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cooking and heating indoors 3. Motor vehicles 4. Fire 5. Boats 6. Power washers and other gas powered tools.


At‐risk Populations include: 1. Babies and infants 2. The elderly


3. People with chronic heart disease, anemia or respiratory illness.


Evaluation


Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster


Carbon monoxide (CO) is an odor‐ less, colorless, poisonous gas that can cause sudden illness and death if pre‐ sent in sufficient concentration in the ambient air. When power outages occur during emergencies such as hur‐ ricanes or winter storms, the use of alternative sources of fuel or electricity for heating, cooling, or cooking can cause CO to build up in a home, garage, or camper and poison the people and animals inside. Generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal‐burn‐ ing devices should never be used inside a home, basement, garage, or camper ‐ or even outside near an open window or window air conditioner.


How to Recognize CO Poisoning: The symptoms and signs of carbon monoxide poisoning are variable and nonspecific. The most common symp‐ toms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and altered mental status. The clinical presentation of CO poi‐ soning is the result of its underlying systemic toxicity. Its effects are caused not only by impaired oxygen delivery but also by disrupting oxygen utilization and respiration at the cellu‐


14 EMS PRO Magazine


lar level, particularly in high‐oxygen demand organs (i.e., heart and brain). Symptoms of severe CO poisoning include malaise, shortness of breath, headache, nausea, chest pain, irritabili‐ ty, ataxia, altered mental status, other neurologic symptoms, loss of con‐ sciousness, coma, and death; signs include tachycardia, tachypnea, hypotension, various neurologic find‐ ings including impaired memory, cogni‐ tive and sensory disturbances; meta‐ bolic acidosis, arrhythmias, myocardial ischemia or infarction, and noncardio‐ genic pulmonary edema, although any organ system might be involved. With a focused history, exposure to a CO source may become apparent. Appropriate and prompt diagnostic testing and treatment is very impor‐ tant.


Red Flags: No fever associated with symptoms, history of exposure, and multiple patients with similar com‐ plaints.


Sources of CO Poisoning


1. Gas‐powered generators 2. Charcoal grills, propane stoves, and charcoal briquettes for both


1. Diagnosis is based on a suggestive history and physical findings coupled with confirmatory testing. Patients should be examined for other condi‐ tions, including smoke inhalation, trau‐ ma, medical illness, or intoxication. 2. Neurological exam should include an assessment of cognitive function such as a Mini‐Mental Status Exam 3. All women of childbearing age who are suspected of having CO poi‐ soning should have a pregnancy test.


Confirmation of Diagnosis


1. The key to confirming the diagno‐ sis is measuring the patient’s carboxy‐ hemoglobin (COHb) level.


2. Carbon Monoxide levels can be tested either in whole blood or exhaled air.


3. It is important to know how much time has elapsed since the patient has left the toxic environment, because that will impact the COHb level. If the patient has been breathing normal room air for several hours, COHb test‐ ing may be less useful.


4. The most common technology available in hospital laboratories for analyzing the blood is the multiple wavelength spectrophotometer, also known as a CO‐oximeter. Venous or arterial blood may be used for testing. 5. A fingertip pulse CO‐oximeter can be used to measure heart rate and oxy‐ gen saturation, and COHb levels. The conventional two‐wavelength pulse oximeter is not accurate when COHb is present.


An elevated COHb level of 2% for


non‐smokers and >9% COHb level for smokers strongly supports a diagnosis


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