CO poster amended - Royal College of Emergency Medicine Guidance/10m. Carbon Monoxi… · trades...
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Support for those affected: CO-Awareness supports victims, their families and friends poisoned by Carbon Monoxide (CO) while trying to raise awareness among health professionals and the general public, of the dangers of CO. Telephone Lynn on 0771 589 9296 Email: [email protected] REGISTERED CHARITY NO. 1125755 Trust in us to help you understand the effects of Carbon Monoxide (CO) and other toxic products of combustion CO is the chemical formula for carbon monoxide CO-Awareness Week starts on the third Monday in November www.COvictim.org Carbon Monoxide (CO) remains the biggest cause of accidental death by poisoning in the UK Could your patient have carbon monoxide (CO) poisoning? Common symptoms include: Headache (commonest complaint) Drowsiness / tiredness / lethargy ‘Flu’-like symptoms / myalgia Nausea / vomiting GI upset (especially in children) Dizziness Confusion Higher level exposure will lead to: Altered conscious level A comatose patient Focal neurology possible Commonest misdiagnoses: Chronic fatigue / ‘Tired all the time’ Migraine or other cause of acute headache Labyrinthitis/ear infection ‘Stroke’ / TIA ‘Collapse ? cause’ A ‘viral illness’/URTI Carbon monoxide is produced from ANY carbon-containing fuel; so gas (mains or bottled), fuel oil (‘kerosene’), coal, charcoal, petrol, diesel, wood – even paper. Symptoms will be worse when inside the affected area, and improve when outside. Any fuel-burning appliance can discharge CO into the breathable atmosphere if incorrectly installed or not maintained properly. Use the Health Protection Agency's 'COMA' acronym (Finlay et al, 2012) and ask the following: C for Cohabitees & companions - is anyone else in the house affected (including pets)? O for Outdoors - do your symptoms improve when out of the house? M for Maintenance - are any heating appliances properly maintained? A for Alarm – do you have a carbon monoxide alarm? Patients who are misdiagnosed and sent home are at risk of continuing exposure, which may result in serious illness or death. TESTS: Do NOT rely on so-called ‘cherry pink’ colouration of mucous membranes. Carboxyhaemoglobin (COHb) is the only useful test, but interpret with extreme caution. COHb has half-life of just FOUR hours breathing ‘clean’ air (shorter with O 2 ). You must not use low/normal COHb to rule out CO poisoning – a careful history is much more likely to give the diagnosis – but raised levels (>4% in non-smokers, >10% in smokers) suggest recent CO exposure. To measure COHb use pulse CO-oximetry (needs dedicated pulse oximeter designed to read COHb), breath analysis, or blood gas analysis as soon as possible, and preferably before commencement of oxygen therapy; but do not delay oxygen. Blood for analysis can be arterial, venous, or capillary. Ordinary pulse oximeters are unreliable in presence of CO – they mis-read COHb as oxy-Hb. Treatment (usually only necessary in more severe cases): High-flow oxygen will help displace CO from the blood. Supportive treatment and baseline investigations as for any other poisoned patient, if required. More on Toxbase. Discuss with local hyperbaric unit any of the following: • Patient unconscious at any time • Persisting altered conscious level • Any focal neurology • Pre-existing ischaemic heart disease • Pregnant patient What to do if CO suspected, but not ‘proved’ by raised COHb level: Take focused history, concentrating on when symptoms are worst. How is the patient’s house heated? Have appliances been maintained regularly? Does their home share a wall with another property? Potential CO sources include heating appliances in neighbouring properties. Do they have a landlord (responsibility for safety issues may rest with them)? If CO still suspected, and patient well enough to discharge: Advise not to use any carbon fuelled appliances until demonstrated to be safe by a trades person competent to work on that fuel. Advise patient or relative to contact relevant agency (or landlord to do so if rented property). Advise to ask trades person about fitting of CO alarms (always in accordance with the manufacturer’s instructions found in the manual provided with each alarm). Document that you have given this advice. Kindly supported by: www.katiehaines.com The College of Emergency Medicine Finlay SE, Kar-Purkayastha I, Murray VSG COMA: 4 questions to detect Carbon Monoxide Poisoning in Primary Care and the Emergency Department Extreme Events and Health Protection Section, Centre for Radiation, Chemicals and Environmental Hazards, Health Protection Agency, London BTS Conference Poster Presentation, P038, Warwick UK, March 2012
Transcript of CO poster amended - Royal College of Emergency Medicine Guidance/10m. Carbon Monoxi… · trades...
Support for those affected:CO-Awareness supports victims, theirfamilies and friends poisoned by CarbonMonoxide (CO) while trying to raiseawareness among health professionals andthe general public, of the dangers of CO.
Telephone Lynn on 0771 589 9296Email: [email protected] CHARITY NO. 1125755
Trust in us to help you understand the effects of CarbonMonoxide (CO) and other toxic products of combustionCO is the chemical formula for carbon monoxide
CO-Awareness Week starts on the third Monday in November www.COvictim.org
Carbon Monoxide (CO) remains the biggest causeof accidental death by poisoning in the UK
Could your patient havecarbon monoxide (CO) poisoning?Common symptoms include:Headache (commonest complaint)Drowsiness / tiredness / lethargy‘Flu’-like symptoms / myalgiaNausea / vomitingGI upset (especially in children)DizzinessConfusion
Higher level exposure will lead to:Altered conscious levelA comatose patientFocal neurology possible
Commonest misdiagnoses:Chronic fatigue / ‘Tired all the time’Migraine or other cause of acuteheadacheLabyrinthitis/ear infection‘Stroke’ / TIA‘Collapse ? cause’A ‘viral illness’/URTI
Carbon monoxide is produced from ANYcarbon-containing fuel; so gas (mains orbottled), fuel oil (‘kerosene’), coal, charcoal,petrol, diesel, wood – even paper. Symptomswill be worse when inside the affected area,and improve when outside. Any fuel-burningappliance can discharge CO into thebreathable atmosphere if incorrectly installedor not maintained properly.
Use the Health Protection Agency's 'COMA' acronym (Finlay et al, 2012) and ask the following:
C for Cohabitees & companions - is anyoneelse in the house affected (including pets)?
O for Outdoors - do your symptoms improvewhen out of the house?
M for Maintenance - are any heatingappliances properly maintained?
A for Alarm – do you have a carbon monoxidealarm?
Patients who are misdiagnosed and senthome are at risk of continuing exposure,which may result in serious illness or death.
TESTS:
Do NOT rely on so-called ‘cherry pink’ colouration ofmucous membranes.Carboxyhaemoglobin (COHb) is the only useful test, butinterpret with extreme caution. COHb has half-life of justFOUR hours breathing ‘clean’ air (shorter with O2). Youmust not use low/normal COHb to rule out COpoisoning – a careful history is much more likely to givethe diagnosis – but raised levels (>4% in non-smokers,>10% in smokers) suggest recent CO exposure.To measure COHb use pulse CO-oximetry (needsdedicated pulse oximeter designed to read COHb),breath analysis, or blood gas analysis as soon aspossible, and preferably before commencement ofoxygen therapy; but do not delay oxygen. Blood foranalysis can be arterial, venous, or capillary. Ordinarypulse oximeters are unreliable in presence of CO – theymis-read COHb as oxy-Hb.Treatment (usually only necessary in more severecases): High-flow oxygen will help displace CO from theblood. Supportive treatment and baseline investigationsas for any other poisoned patient, if required. More onToxbase.
Discuss with local hyperbaric unit any of the following:• Patient unconscious at any time• Persisting altered conscious level• Any focal neurology• Pre-existing ischaemic heart disease• Pregnant patientWhat to do if CO suspected, but not ‘proved’ by raised COHblevel:Take focused history, concentrating on when symptoms areworst.How is the patient’s house heated? Have appliances beenmaintained regularly? Does their home share a wall withanother property? Potential CO sources include heatingappliances in neighbouring properties. Do they have a landlord(responsibility for safety issues may rest with them)?If CO still suspected, and patient well enough to discharge:Advise not to use any carbon fuelled appliances untildemonstrated to be safe by a trades person competent to workon that fuel. Advise patient or relative to contact relevantagency (or landlord to do so if rented property). Advise to asktrades person about fitting of CO alarms (always in accordancewith the manufacturer’s instructions found in the manualprovided with each alarm). Document that you have given thisadvice.
Kindly supported by:
www.katiehaines.com
The College ofEmergency Medicine
Emergency dept CO poster revised.pdf 1 28/06/2012 16:13
Emergency dept CO poster revised.pdf 1 04/07/2012 12:38
Finlay SE, Kar-Purkayastha I, Murray VSG
COMA: 4 questions to detect Carbon Monoxide Poisoning in Primary Care and the Emergency Department
Extreme Events and Health Protection Section, Centre for Radiation, Chemicals and Environmental Hazards, Health Protection Agency, London
BTS Conference Poster Presentation, P038, Warwick UK, March 2012
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