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AIP: Headache > Carbon monoxide poisoning > Flashcards

Carbon monoxide poisoning Flashcards

1
Q

How does carbon monoxide poisoning affect the blood?

A

CO has a high affinity for haemoglobin nd myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia

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2
Q

How does carbon monoxide poisoning affect the oxygen dissocation curve and what does this lead to?

A

left shift: i.e. Hb saturation is higher for the same partial pressure of oxygen

when CO binds to Hb, makes the other unoccupied haem groups more likely to bind to oxygen (increases its affinity) means that the Hb will be less likely to release oxygen to the itssues and this can lead to suffocation (tissue hypoxia)

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3
Q

How might you determine from the history that carbon monoxide poisoning could be contributing to the presentation?

A

badly maintained housing e.g. student houses, issues with boiler/heating

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4
Q

What are 5 common clinical features of carbon monoxide toxicity?

A
  1. Headache
  2. Nausea and vomiting
  3. Vertigo
  4. Confusion
  5. Subjective weaknes
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5
Q

How common is headache in carbon monoxide toxicity?

A

90% of cases

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6
Q

What are 6 features of severe carbon monoxide toxicity?

A
  1. Pink skin and mucosae
  2. Hyperpyrexia
  3. Arrhythmias
  4. Extrapyramidal features
  5. Coma
  6. Death
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7
Q

What investigation may be misleading when investigating carbon monoxide poisoning and why?

A

pulse oximetry may be falsely high due to similarities between oxyhaemoglobin and carboxyhaemoglobin

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8
Q

What is the diagnostic investigation for carbon monoxide poisoning?

A

VBG/ABG - carboxyhaemoglobin concentration >20%

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9
Q

In addition to ABG/VBG what other investigations are useful in suspected carbon monoxide poisoning? 3 things

A
  1. ECG: to look for cardiac ischaemia
  2. CXR: looking for evidence of acute respiratory distress syndrome
  3. Creatine kinase: rhabdomyolysis
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10
Q

What are the typical carboxyhaemoglobin levels in non-smoekrs vs smokers?

A
  • <3% non-smokers
  • <10% smokers
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11
Q

At what carboxyhaemoglobin levels are patients with carbon monoxide poisoning symptomatic?

A

10-30% (headache, vomiting)

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12
Q

At what level of carboxyhaemoglobin is carbon monoxide considered severe?

A

>30%

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13
Q

In which setting should patients with carbon monoxide poisoning be assessed?

A

emergency department

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14
Q

What causes carbon monoxide to be present in the home?

A

incorrectly insalled, poorly maintained or poorly ventilated household appliances such as cookers, heaters and central heating boilers are the most common causes of accidental exposure

(also blocked flues/chimneys, burning fuel in enclosed space e.g. car engine, blocked car exhast, paint fumes)

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15
Q

What are 2 aspects of the management of carbon monoxide poisoning?

A
  1. 100% high-flow oygen via non-rebreathe mask
  2. Hyperbaric oxygen
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16
Q

How should high-flow oxygen be delivered in carbon monoxide poisoning?

A

non-rebreathe mask at 100%

administered as soon as possible with treatment continuing for minimum of 6 hours

17
Q

How does delivering high-flow oxygen work to treat carbon monoxide poisoning?

A

decreases half-life of carboxyhaemoglobin

18
Q

How long should high-flow oxygen be given for in carbon monoxide poisoning?

A
  • minimum of 6 hours
  • continued until all symptoms have resolved, rather than monitoring CO levels
19
Q

What guides when treatment should be stopped in carbon monoxide poisoning?

A

when symptoms resolve (rather than from monitoring CO levels)

20
Q

What are target oxygen saturations in carbon monoxide poisoning management?

A

100%

21
Q

What is hyperbaric oxygen?

A

floods body with oxygen to competitively compete for binding to haem with CO

breathe in pure oxygen inside a highly pressurised environment

22
Q

When is hyperbaric oxygen therapy indicated? 6 situations

A
  1. severe cases e.g. levels >25%
  2. Loss of consciousness at any point
  3. Neurological signs other than headache
  4. Myocardial ischaemia
  5. Arrhythmia
  6. Pregnancy
23
Q

What must be done before hyperbaric oxygen is started in carbon monoxide poisoning?

A

discussion with a specialist

AIP: Headache (10 decks)

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