Carbon monoxide poisoning can go unnoticed and is life-threatening. The gas displaces vital oxygen from the blood. Poorly maintained furnaces are the most common cause of carbon monoxide poisoning.
What is carbon monoxide poisoning?
Carbon monoxide poisoning is intoxication with the gas carbon monoxide, or carbon monoxide in technical terms. Medical terminology is therefore carbon monoxide intoxication. The intoxication can occur in as an acute life-threatening crisis or as a chronic intoxication that progresses without obvious symptoms. Carbon monoxide is a colorless gas with no odor. The substance consists of a carbon atom linked to an oxygen atom. The chemical name is CO (C: carbon, O: oxygen). The molecule has great structural similarity with oxygen (O2: 2 oxygen atoms per molecule). This is ultimately the reason for the toxic effect of carbon monoxide. Instead of oxygen, the gas binds to physiologically important structures in the metabolism. There, the vital breathing gas is displaced and carbon monoxide poisoning occurs.
Causes
Carbon monoxide poisoning is causally related to a blockage of the red blood pigment (hemoglobin), which absorbs little oxygen. This oxidant can no longer be carried to the sites of consumption, or only inadequately. The result is an oxygen shortage in the organs. For the muscle cells, carbon monoxide means double stress: they have an internal transport protein for oxygen, myoglobin, which is similar to hemoglobin. In the same way, carbon monoxide also has an effect here. In addition, carbon monoxide suppresses energy production (“combustion”) in all body cells quite directly. This is called internal asphyxiation and is a lesser known cause of carbon monoxide poisoning. An elevated concentration of carbon monoxide in the air you breathe can have several causes:
1) Incomplete combustion: poorly drawing coal, wood or gas stoves,
Car and industrial exhaust fumes, fires.
2) Natural concentration peaks in caves and mines.
Both of these causes usually lead to accidents. However, some people use car exhaust as part of a suicide attempt from carbon monoxide poisoning.
Symptoms, complaints, and signs
Symptoms of carbon monoxide poisoning depend on the concentration of the gas in the air one breathes and the length of time someone is exposed to the poison. Symptoms range from moderate dizziness to death from oxygen deprivation. Based on an indication of particles per million (ppm) in the air breathed, approximate thresholds for the onset of symptoms can be established for carbon monoxide poisoning. For example, at 35 ppm, only dizziness and headache occur after several hours. At 200 ppm and above, there may also be a clouding of judgment and the headache comes on more quickly. At 400 ppm, very severe headaches occur within two hours. At 800 ppm and above, convulsions, nausea and unconsciousness occur within two hours. The heart rate increases from a concentration of 1,600 ppm, and death can occur here after just a few hours. At 3,200 ppm, death is expected within half an hour. At 6,400 ppm and above, seizures complement the symptoms. Death occurs within twenty minutes. At 12,800 ppm, fainting occurs after a few breaths and death within a few minutes. Meanwhile, in children, the sick, and the elderly, lower concentrations of carbon monoxide in the air are sufficient to cause severe symptoms.
Diagnosis and progression
Carbon monoxide poisoning manifests with symptoms such as nausea, headache, and irregular breathing (“Cheyne-Stokes breathing”). A pink coloration of the skin is typical. These symptoms already threaten at a concentration of 0.03% of the gas in the air. This value can already be reached in large cities with high traffic volumes. In more severe cases, convulsions and finally unconsciousness occur. The physician directly detects the hemoglobin-bound carbon monoxide on the blood count. Severe acute and chronic carbon monoxide poisoning can lead to serious consequential damage to the nervous system and muscles. Even a concentration of 1% carbon monoxide in the ambient air causes death within a few minutes. This is because hemoglobin binds the poisonous gas 200 times more strongly than oxygen and therefore accumulates rapidly in the blood.Therefore, even low concentrations lead to carbon monoxide poisoning.
Complications
Carbon monoxide poisoning is a very serious stress to the human body. If this poisoning is not treated in time or persists for a long period of time, the patient may lose consciousness or, further, in the worst case, die. For this reason, very rapid treatment is necessary in the case of carbon monoxide poisoning. The affected person primarily suffers from acute shortness of breath and also headaches. Furthermore, the shortness of breath may cause panic attacks or sweating. If the inhalation of carbon monoxide in large quantities is not stopped, unconsciousness usually occurs. In this case, the patient may injure himself by falling. If rescue does not occur afterwards, the affected person will die. Likewise, internal organs and nerves are damaged during carbon monoxide poisoning, so irreversible secondary damage can occur even after rescue. It is not uncommon for carbon monoxide poisoning to cause psychological symptoms as well. The treatment itself does not lead to further complications. However, it does not lead to a positive course of the disease in every case. If necessary, carbon monoxide poisoning reduces life expectancy.
When should you go to the doctor?
If someone suspects carbon monoxide poisoning in someone they know, call 911 immediately. This is a life-threatening situation that requires immediate action. Prompt emergency medical care can prevent or minimize permanent consequential damage. In addition to acute carbon monoxide poisoning, chronic carbon monoxide poisoning can also occur. The symptoms of chronic carbon monoxide poisoning last for several weeks. An intensive search for the cause must be carried out. The poisoning must be treated professionally. Possible sources of carbon monoxide exposure may be in clogged chimney flues or a garage that has not been adequately ventilated.
Treatment and therapy
Carbon monoxide poisoning requires immediate expulsion of the toxic gas from the blood. To do this, the patient undergoes hyperbaric oxygenation. This is artificial respiration with 100% oxygen. In the simplest case, it is administered through a breathing mask, but sometimes the patient is intubated. A tube is a fixed tube in the trachea, which is unavoidable at the latest when unconsciousness sets in. Hyperbaric chambers are a very effective, fast-acting method that unfortunately will not be available everywhere. Patients must be constantly monitored so that the physician can intervene immediately in the event of cardiovascular complications. Monitoring also includes blood values to clarify the detoxification status. In addition, if the blood is acidified, bicarbonate (soda ash) must be given by infusion. Follow-up treatment may require rehabilitation aimed at alleviating secondary damage. In the case of suicide attempts, the psychiatrist is also dedicated to the patient after surviving carbon monoxide poisoning.
Outlook and prognosis
In the case of carbon monoxide poisoning, the prognosis varies. If there was no carbon monoxide warning device in the person’s home, camper, or garage, they will not notice the odorless poison. It often escapes from defective gas heaters or a charcoal grill placed in the home that is still burning out. Just a few breaths of the fumes are enough for unconsciousness to occur. Just a few more breaths will inevitably lead to death. If people are rescued at the right time, or if the carbon monoxide warning device sounds, the outlook is better. In many cases, campers or visitors to a shisha bar, for example, could still be rescued in time in the event of highly elevated carbon monoxide levels. The patients must be supplied with oxygen immediately so that they do not die from the smoke gases already inhaled. Because of the duration of the CO2 quantities that can be exhaled in the open air, it is not sufficient merely to bring the affected persons out into the fresh air. The affected persons must be ventilated with oxygen immediately. In this way, the poisoning process can be interrupted and revised. In carbon monoxide poisoning, the vital transport of oxygen by hemoglobin is blocked. If it remains so, the prospects for survival are poor. The heart and brain are damaged by carbon monoxide poisoning.On average, 10 percent of all people who suffer accidental carbon monoxide poisoning die. The remaining 90 percent of those affected could be discharged after clinical treatment.
Prevention
Carbon monoxide poisoning can be prevented with a few safety measures. Since the most common cause is defective indoor combustion furnaces, a professional should perform regular maintenance here. Measurements of the MAK values (Maximum Workplace Concentration) in the workplace provide early warning of impending danger. In some occupations (road construction, firefighting), continuous exposure cannot be avoided. In such cases, respirators should be worn if necessary. Otherwise, it is recommended to avoid places with a high risk of carbon monoxide poisoning.
Aftercare
In most cases, victims of carbon monoxide poisoning do not have any particular options for aftercare. First and foremost, the cause of this poisoning must be clarified so that it does not recur. The further course depends very much on the severity of the carbon monoxide poisoning, so that no general prediction can be made. As a rule, carbon monoxide poisoning is alleviated by inhaling oxygen, which can be done in a hospital or by an emergency physician. In severe cases, a longer stay in a hospital is necessary to relieve the symptoms of this poisoning. In any case, the affected person should take it easy and not exert himself. Physical or stressful activities should be avoided in any case. In some cases of carbon monoxide poisoning, a psychological examination and counseling is also necessary. This is especially true if the person has attempted suicide. In this case, intensive and loving conversations with the parents or with relatives and friends also have a positive effect on the further course. In many cases, carbon monoxide poisoning reduces the life expectancy of the affected person.
What you can do yourself
First and foremost, in the event of carbon monoxide poisoning, the affected person must be brought to safety and removed from the poisoned room. A direct supply of oxygen or, in an emergency, mouth-to-mouth resuscitation can prevent further complications or, in the worst case, the death of the patient. However, an emergency physician should always be called in the event of carbon monoxide poisoning. The emergency physician can treat and stabilize the patient. In most cases, a short stay in the hospital is necessary. The overacidification of the blood with carbon dioxide must also be controlled and possibly avoided. In some cases, carbon monoxide poisoning can also lead to long-term damage, so that patients have to rely on the help of their friends and family. If carbon monoxide poisoning occurs as a result of a suicide attempt, the affected person must undergo psychological treatment. This may also require a stay in a closed hospital. The help of family and friends is also very important in the case of psychological discomfort and can lead to an accelerated recovery. In an acute emergency, the patient must likewise be calmed and placed in a stable position until the emergency physician arrives.