References

Allred EN, Bleecker ER, Chaitman BR Short-term effects of carbon monoxide exposure on the exercise performance of subjects with coronary artery disease. N Engl J Med. 1989; 321:(21)1426-32

Ball EG, Strittmatter CF, Cooper O The reaction of cytochrome oxidase with carbon monoxide. J Biol Chem. 1951; 193:(2)635-47

Barret L, Danel V, Faure J Carbon monoxide poisoning, A diagnosis frequently overlooked. J Toxicol Clin Toxicol. 1985; 23:(4–6)309-13

Baum CR What's new in pediatric carbon monoxide poisoning?. Clin Pediatr Emerg Med. 2008; 9:(1)43-6

Burkhart JE, Stoller JK Oxygen and aerolized delivery: matching the device to the patient. Cleve Clin J Med. 1998; 65:200-8

Burney RE, Wu SC, Nemiroff MJ Mass carbon monoxide poisoning: Clinical effects and results of treatment in 184 victims. Ann Emerg Med. 1982; 11:(8)394-9

Bozeman WP, Barish RA Confirmation of the pulse oximetry gap in carbon monoxide poisoning. Ann Emerg Med. 1997; 30:(5)608-11

Camporesi EM Hyperbaric oxygen therapy: a committee report. Undersea Hyperbaric Med Soc. 1996; 7-10

Caravati EM, Adams CJ, Joyce SM Fetal toxicity associated with maternal carbon monoxide poisoning. Ann Emerg Med. 1988; 17:(7)714-7

Nonfatal, unintentional, non-fire related carbon monoxide exposures, United States 2004–2006. MMWR. 2008; 57:896-9

Chamberland DL, Wilson BD, Weaver LK Transient cardiac dysfunction in acute carbon monoxide poisoning. Am J Med. 2004; 117:623-5

Chesney ML Carbon monoxide poisoning in the pediatric population. Air Med J. 2002; 21:(6)10-13

Choi IS Delayed neurological sequelae in carbon monoxide intoxication. Arch Neurol. 1983; 40:(7)433-5

Coburn RF Endogenous carbon monoxide production. N Engl J Med. 1970; 282:(4)207-9

Coburn RF, Mayers LB Myoglobin oxygen tension determined from measurements of carboxyhemoglobin in skeletal muscle. Am J Physiol. 1971; 220:(1)66-74

Coburn RF, Forman HJ Carbon monoxide toxicity. In: Farhi LE, Tenney SM Bethesda: Gas exchange American Physiological Society; 1987

Copel JA, Bowen F, Bolognese RJ Carbon monoxide intoxication in early pregnancy. Obstet Gynecol. 1982; 59:26-8

Crocker PJ, Walker JS Pediatric carbon monoxide toxicity. J Emerg Med. 1985; 3:443-8

Ernst A, Zibrak JD Carbon monoxide poisoning. N Engl J Med. 1998; 339:(22)

Feldmeier JJ Hyperbaric Oxygen 2003: Indications and Results.Kensington: Underwater and Hyperbaric Medical Society; 2003

Gasman JD, Varon J, Gardner JP Carbon monoxide poisoning. West J Med. 1990; 153:(6)656-7

Ginsberg MD, Myers RE, McDonaugh BF Experimental carbon monoxide encephalopathy in the primate II; Clinical aspects, neuropathology and physiologic correlation. Arch Neurol. 1974; 30:(3)209-16

Ginsberg MD, Myers RE Fetal brain injury after maternal carbon monoxide intoxication, clinical and neuropathologic aspects. Neuro. 1976; 26:(1)15-23

Ginsberg MD Carbon monoxide intoxication; Clinical features, neuropathology, and mechanisms of injury. J Toxicol Clin Toxicol. 1985; 23:(4–6)281-8

Henry CR, Satran D, Lindgren B Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006; 295:(4)

Herman LY Carbon monoxide poisoning presenting as an isolated seizure. J Emerg Med. 1998; 16:(3)429-32

Horowitz AL, Kaplan R, Sarpel G Carbon monoxide toxicity: MR imaging in the brain. Radiology. 1987; 162:(3)787-8

Ikeda T, Kondo T, Mogami H Computerized tomography in cases of acute carbon monoxide poisoning. Med J Osaka Univ. 1978; 29:(3–4)253-62

Ilano AL, Raffin TA Management of carbon monoxide poisoning. Chest. 1990; 7:(1)165-9

Jones JS, Lagasse J, Zimmerman G Computed tomographic findings after acute carbon monoxide poisoning. Am J Emerg Med. 1994; 12:(4)448-51

Klasner AE, Smith SR, Thompson MW Carbon monoxide mass exposure in a pediatric population. Acad Emerg Med. 1998; 5:992-6

Koren G, Sharav T, Pastuszak A A multicenter, prospective study of fetal outcome following accidental carbon monoxide poisoning in pregnancy. Reprod Toxicol. 1991; 5:(5)397-403

Mathieu D, Nolf M, Durocher A Acute carbon monoxide poisoning, risk of late sequelae and treatment by hyperbaric oxygen. J Toxicol Clin Toxicol. 1985; 23:(4–6)315-24

False elevation of carboxyhemoglobin: a case report. Pediatr Emerg Care. 2011; 27:(2)138-40

Myers RA Carbon monoxide poisoning. J Emerg Med. 1984; 1:245-8

Myers RA, Snyde S, Majerus TC Cutaneous blisters and CO poisoning. Ann Emerg Med. 1985; 14:(6)603-6

Myers RA, Britten JS Are arterial blood gases of value in treatment decisions for carbon monoxide poisoning?. Crit Care Med. 1989; 17:(2)139-42

Miura T, Mitomo M, Kawai R CT of the brain in acute carbon monoxide intoxication: characteristic features and prognosis. Am J Neuroradiol. 1985; 6:(5)739-42

Nelson LS, Hoffman RS Inhaled toxins: carbon monoxide, 5th ed. In: Marx J St Louis: Mosby/ Elsevier; 2005

Pace N, Stajman E, Walker EL Acceleration of carbon monoxide elimination in man by high pressure oxygen. Science. 1950; 111:652-4

Parkinson RB, Hopkins RO, Cleavinger HB White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology. 2002; 58:(10)1525-32

Penney DG Acute carbon monoxide poisoning in an animal model: The effects of altered glucose on morbidity and mortality. Toxicology. 1993; 80:(2–3)85-101

Piantadosi C The role of hyperbaric oxygen in carbon monoxide, cyanide and sulfide intoxications. Prob Resp Care. 1991; 4:(2)215-31

Piatt JP, Kaplan AM, Bond GR Occult carbon monoxide poisoning in an infant. Pediatr Emerg Care. 1990; 6:(1)21-3

Roughton FJW, Darling RC The effect of carbon monoxide on the hemoglobin dissociation curve. Am J Emerg Med. 1944; 141:17-31

Blood carboxyhemoglobin changes during tobacco smoking. Postgrad Med J. 1970; 49:(576)684-7

Satran D, Henry CR, Adkinson C Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005; 45:(9)

Shapiro AB, Maturen A, Herman G Carbon monoxide and myonecrosis, A prospective study. Vet Hum Toxicol. 1989; 31:(2)136-7

Sokal JA, Kralkowska E The relationship between exposure duration, carboxyhemoglobin, blood glucose, pyruvate and lactate and the severity of intoxication in 39 cases of acute carbon monoxide poisoning in man. Arch Toxicol. 1985; 57:(3)196-9

Tomaszewski C, Rosenberg N, Wathen J Prevention of neurological sequelae from carbon monoxide by hyperbaric oxygen in rats. Neurology. 1992; 42

Thom SR Antagonism of carbon monoxide-mediated brain lipid peroxidation by hyperbaric oxygen. Toxicol Appl Pharmacol. 1990; 105:(2)34-4

Thom SR, Taber RL, Mendiguren II Delayed neuropsychologic sequelae after carbon monoxide poisoning: Prevention by treatment with hyperbaric oxygen. Ann Emerg Med. 1995; 25:(4)474-80

Tomaszewski T Carbon Monoxide, 8th edition. In: Goldfrank L, Flomenbaum N United States: McGraw-Hill; 2006

Turner M, Hamilton-Farrell MR, Clark RJ Carbon monoxide poisoning: an update. J Accid Emerg Med. 1999; 16:(2)92-6

Vreman HJ, Ronquillo RB, Ariagno RL Interference of fetal hemoglobin with the spectrophotometric measurement of carboxyhemoglobin. Clin Chem. 1998; 34:(5)975-7

Waisman D, Shupak A, Weisz G Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute. Pediatrics. 1998; 102

Walker E, Hay A Carbon monoxide poisoning is still an under recognized problem. BMJ. 1999; 19:(7217)1082-3

Weaver LK, Hopkins RO, Chan KJ Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002; 347:(14)1057-67

Carbon monoxide poisoning: a comprehensive review for prehospital specialists

03 February 2012
Features
02 February 2012
Volume 4 · Issue 2

Abstract

As one of the leading causes of poisonings worldwide, it is imperative that prehospital specialists are aware of carbon monoxide (CO) poisoning and its management. Awareness of the epidemiology, and the common presentations of CO poisoning may lead to prompt evaluation and early initiation of life-saving therapy. Children under 5 years of age have the highest incidence of CO-related ER visits and are at greatest risk of CO toxicity. The clinical features are nonspecific and misdiagnoses are common. Therefore, prehospital providers should have a high index of suspicion for CO intoxication in patients that experience headache, vomiting, or altered level of consciousness following exposure to hydrocarbon combustion within an enclosed space. A carboxyhaemoglobin level is a quick and reliable way to diagnose CO exposure. To prevent complications such as altered cerebellar function, seizures, rhabdomyolysis and dysrhythmias, early recognition and treatment is imperative. Removal from the source of exposure and the provision of 100% oxygen form the cornerstone of management. Preventive strategies should also be explored in susceptible populations.

Carbon monoxide (CO) is the major cause of death from poisoning in the UK (Turner et al, 1999). Based on Centers for Disease Control and Prevention (CDC) data from 2004-2006, children younger than 5 years had the highest rate estimated rate of CO-related emergency room visits amongst all age groups (CDC, 2008). It is important for the prehospital specialist to remember certain situations may lend themselves to a greater risk of CO poisoning. Historical clues include a history of enclosed spaces, especially during colder months when the use of heating is more likely.

Numbers of cases sublethal exposure to CO in the UK are traditionally quoted as 200 per year, but up 250 000 gas appliances are condemned annually. Therefore, as many as 25 000 people every year may be exposed to the effects of CO within the home. It is believed that an overwhelming majority of cases go unrecognized as patients are often misdiagnosed and as a result, remain untreated (Walker and Hay, 1999).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Carbon Dioxide
Epidemiology
Poisoning
Therapy