Morning Report: 12/20/2013

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
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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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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