T’IS THE SEASON
Your ambulance is dispatched to a residence where multiple residents are complaining of nausea, dizziness, and other flu-like symptoms. At least one of those inflicted is also exhibiting with a flushed, reddish, skin tone (Bright red skin tones are a late, and dangerous, state of poisoning). It is best to remove the victims and your crew from the interior. You might call for the local fire department to come out and check for levels of Carbon Monoxide (although it is NOT a requirement in New York State, some ambulance corps have invested in their own detectors).
Getting those occupants to fresh air, opening windows to improve fresh air ventilation inside, and putting them on a non-rebreather mask with high flow O2, is a priority. Monitor patients for signs of hypertension which may indicate cardiac complications from the exposure. If you have a choice of hospital facility, and especially if your victim(s) is suffering from an elevated level of exposure, bring them to a facility with a hyperbaric chamber. Do not delay transport.
As the wintry weather sets in the incidence of carbon monoxide poisoning greatens, CO poisoning can occur anytime during the year. Anywhere there is a source of flame as in most home heating units there is the possibility of carbon monoxide poisoning incident. Common sources of Carbon Monoxide come from any vehicle with a gas engine, camp stoves, lanterns, burning charcoal, wood stoves, gas ranges, heaters, furnaces, and poorly vented chimneys. While most residences and other facilities are SUPPOSED to be equipped with CO detectors, just because there is no alarm, do not discount the possibility.
Common symptoms of CO poisoning include headaches, fatigue, dizziness, abdominal pains, chest pain, sluggishness, and on the later stages, coma. And as mentioned above, a bright red skin tone is apparent when the blood has absorbed higher levels of Carbon Monoxide. Pulse oximeters are useless indicators of CO poisoning as they only measure the Oxygen in the blood and does not differentiate whether is Oxygen or Carbon Monoxide bound to the hemoglobin. There is modern technology that will measure the level of CO in the blood, a Pulse CO-oximetry will measure the presence and level.
Many people are exposed to low levels of CO every day and the body itself helps to rid itself of the harmful molecules, but Carbon Monoxide poisoning can be fatal if the levels become too high or the victim is not treated promptly. Even those who appear to make a full recovery may have long-term effects especially with organs that depend on Oxygen such as the brain and heart. Outcomes may also differ due to age and health status; pregnant women and their fetuses are especially endangered from CO exposure.
Most healthy patients will recover from mild CO exposure with clean and/or pure Oxygen. Up to 40% of those exposed to high CO levels may experience seizures and cardiac disorders even after the initial recovery. Firefighters are constantly exposed to higher levels of Carbon Monoxide and need to be carefully assessed. Carbon Monoxide poisoning will often take hours to get rid of, the half-life of CO is a minimum of three to four hours.
Remember that exposure to Carbon Monoxide can happen any time of the year. Your best option is to transport CO victims to the hospital and administer Oxygen during transport. Always bear in mind that all responding emergency services personnel (EMS, FD, or PD) may have also been exposed and should be checked. If your service does have a Pulse CO-oximetry available, it is a wise idea to check yourself and fellow crew members.