COX Slides

8/11/2019 COX Slides

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Carbon MonoxideCarbon MonoxideOximetryOximetry


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Course ObjectivesCourse Objectives

1. Define carbon monoxide and carbonmonoxide poisoning.

2. Describe the causes of carbon monoxide

poisoning.3. Identify signs and symptoms of carbonmonoxide poisoning.

. Describe the !"# care and treatment fora patient suffering carbon monoxidepoisoning.


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Course Objectives$ cont%dCourse Objectives$ cont%d

&Describe the steps needed to proper'yidentify carbon monoxide poisoning usinga CO Oximeter

&Describe ho( to identify fa'se readings ofa CO Oximeter

&Identify the ris)s of carbon monoxide

poisoning to *M# providers andfirefighters


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Course Objectives$ cont%dCourse Objectives$ cont%d

&Describe the danger+s, in treating andre'easing +not transporting, a patient (itha signficant carbon monoxide exposure


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-$*M Course Objectives -$*M Course Objectives+in addition to !"# objectives,+in addition to !"# objectives,

&Describe (hen I/ therapy and advancedair(ay procedures may be needed in apatient (ith carbon monoxide poisoning.


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ey /ocabu'aryey /ocabu'ary

&Carbonmonoxide

&Carboxy$hemog'obin

&Concentration&Duration

& a'f$'ife& emog'obin

& ydrocarbon& yperbaric

oxygentreatment + !O,


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ey /ocabu'aryey /ocabu'ary +continued,+continued,

& ypoxia&Imitator

&Impairments&Incomp'ete

combustion

&"i uefaction&Mimic

&Mo'ecu'es&0arts per mi''ion

+00M,


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ey /ocabu'aryey /ocabu'ary +continued,+continued,

&0athophysio'ogy&0hysio'ogica'

&0oisoning&4ed b'ood ce''s

uffocation& issue hypoxia

& ranscutaneous


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Carbon MonoxideCarbon Monoxide0oisonings0oisonings

&56777 fata'ities annua''y in 8#&17%s of thousands poisonings annua''y in

8#&Most common cause of accidenta'

postings deaths for decades


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9hat is Carbon Monoxide:9hat is Carbon Monoxide:

&Co'or'ess&Odor'ess

& aste'ess&;#i'ent )i''er rans'ating 00M torans'ating 00M to#pCO#pCO

& 00M or ;0arts 0er Mi''ion< is the atmosphericconcentration of the gas.

& 00M is a common fire ground safety measurement6often mis'eading as CO forms in poc)ets.

& #pCO as measured by a CO Oximeter is a function of00M CO and tota' time of exposure to the poison.

& -ge and hea'th may be a factor.& *ven 'o( 00M 'eve's can 'ead to high #pCO if exposure

is 'ong enough? common in overhau' after a fire.& *ven at 57 00M for @7 minutes$ re uires assessment

and possib'e medica' treatment (ith oxygen.


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;; 00M CO< x ;*xposure time< A #pCO00M CO< x ;*xposure time< A #pCO


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Causes of CarbonCauses of CarbonMonoxideMonoxide

&Incomp'ete combustion of (ood6 or byhydrocarbon products such as> B ome heating oi's B Charcoa' B erosene B Coa' B =as


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Common CO 0oisoning #ourcesCommon CO 0oisoning #ources

& au'ty furnaces6 heaters& -uto exhaust& =as generators& Charcoa' gri''s used indoor & obacco smo)e& ires

& #ma'' gas engines or e uipment& =as app'iances& =as heaters in enc'osed area


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-n Idaho examp'e . -n Idaho examp'e .

& ;- fami'y of eight peop'e near'y died #undaynight6 after using a charcoa' gri'' to heat theirtrai'er home. O(yhee County Deputies arrived to

the home after a frantic E$1$1 ca'' from one ofthe (omen inside the house. -'' eight inc'udingfive chi'dren (ere ta)en to an area hospita' andtreated for Carbon Monoxide poising.Investigators say the fami'y is doing fine6 but'uc)y to be a'ive.< B Idaho 0ress ribune6 277F


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Carbon monoxide pathophysio'ogyCarbon monoxide pathophysio'ogyovervie(overvie(

& Carbon monoxide is inha'ed and passed from the 'ungsto the b'ood binding to hemog'obin.

B 0roduces carboxyhemog'obin. B -ffinity to hemog'obin 257 G greater than oxygen. B 4educes oxygen carrying capacity of b'ood. B -'ters re'ease of remaining oxygen to ce''s.

& -cts as an intrace''u'ar toxin. B 0oisons ce''s and tissue.


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Carbon monoxide pathophysio'ogyCarbon monoxide pathophysio'ogyovervie($ cont%dovervie($ cont%d

& !inds (ith myog'obin in musc'e. B Interferes (ith heart and s)e'eta'

musc'e.

& Immediate threat to 'ife. B Oxygen starvation. B Cardiac arrhythmias. B -'ters judgment6 reasoning.


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Carbon monoxide pathophysio'ogyCarbon monoxide pathophysio'ogyovervie($ cont%dovervie($ cont%d

& "ong$term hea'th effects B Centra' nervous system damage. B Cardiovascu'ar damage.


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9here does oxygenation ta)e9here does oxygenation ta)ep'ace:p'ace:

& !'ue dots represent carbondioxide6 (hite dots representoxygen.

& Oxygen entersthrough the 'ungs andis exchanged (ith

carbon dioxide at thea'veo'i.& During CO poisoning6

oxygen cannot bind tothe hemog'obin +noroom at the inntheory,


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-nother examp'e of oxygenation -nother examp'e of oxygenationOxygen is carried from the 'ungs by the b'oodhemog'obin to the tissues? here the beatingheart is sho(n6 and norma' hea'thy oxidativemetabo'ism goes on.

During Carbon Monoxide poisoning6 CO is carried fromthe 'ungs by the b'ood hemog'obin to the tissues6preventing oxygen from being carried6 and b'oc)ingnorma' oxidative metabo'ism. Hote ho( s'o('y and(ea)'y the heart is beating6 since it is starved foroxygen +i.e.. b'ue in co'or,.


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9ho is igh 4is):9ho is igh 4is):

pecific Occupations +fire *M#,&*'der'y

&Chi'dren&Infants&0regnant mothers

&8nborn chi'dren&0eop'e (ith existing hea'th prob'ems


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#igns #ymptoms#igns #ymptoms

& eadache&DiJJiness&9ea)ness&Hausea&/omiting&Chest pain& -'tered "OC& 'u$'i)e


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#igns #ymptoms#igns #ymptoms +continued,+continued,

uspect CO poisoning (hen>

B #evera' symptoms are reported at same time B Ho other cause can be identified B More than one person at scene reports simi'ar

symptoms


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Hervous #ystem *ffectsHervous #ystem *ffects

&*ffects may mimic a stro)e&!rain death

&"ong term neuro'ogica' effects may resu't


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Detection for *M# respondersDetection for *M# responders

& CO Oximetry> non$invasive method ofdetecting carbon monoxide in patients B CO$oximeter +examp'e> Massimo 4ad$5F,

B Detects carboxyhemog'obin 'eve's B Detects oxyhemog'obin 'eve's B Obtains pu'se rate

B #ma''6 handhe'd battery operated B inger c'amp simi'ar to a pu'se ox& 0u'se oximeters cannot detect CO


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-"# reatment -"# reatment

& 4e$assess "OC vita' signs&*va'uate respiratory system&I/

&* = monitoring$ every patient (ithsuspected CO poisoning shou'd receive* = monitoring

& 8se CO$oximeter if avai'ab'e& ransport to most appropriate faci'ity


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#pecia'iJed reatment#pecia'iJed reatment

& yperbaric oxygen treatment or !O may be recommended. his issti'' a some(hat controversia' treatment as the true reasons behindpatient improvement are not (e'' understood.

& yperbaric facts$ 0atients undergoing hyperbaric treatment are

p'aced in a chamber (here 177 oxygen is circu'ated. he oxygenis pressuriJed so that air pressure may be 2$3 times greater thannorma'. #ome theoriJe this a''o(s the 'ungs and s)in to absorbmore concentrated oxygen in a shorter period of time.

& yperbaric oxygen acce'erates the c'earance of CO from the body6

restoring oxygen de'ivery and preventing toxic effects on the centra'nervous system and b'ood vesse's.

& o''o( 'oca' protoco's for guidance


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A typical SpCO triage algorithm A typical SpCO triage algorithmMeasure SpCO

0-3% >3%

No further medicalevaluation of SpCO

needed

Loss of consciousness,altered mental status or

SpCO >2 %

!es No

"ransport on #00%o$ &en for '( evaluation)

Consider transport tohospital *ith h per+aric

cham+er

SpCO >#2 SpCO .determined +local protocol/

"ransport on #00%o$ &en for '( evaluation

S mptoms of COe$posure

"ransport on #00%o$ &en for '( evaluation

Course of actiondetermined + local

protocol

!es No


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Pitfalls for responders to be aware of-Pitfalls for re sponders to be aware of-

&4esponders shou'd be very cautious (ith;treat and re'ease< on patients (ith COexposure due to potentia''y 'ong ha'f 'ife.

&Moderate to high readings shou'd ALWAYS be confirmed on more than onefinger +2 minimum6 3 is preferred,.

&0atients (ho are extreme'y co'd or have;c'ub nai's< may produce a fa'se reading.


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Conc'usionConc'usion

&Consider CO poisoning (hen symptomsseem suspicious or vague or if the patienthas been in an enc'osed environment (ith

identified signsNsymptoms.&*ar'y recognition and treatment and

transport to a hospita' are critica''y

important in saving the patient andpreventing others from being poisoned as(e''.

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