1. PULSE Classroom Carbon Monoxide: The Odorless Killer

2. PULSE Classroom Introduction Carbon monoxide –Colorless, odorless, tasteless, toxic gas –By-product of incomplete combustion –Commonly found in all areas of home and work –Difficult to detect, easy to misdiagnosis –Deadly poison, immediate threat to life –Numerous long-term health effects

3. PULSE Classroom After completing this course, the participant should be able to: define carbon monoxide (CO) and carbon monoxide poisoning. identify signs and symptoms of CO poisoning. identify current methods for diagnosing CO poisoning. describe the risks firefighters face with CO. describe the role of the EMS provider in treating patients with CO poisoning. After completing this course, the participant should be able to: define carbon monoxide (CO) and carbon monoxide poisoning. identify signs and symptoms of CO poisoning. identify current methods for diagnosing CO poisoning. describe the risks firefighters face with CO. describe the role of the EMS provider in treating patients with CO poisoning. Objectives

4. PULSE Classroom Objective 1: What Is CO?  Definitions  Carbon monoxide  Carbon monoxide poisoning  Carboxyhemoglobin  Definitions  Carbon monoxide  Carbon monoxide poisoning  Carboxyhemoglobin

5. PULSE Classroom Objective 1: Why Is CO Poisoning so Deadly? Pathophysiology Binds to hemoglobin occupying site intended for oxygen Prevents release of oxygen to cells Intracellular toxin Binds with myoglobin in cardiac and muscle cells causing significant muscle impairment Pathophysiology Binds to hemoglobin occupying site intended for oxygen Prevents release of oxygen to cells Intracellular toxin Binds with myoglobin in cardiac and muscle cells causing significant muscle impairment

6. PULSE Classroom Objective 1: How Many People Are Affected Each Year? Leading cause of toxic-related death in United States As many as 40,000 emergency department visits for carbon monoxide poisoning per year 1,000 to 2,000 accidental deaths per year

7. PULSE Classroom Knowledge Assessment What are some common sources of CO? Why is CO sometimes difficult to diagnose?

8. PULSE Classroom Objective 2: The Symptoms Immediate symptoms –Headache –Dizziness and weakness –Chest pain –Nausea and vomiting –Confusion –Loss of memory, concentration, orientation –High doses: loss of consciousness and death

9. PULSE Classroom Objective 2: The Symptoms Other symptoms Neurological –Long-term nervous system damage Cardiovascular –Hypotension –Dysrhythmias –Clotting disorders Respiratory –Hypoxia –Shortness of breath

10. PULSE Classroom Objective 2: What Is Considered a Dangerous CO Level? Cohb%Signs & Symptoms 5%Headache 10%Headache, shortness of breath with exertion 10-20%Moderate headache, shortness of breath with mild exertion 20-30%Worsening headache, nausea, dizziness, fatigue 30-40%Severe headache, vomiting, vertigo, altered judgment 40-50%Confusion, syncope, tachycardia 50-60%Seizures, shock, apnea, coma > 70 ppmHeadache, fatigue, nausea > 150- 200 ppm Disorientation, unconsciousness, and death possible

11. PULSE Classroom Knowledge Assessment What are some of the conditions that CO poisoning can mimic? TRUE or FALSE: CO levels at 5% is when most people start to exhibit symptoms. Name five common immediate symptoms of CO poisoning.

12. PULSE Classroom Objective 3: Diagnosis Traditional methods –Blood draw –Carboxyhemoglobin saturation –ABG –CBC –Breath analyzers –Brain imaging scans –MRI –PET

13. PULSE Classroom Objective 3: Limitations of Traditional Diagnosis Clinical signs and symptoms are often misleading Without clear signs and symptoms, diagnosis may be missed Not feasible for use in the field

14. PULSE Classroom Objective 3: Revolutionary Technology  Masimo Rainbow™ SET Pulse CO-Oximetry™ (Rad-57)  Portable  Noninvasive  Accurately measures CO in seconds  Easy to operate  Allows rapid and accurate triage

15. PULSE Classroom Obj. 3:Rad-57 vs. Blood Sample

16. PULSE Classroom Objective 4: Who Benefits? Firefighters –High risk for exposure during: overhaul phase of structure fires. all wild land fires. rescue situations. training situations. –Administer test to each other

17. PULSE Classroom Objective 5: Who Benefits? Patients at the scene –CO is the cause of most fire-related deaths –Misdiagnosis is common –Quick diagnosis leads to quick treatment

18. PULSE Classroom Objective 5: Who Benefits? Patients in the ER –Quickly spot CO poisoning without blood draw –Differential diagnosis for comatose or altered patients

19. PULSE Classroom Objective 5: Who Benefits? MCI victims –High CO levels post-incident –Limited breathing protection and compressed air resources –Essential CO screening of rescue personnel and patients –Hospital transport and screening not feasible –Maximize resources and minimize errors

20. PULSE Classroom Knowledge Assessment Name three duties in which firefighters are exposed to CO. What are three traditional methods for checking CO levels?

21. PULSE Classroom Summary CO is a common poison found in combustion fumes –Difficult to diagnose in the field through traditional means –New technology makes screening quick, easy, and accurate –Result is better patient outcomes –www.masimo.com/CPUB/clinicals.htmwww.masimo.com/CPUB/clinicals.htm