CO poisoning

[LucidResq]

For those who have experience with it, how have you seen pts present with CO poisioning?

Do any of you carry those pulse-ox-like devices that measure CO levels?

 

[Ridryder911]

Wish we carried field Co oximetry, but in reality terms they are very expensive for the number of Co responses we respond to.

I have seen a lot of Co retention mainly in firefighters, especially in the "clean up" phase which is the most dangerous portion. Most of the O2 has been replaced with Co.

Of course I have seen the usual poor heater furnaces, suicidal (auto), of common citizens.

The old symptoms of "flushed cherry like appearance" is true, unfortunately it is in the post mortem phase. I usually seen H/A, nausea, "ill feeling" without any specific complaint.


R/r 911

 

[ffemt8978]

We looked into them, but at over 5 grand a pop it was an impossible sell. So we still treat based upon index of suspicion and what our donated atmospheric testers tell us.

 

[LucidResq]

We looked into them, but at over 5 grand a pop it was an impossible sell. So we still treat based upon index of suspicion and what our donated atmospheric testers tell us.

Wow. I didn't know they were that expensive. Who on Earth can afford to carry them?

 

[Ridryder911]

That is why they had a special insert edition in JEMS, on writing grants to obtain equipment. Nice little section, but for most EMS a hassle for a piece of equipment barely used.

R/r 911

 

[VentMedic]

The Masimo RAD-57 is a nice device.

Besides COHb, it can come with the option of MetHb (methemoglobin) which will also skew you SpO2 reading. Methemoglobinemia may need to be considered especially when exposed to oxidizing medications and other chemicals, including nitrates, nitrites, prilocaine and lidocaine, nitric oxide, and aniline dyes.

Unlike CO, skin discoloration can occur in patients who are not anemic with as little as 1.5 g/dL, or approximately 10% of Hb showing MetHb. If this discoloration does not disappear with 100% O2, provided there is not a significant pulmonary history as a cause for cyanosis, it would be wise to thoroughly check their medications, question recent endoscopy or bronchoscopy procedures and look for open or spilled chemicals or exposure.

If it is used for potentially known situations like fire rehab and northern homes then you may not need the additional MetHb. If it is used for general N/V/SOB, then yes it may be needed.

The question to ask would be how much is it going to change what you do?

 

[paramedix]

Most of my CO patients I've attended to were already dead by the time I got to them. They were all gassings (suicides). We respond to a lot of suicides where people gassed themselves in their car or similar.

Regarding the CO monitors on our vehicles... nope. Would be nice to have, but as Rid mentioned, they are a bit expensive for the pre-hospital setting.

 

[Airwaygoddess]

Treatment

We tend to see CO2 problems when the weather gets cold, had a few from camping, (wrong type of camping lamp inside tent) The patient or sometimes "patients" C/O headache, nausea, and feeling poorly, change in skin color and condition, and patient's neruo status. Hi flow O2 is the treatment needed to help blow off the CO2 that is on compromising the hemoglobin. Frequent vital signs. Red flag goes up when more then one patient complains of the same or similar signs and systems. Airway, Breathing, Circulation, it needs to work together....

 

[BossyCow]

We get them during extended power outages with people using more 'creative' ways to stay warm. Its one of those calls where what they were doing before it happened tells us more about their condition than their symptoms do. Its hard to convince new EMT's that a high O2 sat isn't always a good thing.