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- James Ashcroft, academic doctor of the basic program1 2,
- Emma Fraser, Senior Development Officer, Safety, Fire, Water and Carbon Monoxide3,
- Sanjay Krishnamoorthy, consultant in acute medicine2 ,
- Sue Westwood-Ruttledge, patient advisor and advocate for carbon monoxide poisoning awareness4
- 1Department of Surgery and Cancer, St Mary's Hospital, London, United Kingdom
- 2Department of Acute Medicine, West Middlebad University Hospital, Isleworth, United Kingdom
- 3London Fire Brigade, London, United Kingdom
- 4Sale, Cheshire, United Kingdom
- Correspondence to J Ashcroft james.ashcroft17 {at} imperial.ac.uk,
What do you want to know
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Carbon monoxide (CO) poisoning can manifest in patients in the form of a wide range of acute and chronic symptoms
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The diagnosis of CO poisoning is based on a comprehensive history exploring the link between symptoms and the environment
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The emission of abnormally high CO levels can be detected by certified carbon monoxide alarms and can be avoided by regular maintenance of fuel appliances.
A 23-year-old man with no medical history comes to the emergency department with three days of headaches, transient visual disturbances, dizziness and high blood pressure. On clinical examination, the patient is red and sleepy, with redness of the sclera, without other visual or systemic symptoms. Venous blood gas in the air shows a very high carboxyhemoglobin (COHb) level of 26.0 (0-3), which leads to the diagnosis of carbon monoxide poisoning.
What is carbon monoxide poisoning?
Carbon monoxide (CO) is a toxic gas produced by fuel combustion. Home CO sources include boilers and central heating systems, stoves and barbecues, as well as fireplaces and fireplaces (Figure).1 Owners of such devices are required to have them repaired by authorized technicians in accordance with the recommended individual guidelines (usually once a year).1 If the outputs of these appliances (such as flues and chimneys) become clogged or normally operate in a closed environment without ventilation, dangerous levels of CO can accumulate in the living areas.1 When inhaled in large quantities, the CO enters the bloodstream and binds to the hemoglobin molecules with a much higher affinity (230 times) than that of oxygen, thus creating a carboxyhemoglobin .2 The binding of CO results in a reduction of oxygen supply to the tissues, leading to tissue ischemia.2
Common domestic sources of CO
Why is it missed?
The presentation of CO intoxication is not frequent enough for the state to be a priority in the areas of medical training, diagnostic decision-making, initial patient testing , advertising and the public …
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