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Carbon Monoxide (CO) Poisoning (Respiratory Management (Oxygen therapy…
Carbon Monoxide (CO) Poisoning
Etiology
Inspiring by-products of the incomplete combustion of carbon or carbon containing material
When a patient has been exposed to smoke, CO poisoning is assumed:red_flag:
Pathophysiology
Due to CO’s affinity for hemoglobin, CO attaches to hemoglobin which is then called carboxyhemoglobin (COHb)
Hemoglobin has an increased affinity for oxygen making it more difficult for oxygen to leave the hemoglobin at the tissue sites
Histotoxic hypoxia
As COHb% (carboxyhemoglobin %) increases, tissue hypoxia increases
Diagnostic Testing
COHb% :red_flag:
20% is usually considered CO poisoning
= 40% is considered severe
50% or more may cause irreversible damage to the CNS
Arterial blood gas measurements with CO-oximetry provide important information regarding the presence of hypoxemia and correct measurement of both oxygen saturation% and COHb%
Differential Diagnosis
COHb % :red_flag:
Smoke exposure: assume CO poisoning :red_flag:
Respiratory Management
Oxygen therapy
FiO2 = 100% until COHb reaches < 10%
Via high-flow with HFNC or Venturi
Hyperbaric oxygen therapy
Severe cases: Mechanical Ventilation
Clinical Signs & Symptoms
COHb: 20%
Asymptomatic
COHb 20-60%
Headache
Extertional dyspnea
Impaired judgment
Nausea
Vomiting
COHb: 60-80%
LOC
Convulsions
Deep coma