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Carbon monoxide poisoning

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Carbon monoxide poisoning Intensive Care Medicine Seminar Royal Victoria Hospital Belfast April 2007 Introduction Carbon monoxide (CO) intoxication is one of the most ... – PowerPoint PPT presentation

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Title: Carbon monoxide poisoning


1
Carbon monoxide poisoning
  • Intensive Care Medicine Seminar
  • Royal Victoria Hospital Belfast
  • April 2007

2
BBC NEWS Corfu children killed by gas leak
3
Introduction
  • Carbon monoxide (CO) intoxication is one of the
    most common causes of accidental and intentional
    poisoning
  • Atmospheric composition lt0.001
  • Blood carboxyhaemoglobin
  • Nonsmokers 1-3
  • Smokers 10-15
  • Sources of CO
  • Motor vehicle exhaust fumes
  • Heating systems
  • Inhaled smoke
  • Propane-powered forklift trucks
  • Methylene chloride

4
Pathophysiology
5
Pathophysiology
  • CO is colourless, odourless, nonirritant toxic
    gas
  • CO toxicity due to
  • Cellular hypoxia
  • Direct cellular injury
  • Cellular hypoxia
  • CO competes with O2 for binding to Hb
  • Affinity of Hb for CO x 200-250 gt affinity for O2
  • O2-Hb dissociation curve shift to the left
  • Impaired tissue release of O2 and cellular
    hypoxia

6
Oxygen-Hemoglobin Dissociation Curve
Ernst A and Zibrak J. N Engl J Med
19983391603-1608
7
Pathophysiology
  • Direct cellular injury
  • CNS reoxygenation injury
  • Lipid peroxygenation
  • Free radical formation
  • CO toxicity in pregnancy
  • Risk of fetal injury

8
Acute Symptoms Reported by 196 Patients after
Exposure to Carbon Monoxide
Ernst A and Zibrak J. N Engl J Med
19983391603-1608
9
Delayed neuropsychiatric syndrome
  • Incidence 10 - 30 of victims 3 - 240 days after
    exposure
  • Cognitive changes
  • Personality changes
  • Parkinsominism
  • Dementia
  • Psychosis
  • Recovery 50 - 75 within 12 months

10
Diagnosis
  • High level of clinical suspicion
  • Serum COHb level
  • Exhaled breath COHb level
  • Measured by spectrophotometry
  • Pulse oximetry cannot distinguish between HbO2
    and COHb
  • Comprehensive neurological and neuropsychological
    assessment
  • CO Neuropsychological Screening Battery
  • CT brain to exclude other conditions

11
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12
Monoplace Hyperbaric Chamber
Tibbles P and Edelsberg J. N Engl J Med
19963341642-1648
13
Treatment
  • High-flow, FiO2 100, normobaric O2
  • O2 shortens the half life of COHb
  • 21 O2 4-6 hours
  • 100 O2 40-80 minutes
  • 100 O2 2.5atm 15-30 minutes
  • Continue O2 until COHb normal
  • Beware concomitant smoke inhalation and burn
    injury
  • Normobaric v Hyperbaric O2 therapy
  • HBO hastens resolution of acute symptoms
  • Unclear evidence for effect of HBO on late
    complications and mortality

14
Suggested Indications for Hyperbaric-Oxygen
Therapy in Patients with Carbon Monoxide Poisoning
Ernst A and Zibrak J. N Engl J Med
19983391603-1608
15
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16
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