CO Poisoning 2024 PDF

Carbon Monoxide Silent Killer Year: 5 Semester: 1 Module: Forensic & Toxicology  Professor: Rania Hashish Forensic Medicine & Clinical Toxicology department Office hours: Sunday 12-2 Pm ...

Carbon Monoxide Silent Killer Year: 5 Semester: 1 Module: Forensic & Toxicology  Professor: Rania Hashish Forensic Medicine & Clinical Toxicology department Office hours: Sunday 12-2 Pm  Case A 68-year-old white woman, presented to the ED in November with complaints of throbbing headaches intermittently for the 24 hrs. She reported taking analgesics without relief. She also reported shortness of breath, dizziness, weakness, and intermittent chest pain. History revealed that her daughter that live with her has not any symptoms, her two grand sons have flu-like symptoms. She reported that she started complaining of headaches after turning on the gas heater. On Examination: Patient looks ill, conscious, oriented to time, place and person. Vital signs : Respiratory rate: 28 cycle/min Pulse: 92 beat/mins Blood pressure : 140/80 Temperature:36.8 C Oxygen saturation: 95% Chest examination: Clear ABG : metabolic acidosis COHb level : 15% Liver and kidney function tests: Normal Cardiac enzymes : Normal ECG :Sinus rhythm with no ST segment channel  Objectives 1. Definition of CO 2. Causes and Sources of CO 3. Who are at risk for poisoning??? 4. Signs and symptoms of CO poisoning 5. Diagnosis of CO poisoning 6. Management of CO poisoning 7. Prevention tips. Dr.Rania Hashish Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 6 Carbon Monoxide CO (carbon monoxide) is a gas that is – Colorless – Odorless – Non irritant Produced from incomplete combustion of any organic substance. CO can kill you and you won’t even know you died!! Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 6 Carbon Monoxide Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Carbon Monoxide (CO) vs. Carbon Dioxide (CO2) Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Common Causes of Incomplete Combustion  Burning wet wood  Burning Green Wood  Lack of O2 During Combustion  MalfunctioningAppliances/ Exhaust Systems Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Sources Endogenous sources: Catabolism of protoporphyrin ring of hemoglobin. CoHb 0.4%-0.7% Higher in patients with hemolytic anemia. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Exogenous sources Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Who are at Risk? EVER YONE, especially: People using alternate heat sources. Individuals working with combustion engines or combustible gases indoors. Personnel at fire scenes (fire-fighters/rescue workers) Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5  Signs and Symptoms Flu-like symptoms: – Fatigue/sleepiness – Shortness of breath – Nausea & Headache – Dizziness & weakness – Confusion or disorientation – High doses: loss of consciousness and death Young children, elderly and household pets are usually effected first CO imparts a cherry red discoloration to the skin (the inherent color of HBCO).  Signs and Symptoms cont. Other symptoms Neurological ( hypoxia) – Long-term nervous system damage Cardiovascular (direct effect) – Hypotension – Dysrhythmias Respiratory – Hypoxia – Shortness of breath – Pulmonary edema (cardiogenic & non-cardiogenic) Objective 1 Objective 2 Objective 3 Objective 4 Objective 5  Diagnosis History : Most important???? Sings & Symptoms: Investigations: Traditional methods – Blood draw – Carboxyhemoglobin level (Co-oximeter) – Breath analyzers (screening) ABG Early it shows respiratory alkalosis. Metabolic acidosis which is more reliable index for severity than COHb.. Chest Xray Pulmonary edema in severe cases. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Oxygen (Specific Antidote): Mechanism of action: 1. Hastens dissociation of CO from carboxyhemoglobin and cytochrome oxidase. 2. Reduces the half-life of carbon monoxide. 3.Enhances oxygen transport to the tissues by plasma. Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Multiplace Hyperbaric Chamber Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Objective 1 Objective 2 Objective 3 Objective 4 Objective 5  Case A 68-year-old white woman, presented to the ED in November with complaints of throbbing headaches intermittently for the 24 hrs. She reported taking analgesics without relief. She also reported shortness of breath, dizziness, weakness, and intermittent chest pain. History revealed that her daughter that live with her has not any symptoms, her two grand sons have flu-like symptoms. She reported that she started complaining of headaches after turning on the gas heater. On Examination: Patient looks ill, conscious, oriented to time, place and person. Vital signs : Respiratory rate: 28 cycle/min Pulse: 92 beat/mins Blood pressure : 140/80 Temperature:36.8 C Oxygen saturation: 95% Chest examination: Clear ABG : metabolic acidosis COHb level : 15% Liver and kidney function tests: Normal Cardiac enzymes : Normal ECG :Sinus rhythm with no ST segment channel  Take Home Message History is very important in diagnosis of CO poisoning  Oxygen in the specific antidote of CO Prevention of exposure is of prime importance Thank you