Developing best practice response to carbon monoxide incidents: A toolkit for health protection frontline staff

Mandal, Sema; Ruggles, Ruth; Leonardi, Giovanni; Goodfellow, F; Bradley, Nori; Murray, V.

doi:10.1016/j.puhe.2010.11.011

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…Patients were subclassified using the following case definitions, based on Mandal et al 34 Confirmed case—symptoms consistent with CO poisoning, raised COHb level and environmental source of CO confirmed.Probable case—symptoms consistent with CO poisoning, raised COHb level, no environmental source of CO identified.Possible case—symptoms consistent with CO poisoning, raised COHb level, no environmental source of CO identified and alternative hypothesis for COHb level likely (eg, heavy smoking/passive smoker, by expert consensus as below).Non-case—symptoms consistent with CO poisoning but COHb level not raised.…”

Section: Methodsmentioning

confidence: 99%

Screening for carbon monoxide exposure in selected patient groups attending rural and urban emergency departments in England: a prospective observational study

Clarke

Keshishian²,

Murray³

et al. 2012

BMJ Open

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ObjectivesCarbon monoxide (CO) exposure does not produce a classical toxidrome and so it is thought that it may easily be missed, allowing patients to continue to be exposed to CO. The aim of this study was to determine the proportion of raised carboxyhaemoglobin (COHb) levels in a targeted population of patients presenting to four emergency departments (EDs) in England.DesignA prospective observational study undertaken over a 9-month period.SettingFour EDs; one in a rural/suburban area and three serving urban populations.Participants1758 patients presenting to the EDs with chest pain, exacerbation of chronic obstructive pulmonary disease (COPD), non-traumatic headache, seizures or flu-like symptoms.Main outcomeMeasures COHb levels measured using a pulse CO-oximeter or venous sample. Patients with COHb levels ≥2.5% (non-smokers) or ≥5% (smokers) completed a questionnaire assessing potential sources. Patients were defined to be positive for CO exposure if they had a positive COHb and either an identified source or no other reason for their raised level.ResultsProportion of positive patients was: overall—4.3%; COPD—7.5%; headache—6.3%; flu-like—4.3%; chest pain—3.3%; seizures—2.1%. A variety of gas and solid (predominantly charcoal) fossil fuel sources were identified.ConclusionsThis study showed that 4.3% of patients presenting to EDs with non-specific symptoms had unexpectedly raised COHb levels 1.4% of patients had a source of CO identified. Study limitations included non-consecutive recruitment, delays in COHb measurements and a lack of ambient CO measurements, which precludes precise determination of incidence. However, this study should alert clinicians to consider CO exposure in patients presenting with non-specific symptoms, in particular headache and exacerbation of COPD, and if necessary refer patients for suitable public-health follow-up, even in the presence of low COHb readings. Further research should include standardised scene assessments.

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Section: Methodsmentioning

confidence: 99%

Screening for carbon monoxide exposure in selected patient groups attending rural and urban emergency departments in England: a prospective observational study

Clarke

Keshishian²,

Murray³

et al. 2012

BMJ Open

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“…CO is often formed due to the incomplete combustion of carbon-containing compounds, primarily in internal combustion engines. Studies by Mandal et al, 2011 show that between 6 and 20% of homes in London have CO levels above World Health Organization (WHO) upper limits (Table 2) (Mandal et al, 2011). The worldwide incidence of CO poisoning has remained stable during the last 25 years (Kinoshita et al, 2020).…”

Section: Co Impact On Humansmentioning

confidence: 99%

Carbon Monoxide Fate in the Environment as an Inspiration For Biorefinery Industry: A Review

Sobieraj

Stegenta-Dąbrowska

Luo

et al. 2022

Front. Environ. Sci.

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Carbon monoxide (CO) is ubiquitous in the environment. In this literature review, the biological CO transformations in ecosystems were summarized as an inspiration for the biorefinery industry. Specifically, for the first time, information about CO fate in soil, water, and the atmosphere was collected, and CO impact on plants, animals, and humans was discussed. The review also addresses the need to develop new solutions to implementing circular bioeconomy and highlights the potential of CO use in biologically mediated processes as an untapped valuable resource. Specific key areas of research were identified as 1) development of water-gas shift (WGS) bioreaction, 2) electricity production during bioelectrochemical syngas conversion (BESs), and 3) electro-fermentation (EF) as a source of added-value biochemicals and fuels.

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“…Mandal et al reported the development of a decision support toolkit for local Health Protection Units in the United Kingdom to assist the management of CO incidents [50]. They discussed the difficulties of defining a case by taking account of a combination of clinical features, environmental monitoring and biological levels.…”

Section: Potential Health Impacts Of Indoor Gas Appliance Use In the United Kingdommentioning

confidence: 99%

Public Health Impacts of Exposure to Carbon Monoxide From Gas Appliances in UK Homes – Are We Missing Something?

Tam

Bevan

Harrison

et al. 2011

Indoor and Built Environment

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Carbon monoxide (CO) is a colourless and odourless poisonous gas formed from the incomplete combustion of substances containing carbon. In the United Kingdom, over 22 million homes have mains or liquefied petroleum gas and consequently there is particular concern regarding potential CO poisoning resulting from malfunctioning domestic gas appliances. Although the number of reported cases of CO poisoning in the United Kingdom is relatively small, there is a high probability of misdiagnosis of the condition due to the ambiguous clinical symptoms of CO poisoning; incidence may therefore be much higher than currently reported. This review discusses the current knowledge on human health and toxicological effects following exposure to CO, focusing particularly on the public health impacts associated with gas appliances in UK homes. In determining the possibility of an underlying threat, the biological plausibility of misdiagnosis, in combination with reported cases, is discussed. The implication of misdiagnosis for public health treatment is also briefly summarised.

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Developing best practice response to carbon monoxide incidents: A toolkit for health protection frontline staff

Cited by 6 publications

References 7 publications

Screening for carbon monoxide exposure in selected patient groups attending rural and urban emergency departments in England: a prospective observational study

Screening for carbon monoxide exposure in selected patient groups attending rural and urban emergency departments in England: a prospective observational study

Carbon Monoxide Fate in the Environment as an Inspiration For Biorefinery Industry: A Review

Public Health Impacts of Exposure to Carbon Monoxide From Gas Appliances in UK Homes – Are We Missing Something?

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