Carbon monoxide poisoning resident survival guide: Difference between revisions
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(Created page with "__NOTOC__ {{CMG}}; {{AE}}; {{VB}} ==Definition== Carbon monoxide (CO) is a colorless, odorless, tasteless, non-irritating gas, that is toxic to humans at concentrations more ...") |
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==Management== | ==Management== | ||
Shown below is an algorithm summarizing the approach to <nowiki>[[ | Shown below is an algorithm summarizing the approach to <nowiki>[[Acute carbon monoxide poisoning]]</nowiki>. | ||
{{familytree/start |summary= | {{familytree/start |summary=CO Poisoning}} | ||
{{familytree | | | | | | | | A01 |A01= }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | | | {{familytree | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | |A01=CO Poisoning}} | ||
{{familytree | | | B01 | | | | | | | | | {{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | |!| | | | | | | | | | | {{familytree | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | | |B01=HPI: <br>headache, dizziness, weakness, nausea, vomiting, chest pain & altered mental status}} | ||
{{familytree | | | C01 | | | | | | | | | | {{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | {{familytree | | | | | | | | | | C01 | | | | | | | | | | | | | | | | | | | | | |C01=Secure airway, breathing, circulation <br> Intubate as needed}} | ||
{{familytree | D01 | | | {{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 | | {{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 | | | | | | | | | | | {{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}} | {{familytree/end}} | ||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||