Thanks to Dr. Shin for a very timely Morning Report!
Carbon Monoxide Toxicity
Carbon Monoxide:
Colorless and odorless and created by incomplete combustion
Common sources are automobile exhaust, coal, wood or kerosene stoves
Pathophysiology:
CO binds reversibly to hemoglobin 230-270x that of oxygen causing functional anemia
Half Life of CO is 3-4h on room air, 30-90 minutes on 100% NR, 15-23minutes in hyperbaric
Presentation:
Vague complaints including malaise, fatigue, lethargy, confusion, depression, chest pain, palpitations, nausea, vomiting, impulsiveness, agitation.
Physical: Usually normal can have Neurologic/neuropsychiatric findings, skin changes
Treatment:
- Cardiac monitor
- Pulse oximetry
- Continue 100% oxygen therapy
- Venous HbCO level
- Consider Immediate Transfer to a Hyperbaric Facility
- CO level >25% or >15% in pregnant women
- Myocardial Ischemia
- Cardiac Dysrhythmias
- Neuropsychiatric abnormalities or history of coma
- Serial neurologic examinations
- In patients who fail to improve clinically, consider other toxic inhalants or thermal inhalation injury
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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