Cognitive 1. Define carbon monoxide and carbon monoxide poisoning. 2. Describe the causes of carbon monoxide poisoning. 3. Identify signs and symptoms of carbon monoxide poisoning.

Cognitive 4. Describe the care and treatment for a patient suffering carbon monoxide poisoning. 5. Discuss methods for diagnosing carbon monoxide poisoning. 6. Identify the risks of carbon monoxide poisoning to EMS providers.

Psychomotor 1. Demonstrate the steps in emergency care of a patient with suspected carbon monoxide poisoning. 2. Demonstrate operation and usage of the Rad 57 for detection of SpCO.

● Chemical symbol – CO ● Colorless ● Odorless ● Tasteless ● “Silent Killer ● “Great Imitator”

● 6,000 fatalities annually in US. ● 40,000-50,000 people seek ED care for CO related problems annually. ● Often called “Silent Killer,” CO’s initial symptoms are often vague, subtle and easily misdiagnosed.

● Incomplete combustion of carbon Carbon- containing fuels. ○ Home heating oils ○ Charcoal ○ Kerosene ○ Coal ○ Gas

● Faulty Furnaces, heaters ● Auto exhaust ● Gas generators ● Charcoal grills used indoor ● Tobacco smoke ● Fires ● Small gas engines or equipment ● Gas appliances ● Gas heaters in enclosed areas

● CO is times more desirable that Oxygen to RBC’s. ● CO readily displaces oxygen from the hemoglobin and forms a compound called carboxyhemoglobin, which does not carry oxygen. ● Carboxyhemoglobin is delivered to cells in place of oxygen resulting in tissue hypoxia. ● Creates suffocation type of environment at cellular level.

● Amount of carbon (concentration) ● Time (duration) ● Activity level (during exposure) ● Health ● Age

● Specific Occupations (Fire & EMS) ● Elderly ● Children ● Infants ● Pregnant mothers ● People with existing health problems

● Headache● Dizziness ● Weakness● Weakness ● Nausea● Vomiting ● Chest Pain● Altered LOC ● Flu-like● Coma ● Death

● Suspect Carbon Monoxide poisoning when: ○ Several symptoms are reported at the same time. ○ No other cause can be identified. ○ More than one person at scene reports similar symptoms/onset.

● Even low-level exposure to carbon monoxide results in long-term impairment of higher cognitive functions such as memory, new learning ability, attention, and concentration. ● Effects may mimic a stroke (The great Imitator) ● Coma and Brain death

● Hypotension ● Tachycardia ● Dysrhythmia’s ● Myocardial Ischemia ● Symptoms may mimic an MI ● Ultimately Ventricular Fibrillation

● Rescuer safety is #1 priority ● Never Enter hazardous scene without proper PPE. ● Evacuate occupants/victims ● Ventilate as needed

● Pulse Oximeters can not detect CO ● Rad-57, non-invasive and continuous method of detecting Carbon Monoxide in patients. ○ Detects carboxyhemoglobin levels ○ Detects oxyhemoglobin levles ○ Obtains pulse rate ○ Small, handheld battery operated ○ Finger clamp similar to a pulse oximeter.

● The Masimo Rad 57C is the only FDA-approved Pulse CO-Oximeter that noninvasively and continuously monitors Carbon Monoxide levels in the bloodstream in seconds. EMS professionals can quickly and easily diagnose carbon monoxide poisoning on the scene. Just slip the sensor on the patient’s finger and press a button. The Masimo Rad 57C accurately detects the percentage of Carbon Monoxide in the bloodstream in just seconds, allowing for prompt and possibly life saving treatment.

● Any patient with suspected carbon monoxide poisoning should receive oxygen via NRB mask. ● The RAD-57C may be used as a screening tool for ASYMPTOMATIC potentially exposed people: ○ If there is a CO alarm in a residence, the RAD-57C may be used to test for levels on the occupants of the location. ○ Any asymptomatic patient with a level of greater than 15% should receive oxygen for 30 minutes, then reassess the patient.

● The RAD-57C may be used as a screening tool for SYMPTOMATIC patients: ○ If there is a CO alarm in a residence, the RAD-57C may be used to test for levels on the ill occupants of the location. ○ Carbon monoxide poisoning does not have specific, clear cut symptoms, and other medical conditions may present with dizziness, nausea or confusion. ○ All symptomatic patients should be transported, regardless of RAD-57C level.

● Remove patient from environment ● Apply high-flow oxygen ● Obtain SAMPLE history ● Complete an assessment ● Obtain vital signs ● Use Rad 57C if available ● Transport to most appropriate facility

● Re-Assess LOC & vital signs ● Evaluate respiratory system ● IV ● EKG monitoring ● Use Rad 57C, if available ● Transport to most appropriate facility

● Hyperbaric oxygen treatment (HBO) may be recommended if SpCO >30 and/or the patient is unconscious, has altered mental status, or the patient is pregnant. ● Follow local protocols for guidance.

● Consider Carbon Monoxide poisoning when symptoms seem suspicious or if patient has been in an enclosed environment. ● Quick diagnosis and treatment is critically important in saving the patient and preventing others from being poisoned as well.

Roy L. Hunter Lisa Camp