Carbon monoxide poisoning resident survival guide: Difference between revisions

Revision as of 18:05, 1 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2]

Definition

Carbon monoxide (CO) is a colorless, odorless, tasteless, non-irritating gas, that is toxic to humans at concentrations more than 100ppm.^[1]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Shown below is an algorithm summarizing the approach to [[Acute carbon monoxide poisoning]].

CO Poisoning

HPI:
headache, dizziness, weakness, nausea, vomiting, chest pain & altered mental status

Secure airway, breathing, circulation
Intubate as needed

Check labs :
CO levels in inspired air
COHb levels in blood by CO-oximeter
Pulse CO-oximeter
Conventional oximeter not helpful
Check pregnancy status in women

Strongly suggestive of poisoning
>2% COHb levels in non smokers
>9% COHb levels in smokers

Check for concomitant cyanide poisoning

Check EKG, troponins & cardiac enzymes for cardiac involvement

Assess for:
COHb levels > 25%
Cardiac involvement
Severe acidosis, prolonged unconsciousness
Neurological impairment or abnormal neuropsychiatric testing
Pt. > 36 yrs in age
Pregnancy

Yes

No

Hyperbaric O₂ therapy
Initiate with in 6 hrs
Atleast one treatment at 2.5 to 3.0 atm

Administer normobaric 100% O₂ till pt is symptom free

look out for complications

Educate pt before discharge
Instruct for possible delayed neurological complications

Repeat medical & neurological exam in 2 weeks

References

Template:WikiDoc Sources

↑ Prockop, LD.; Chichkova, RI. (2007). "Carbon monoxide intoxication: an updated review". J Neurol Sci. 262 (1–2): 122–30. doi:10.1016/j.jns.2007.06.037. PMID 17720201. Unknown parameter |month= ignored (help)

[Prockop-2007-1] Prockop, LD.; Chichkova, RI. (2007). "Carbon monoxide intoxication: an updated review". J Neurol Sci. 262 (1–2): 122–30. doi:10.1016/j.jns.2007.06.037. PMID 17720201. Unknown parameter |month= ignored (help)

[1]

@@ Line 22: / Line 22: @@
 ==Management==
-Shown below is an algorithm summarizing the approach to <nowiki>[[disease name]]</nowiki>.
+Shown below is an algorithm summarizing the approach to <nowiki>[[Acute carbon monoxide poisoning]]</nowiki>.
-{{familytree/start |summary=PE diagnosis Algorithm.}}
+{{familytree/start |summary=CO Poisoning}}
-{{familytree | | | | | | | | A01 |A01= }}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
+{{familytree | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | |A01=CO Poisoning}}
-{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree | | | |!| | | | | | | | | |!| }}
+{{familytree | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | |B01=HPI: <br>headache, dizziness, weakness, nausea, vomiting, chest pain & altered mental status}}
-{{familytree | | | C01 | | | | | | | | |!| |C01= }}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree | |,|-|^|.| | | | | | | | |!| }}
+{{familytree | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | |C01=Secure airway, breathing, circulation <br> Intubate as needed}}
-{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree | |!| | | | | | | | | |,|-|^|.| }}
+{{familytree | | | | | | | | | | D01 | | | | | | | | | | | | | | | | | | | | | |D01=Check labs : <br>CO levels in inspired air <br>COHb levels in blood by CO-oximeter <br>Pulse CO-oximeter <br>Conventional oximeter not helpful <br>Check pregnancy status in women}}
-{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
-{{familytree | | | | | | | | | | |!| | | | |!| }}
+{{familytree | | | | | | | | | | E01 |~|~|~|~|~| E02 | | | | | | | | | | | | | |E01=Strongly suggestive of poisoning <br>>2% COHb levels in non smokers <br>>9% COHb levels in smokers |E02=Check for concomitant cyanide poisoning}}
-{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
+{{familytree | F01 |~|~|~|~|~|~| F02 | | | | | | | | | | | | | | | | | | | | | |F02=Assess for: <br>COHb levels > 25% <br>Cardiac involvement <br>Severe acidosis, prolonged unconsciousness <br>Neurological impairment or abnormal neuropsychiatric testing <br>Pt. > 36 yrs in age <br> Pregnancy |F01= Check EKG, troponins & cardiac enzymes for cardiac involvement}}
+{{familytree | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | G01 | | | | G02 | | | | | | | | | | | | | | | | | | |G01=Yes |G02=No}}
+{{familytree | | | | | | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | H01 | | | | H02 | | | | | | | | | | | | | | | | | | |H01=Hyperbaric O<sub>2</sub> therapy <br>Initiate with in 6 hrs <br>Atleast one treatment at 2.5 to 3.0 atm |H02=Administer normobaric 100% O<sub>2</sub> till pt is symptom free }}
+{{familytree | | | | | | | |`|-|-|v|-|-|'| | | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | | | | I01 | | | | | | | | | | | | | | | | | | | | | |I01=look out for complications}}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | | | | J01 | | | | | | | | | | | | | | | | | | | | | |J01=Educate pt before discharge <br> Instruct for possible delayed neurological complications}}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | | | | K01 | | | | | | | | | | | | | | | | | | | | | |K01=Repeat medical & neurological exam in 2 weeks}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
+{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
 {{familytree/end}}