Emergency department screening for unsuspected carbon monoxide exposure

Turnbull, Timothy L.; Hart, Raymond G.; Strange, Gary R.; Cooper, Mary Ann; Lindblad, Robert; Watkins, Joan M; Ferraro, C

doi:10.1016/s0196-0644(88)80240-3

Cited by 22 publications

(6 citation statements)

References 11 publications

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“…18 A handheld breath analyzer can be used at the bedside to quickly rule out carbon monoxide poisoning; however, the incidental presence of ethanol can result in a falsepositive reading. 19 Carbon monoxide poisoning is difficult to diagnose without use of the previously mentioned devices. Pulse oximetry is unreliable because it grossly overestimates oxygen saturation in the presence of COHb.…”

Section: Diagnosismentioning

confidence: 99%

“…Patients who smoke more than two packs per day can have COHb levels approaching 10%. 19 A venous sample collected earlier in a heparinized tube may provide important clues to the presence of COHb in patients who have been treated with oxygen for some time. Any patient with a high COHb level (~25%) or serious symptoms (eg, syncope) may need more intensive treatment beyond routine oxygen therapy.…”

Section: Diagnosismentioning

confidence: 99%

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Carbon monoxide poisoning

Tomaszewski

1999

Postgraduate Medicine

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The number of deaths from carbon monoxide (CO) poisoning remained constant for many years but has recently started to fall. There are three reasons. Firstly, it has become more fashionable to commit suicide by more sophisticated methods, particularly now that tranquillisers and antidepressants are widely prescribed. Secondly, Britain's domestic gas supply is being changed over from coal gas to natural gas, which contains no carbon monoxide-though so far only an eighth of the country has actually been converted to the new gas. Thirdly, and perhaps most significant, is the changeover which has taken place in the manufacture of gas for domestic use, coal carbonization having given way to oil reforming. Techniques for reducing the amount of CO present have also been introduced, but as G. Thurston' has shown, inadequate combustion or ventilation can be lethal even when the original fuel contains no CO. So in about eight years, when the whole country has been converted to natural gas, there will still be numbers of patients with CO poisoning needing resuscitation.Recently J. S. Smith and S. Brandon2 reviewed 206 episodes of CO poisoning in Newcastle. The mortality rate was 3900. In 20% of patients recovery was complicated by prolonged delirium suggesting that "all degrees of functional or structural neurological damage may have occurred, yet oxygen therapy was given in only 43.8% of suicidal and 32-5% of accidental exposures." They suggest that in view of the risk of persistent neuropsychiatric sequelae current patterns of management should be revised.In selecting a form of therapy there are two aspects to consider: firstly, the prevention of death and, secondly, the reduction of neuropsychiatric sequelae such as those described by H. Garland and J. Pearce.3 Carboxyhaemoglobin should be eliminated as quickly as possible because its presence alters the dissociation curve of the remaining oxyhaemoglobin, impeding oxygen release to the tissues.4 J. S. Haldane5 was the first to describe the use of hyperbaric oxygen in CO poisoning, when he failed to poison a mouse placed in a jar containing two atmospheres of oxygen and one of CO. This was all the more remarkable for the fact that the affinity of haemoglobin for CO is about 250 times that for oxygen. Hyperbaric oxygen keeps the patient's tissues oxygenated by the oxygen physically dissolved in the plasma at a time when his haemoglobin is not available to him for oxygen transport. It is also the most efficient means of reducing the carboxyhaemoglobin level, as was shown by T. A. Douglas and his colleagues6 in 1962 when they compared the efficiencies of oxygen at one atmosphere's pressure, oxygen at two atmospheres' pressure, and of 50/% and 70 % carbon dioxide in oxygen.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Carbon monoxide poisoning

Tomaszewski

1999

Postgraduate Medicine

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“…The analyzer has also been used by Turnbull to screen a convenience sample of all adults, regardless of complaint, presenting to an ED. He concluded that routine screening of ED patients for unsuspected CO exposure is not practical [8]. Recently, a study of 382 subjects who underwent breath analysis for CO and completed a questionnaire about possible sources of CO exposure showed breath analysis results correlated well with CO exposure.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive measurement of carbon monoxide levels in ED patients with headache

et al. 2006

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Objectives: Carbon Monoxide (CO), the third most common cause of acute poisoning death, is easily overlooked in the emergency department (ED). Nonspecific complaints such as headache, weakness, or malaise may easily result in misdiagnosis. The objectives of this study are to determine the frequency of CO poisoning in patients presenting to the ED complaining of headaches and to determine the feasibility of using noninvasive CO analyzers as a screening tool.Methods: This prospective controlled study examined, during the winter months, adult patients presenting with a complaint of atraumatic, afebrile headaches. All subjects submitted a sample for a CO breath analyzer. Participants with elevated carboxyhemoglobin (COHb) levels (nonsmokers >2%, smokers >5%) underwent venous COHb testing. Control patients, without headaches, presenting to the ED were similarly studied.Results: We enrolled 170 subjects and 98 controls. Of the 170 subjects, 12 (7.1%) had elevated COHb levels confirmed by venous COHb levels. Of the 98 controls, 1 (1.0%) had an elevated COHb level (p<0.05). There were no differences in demographic factors between the two groups (p > 0.16).Conclusions: Noninvasive measurement of CO levels in ED patients with headaches is rapid and specific. During winter months, elevated CO levels are present in over 7% of ED patients with headaches.

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“…10,11 Except for the study described in the introduction, there has been no previously published report in the medical literature of a model for routine CO screening by emergency services personnel in the field. Therefore, the decision was made to place the detectors in the hands of EMS personnel.…”

Section: Discussionmentioning

confidence: 99%