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Carbon Monoxide Poisoning : Causes, Clinical Features, Complication, Prevention & Management

By March 18, 2018 No Comments
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Carbon monoxide poisoning may occur as a result of industrial or household incidents or attempted suicide. Carbon monoxide is also known as silent killer as it is colourless, odourless, tasteless and it has no sound. No one can tell when they are inhaling it but can be very dangerous to health.  It is implicated in more deaths than any other toxin except alcohol. Carbon monoxide exerts its toxic effect by binding to circulating haemoglobin and thereby reducing the oxygen carrying capacity of the blood. Haemoglobin absorbs carbon monoxide 200 times more readily than it absorbs oxygen. Carbon monoxide-bound haemoglobin, called carboxyhaemoglobin, does not transport oxygen. The cause of carbon monoxide toxicity is simply due to breathing in carbon monoxide.

Causes

  • Some of the causes of CO poisoning are household and kitchen appliances like gas fires, heating system, water heater, cookers and open fire which uses gas, oil and firewood may be the possible cause of CO gas so make sure to limit the uses of it.
  • Long term smokers may develop the risk of CO poisoning as smoking cigarettes causes blood levels of CO to elevate.
  • Blocked chimneys and not enough ventilation system in house can stop CO from escaping.

Clinical features

  • Because the central nervous system  (CNS) has a critical need for oxygen, CNS symptoms predominate with carbon monoxide toxicity.
  • A person poisoned may appear intoxicated  (from cerebral hypoxia).
  • Other signs and symptoms include headache, muscular weakness, palpitations, dizziness and confusion which can gradually or rapidly progress to coma
  • Skin colour, which can range from pink or cherry red to cyanotic(bluish discolour) and pale is not reliable sign.
  • Pulse oximetry or saturation is also not valid because the haemoglobin is well saturated. It is saturated with oxygen, but the pulse oximeter indicates only if the haemoglobin is saturated; in this case it is saturated carbon monoxide rather than with oxygen.
  • The signs are flu-like symptoms such as headache, vomiting,  nausea and visual disturbance
  • Other symptoms are abdominal disturbances, chest pain, difficulty in breathing and sometimes seizures may appear due to the possible damage to CNS.
  • Long term exposure to CO gas can cause some serious problems such as heart problems and serious brain damage.

Complications : The complication can be serious and long term.

  • Brain damage
  • Has been linked with the symptoms of Parkinson’s disease  which include stiffness, slow movements and shaking.
  • Heart damage includes coronary heart disease.

Prevention

  • Awareness regarding the CO poisoning
  • Limit the use of home appliances and keep in good working condition and make sure to have them serviced regularly.
  • Do not overuse the gas, heating appliances, grill and barbecue indoors.
  • All the rooms must be well ventilated.
  • Service exhaust pipe in owning automobiles once a year.
  • Use of mask while outdoors if its too polluted.
  • General health check up may be helpful in recognising CO poisoning in early stage.
  • Make sure to install CO alarm or detectors.
  • Less smoking cigarettes

Management

Exposure to carbon monoxide  requires immediate treatment. Goals of management are to reverse cerebral and myocardial hypoxia and to hasten elimination of carbon monoxide.  Whenever a person inhales a poison, the following general measures to apply. It can also be the first aid to provide.

  • Carry the person to fresh air immediately  open all the doors and windows simply to ventilate
  • Loosen all tight clothing.
  • Initiate cardiopulmonary resuscitation if needed; administer 100% oxygen (in medical facility)
  • Prevent chilling; wrap the person in blankets.
  • Keep person quiet and calm as much as possible
  • Do not give alcohol in any form or permit the person to smoke.

In addition, for the person with carbon monoxide poisoning, carboxyhaemoglobin levels are analysed on arrival at emergency department and before treatment with oxygen if possible. 100% oxygen is administered at the atmospheric or preferably hyperbaric pressures to reverse hypoxia and accelerate the elimination of carbon monoxide. Oxygen is administered until the carboxyhaemoglobin level is less than 5%. The person is monitored continuously.  Psychoses, spastic paralysis, ataxia, visual disturbance and deterioration of the mental status and behaviour may persist after resuscitation and may be symptoms of permanent brain damage.

When unintentional carbon monoxide poisoning occurs, the health department should be contacted so that the dwelling or building in question can be inspected. A psychiatric consultation is warranted if poisoning was determined to be a attempted suicide.

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