Carbon Monoxide Poisoning

Substance

carbon monoxide

Common name or Trade name  

一氧化碳

      Involving system

CO produces toxicity by binding to hemoglobin, thereby reducing oxygen-carrying capacity, and by binding to myoglobin, which may impair cardiac output and result in cerebral ischemia [1].

Presentation

   Asymptomatic                                                                HbCO 0—10% 

   Mild headache, respiratory distress HbCO 10—20%

    Headache, nausea. Lethargy, weakness HbCO 20—30%

   Nausea, vomiting, syncope, weakness HbCO 30—40%

   Unconsciousness seizure, arrhythmia. HbCO 50%

   Deep coma                                                                                   HbCO 60%

   Fatal 70% [2] 

   Fetus HbCO level higher than maternal HbCO 15%[2]

Antidote and Treatment

   ACLS if hemodynamic unstable.

    NRM or mask 100%

HBO (hyperbaric oxygenation) when coma. AMS. ABG pH<7.1, Cardiac ischemia. HbCO> 25%; pregnant female HbCO> 20% [2]

   Disposition 

        Admission if complication with rhabdomyolysis, aspiration pneumonia, AMS, etc.

References

[1]. Olson KR. Carbon monoxide poisoning: mechanisms, presentation, and controversies in management. J Emerg Med. 1984;1(3):233–243. doi:10.1016/0736-4679(84)90078-7

[2].急性中毒救命術, 第三版. P.309—17.

~~ April, 26th, 2020.  Yu-Jang Su