POOJA SANTHOSH

120201374

Odourless

Colourless

Non-irritating

Lighter than air

Plasma level : 1-5%

Smokers : 7-8%

Incomplete combustion –wood/charcoal

Automobile exhaust

Fire

Tobacco smoke

Endogenous CO from haeme degradation (non-toxic on its own)

Plasma concentration > 50-60%

Lungs absorb CO combines with Hb(85%) + myoglobin (15%) eliminated through lungs

Affinity to Hb: 230-270 times

Leftward shift of Oxyhaemoglobin dissociation curve

Decreased ability of carrying and releasing Oxygen

Acute Poisoning Early: Non-specific

2 classical features (rare):Cherry red colour – blood + tissues

Cutaneous bullae/blisters

Based on severity:Mild (COHb <30%)

Moderate (30-40%)

Severe (>40%)

Mild Severity Headache

Nausea

Vomiting

Dizziness

Exertional Dyspnea

Moderate Chest pain

Blurred vision

Confusion

Weakness

Increasing dyspnea

Tachycardia

Tachypnea

Ataxia

Severe Trismus

Muscle Spasms

Convulsions

Palpitations

Disorientation

Vent arrhythmias

Hypotension

MI

Resp failure

Coma

Headache, dizziness, confusion

Weakness, nausea, vomiting, abdominal pain

Paraesthesias

Visual disturbances

Hypertension

Hyperthermia

Cherry red skin

Palpitations

Aggravation of Angina

Estimation of COHb level

Pulse oximetry

Arterial blood gases

ECG

Chest X-ray

Bedside tests

Alcoholic intoxication

Hyperventilation syndrome

Cerebrovascular accident

Meningitis/encephalitis

Migraine

Epilepsy

Food poisoning

Imm removal from contaminated env

100% O2 -endotracheal tube

Monitor C&D

Neurologic exam + CAT scan + fundoscopic exam

If ICT increased Hyperventilation

Head elevation

Mannitol

NaHCO3 not given – Metabolic Acidosis

Convulsions – Diazepam iv

Antidote : Hyperbaric Oxygen

Cherry red colour of skin, blood, tissue

Cutaneous bullae

Pulmonary, cerebral edema

Necrosis and cavitation of Basal ganglia

Collect blood from peripheral vein. Preservative: Sodium fluoride.

Suicidal Increased suicide in western countries earlier by

‘Putting the head in the gas oven’

Now, suicide via inhaling exhaust fumes

Accidental Incomplete combustion of natural gas (ill-ventilated)

Defective exhaust system of automobile

Conglagration – large building in flames

• Homicidal (rare)