO poisoning, is warranted. 

AND THESE TREATMENTS ARE NOT CONCLUSIVE IN MANY STUDIES THUS FAR…(editorial comment by castMD.com)

Richard A. Neubauer, M.D.
Virginia Neubauer
Alan Ko Chi Nu,
M.D. William S.
Maxfield, M.D., FACNM
, is Medical Director, Ocean Hyperbaric
Neurologic Center, Lauderdale-by-the-Sea, FL. is
Research Director, Ocean Hyperbaric Neurologic Center.
, is a hyperbaric physician practicing in Taipei, Taiwan.
, is a radiologist and Chief of Nuclear Medicine at
Ocean Hyperbaric Neurologic Center.

(adapted from:  Journal of American Physicians and Surgeons Volume 11 Number 2 Summer 2006)

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