Carbon monoxide poisoning resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | |C01=Secure airway, breathing, circulation <br> Intubate as needed}} | {{familytree | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | |C01=Secure airway, breathing, circulation <br> Intubate as needed}} | ||
{{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 | | | | | | | | | | 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 | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | E01 |~|~|~|~|~| E02 | | | | | | | | | | | | | |E01=Strongly suggestive of poisoning<ref name="emergency.cdc.gov">{{Cite web | last = | first = | title = CDC Natural Disasters | Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster | url = http://emergency.cdc.gov/disasters/co_guidance.asp | publisher = | date = | accessdate = 1 December 2013 }}</ref> | {{familytree | | | | | | | | | | E01 |~|~|~|~|~| E02 | | | | | | | | | | | | | |E01=Strongly suggestive of poisoning<ref name="emergency.cdc.gov">{{Cite web | last = | first = | title = CDC Natural Disasters | Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster | url = http://emergency.cdc.gov/disasters/co_guidance.asp | publisher = | date = | accessdate = 1 December 2013 }}</ref> | ||
<br>>2% COHb levels in non smokers <br>>9% COHb levels in smokers |E02=Check for concomitant cyanide poisoning}} | <br>>2% COHb levels in non smokers <br>>9% COHb levels in smokers |E02=Check for concomitant [[cyanide poisoning]]}} | ||
{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | {{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 | 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 | | | | | | | |,|-|-|^|-|-|.| | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | G01 | | | | G02 | | | | | | | | | | | | | | | | | | |G01=Yes |G02=No}} | {{familytree | | | | | | | G01 | | | | G02 | | | | | | | | | | | | | | | | | | |G01='''Yes''' |G02=No}} | ||
{{familytree | | | | | | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | |}} | {{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 | | | | | | | 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 }} | ||
| Line 44: | Line 44: | ||
{{familytree | | | | | | | | | | I01 | | | | | | | | | | | | | | | | | | | | | |I01=look out for complications}} | {{familytree | | | | | | | | | | I01 | | | | | | | | | | | | | | | | | | | | | |I01=look out for complications}} | ||
{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | J01 | | | | | | | | | | | | | | | | | | | | | |J01=Educate pt before discharge <br> Instruct for possible delayed neurological complications}} | {{familytree | | | | | | | | | | J01 | | | | | | | | | | | | | | | | | | | | | |J01=Educate pt before discharge <br> '''Instruct for possible delayed neurological complications'''}} | ||
{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | {{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | | | | | K01 | | | | | | | | | | | | | | | | | | | | | |K01=Repeat medical & neurological exam in 2 weeks}} | {{familytree | | | | | | | | | | K01 | | | | | | | | | | | | | | | | | | | | | |K01=Repeat medical & neurological exam in 2 weeks}} | ||
Revision as of 18:09, 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]
>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
- ↑ 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) - ↑ "CDC Natural Disasters". Retrieved 1 December 2013. Text " Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster " ignored (help)