EMS: Courage and Compassion in Action: The Silent Killer

By Shawn GodfreyPrint Story | Email Story
Shawn Godfrey
While homebound during the winter, a 64-year-old man complains of a headache, dizziness, and has been vomiting over the past two days. He is also experiencing intermittent bouts of diarrhea and has had the "chills on and off." What do you think? Sounds like the flu or a gastrointestinal affliction, right? Actually, you may be surprised to learn that the symptoms of carbon monoxide (CO) poisoning closely resemble those of influenza and are often misinterpreted. For emergency responders, the on-scene findings at a CO incident may be relatively obvious: a report of a CO detector's activation with occupants feeling nauseous and weak, or an attempted suicide victim inside a running automobile in a closed garage. During the obvious incidents, not many on-scene findings are necessary to confirm that CO poisoning is the probable cause of a patient's illness. Other times, the call isn't so obvious: a person simply complaining of a headache; or someone arrives home to find a family member unconscious. It is during these incidents where undetected environmental factors, like carbon monoxide, can be dangerous or even deadly for emergency responders. Rescuers may not immediately realize the cause of the patient's condition, therefore exposing them to the very same dangers that caused the patient's illness in the first place. Based on previous incidents that were eventually traced to CO poisoning, surveys have shown that many ambulance units across the country now carry portable CO detectors in order to (1) allow safe entry to the scene and (2) provide continuous on-scene monitoring while treating the patient(s). Etiology Carbon monoxide is the leading cause of fatal poisoning in the industrialized world. It results in as many as 70,000 emergency room visits per year and in thousands of deaths. Up to 30 percent of survivors of severe poisoning are left with disabling psychological and neurological symptoms, which sometimes last for years. As the cold weather returns and as gas-fires and boilers are brought back in use, CO poisoning caused by poorly maintained or inexpertly installed equipment is an ever-present risk. Typically, carbon monoxide is produced by the incomplete combustion of wood or hydrocarbon products, although, it can be generated as a byproduct of burning almost anything. Several incidents occur each year in homes with fireplaces or wood-burning stoves/heaters. Poor ventilation in areas where stoves, heaters and generators are used can lead to a buildup of poisonous carbon monoxide fumes. One of the most common sources of exposure is the internal combustion engine. On average, two-thirds of a pound of CO is produced for every mile a car travels. Cigarettes also release carbon monoxide. Other incidents have been reported in apartments where gas stoves are being used for heat. In at least one case, carbon monoxide poisoning was caused by the use of a charcoal grill within an apartment's bathtub. More than 50 percent of all carbon monoxide incidents occur within homes. Twenty percent of all incidents occur in businesses of various types. Basic Physiology Because it's colorless, odorless, and tasteless nature, it is often referred to as "The Silent Killer." The body produces carbon monoxide as a by-product of hemoglobin degradation, but the gas does not reach toxic concentrations unless it is inhaled from exogenous sources. When carbon monoxide is inhaled--even in tiny concentrations--it combines with the hemoglobin in the red blood cells preventing the delivery of oxygen to the body's cells. Fortunately, oxygen binds to the hemoglobin only slightly so it can allow for quick and easy release at the receiving cells. Conversely, carbon monoxide adheres itself to the hemoglobin approximately 210 times more tightly, rarely releasing it at the receiving cells. In other words, if oxygen and carbon monoxide are competing for position on the hemoglobin, carbon monoxide, with an approximately 210 higher affinity to hemoglobin than oxygen, will easily prevail. Signs and Symptoms Those suffering from carbon-monoxide poisoning may initially complain of headache and/or nausea and fatigue, but the symptoms can rapidly progress to coma and even death. It is therefore critical that carbon monoxide be eliminated from the body as soon and as quickly as possible. Lower-level carbon-monoxide patients usually describe their symptoms as flu-like. They frequently complain of tiredness, headache, visual disturbances and runny nose and may not associate or recognize the symptoms as being the result of CO poisoning. A one-month retroactive study of patients reporting to a hospital emergency room with flu-like symptoms revealed that almost one quarter of them (23.6 percent) had a CO level greater than 10 percent (a diagnosis of carbon-monoxide poisoning is generally confirmed by a CO level greater than 10 percent). Often, several members of the same family or those in a given building will complain of the same symptoms. Children are thought to be more susceptible to CO poisoning because they have a higher respiratory rate than adults and will breathe in more CO than an adult in the same environment. Also, children can be more difficult to evaluate since they can not describe their symptoms. Some people may not suspect that CO poisoning is occurring until major symptoms appear. Carbon-monoxide poisoning can mimic gastroenteritis (nausea and vomiting). Other manifestations may cause what appears to be a neurological or psychiatric disorder. High risk groups include infants, the elderly, pregnant women, and anyone with a previous history of cardiac insufficiency or chronic obstructive pulmonary disease or COPD. Lay and Professional Treatment One of the most important considerations in the treatment of carbon monoxide exposure victims is the immediate recognition of the problem. Once suspected or detected, the following action can be taken by anyone:   ●Move the victim(s) to fresh air;   ●Activate the Fire/Emergency Medical Service System (EMS) by dialing 911;   ●Monitor victim(s) for respiratory problems;   ●Ventilate the affected area; Once arriving at the scene, it is recommended that Basic Life Support (e.g. Emergency Medical Technician (EMT)) personnel should:   ●Evaluate the victim(s) for respiratory tract irritation, bronchitis, or other respiratory ailments   ●Administer humidified 100 percent oxygen by tight-fitting face mask and assist ventilations as needed.   ●Monitor vital signs.   ●Monitor level of consciousness.   ●Consider early transport to a hyperbaric oxygen chamber for severely poisoned victims.   ●Place the victim in a position of comfort and keep them warm. Once arriving at the scene, it is recommended that advanced life support (e.g., paramedic) personnel should:   ●Further evaluate the respiratory tract for dysfunction or possible compromise � initiate advanced airway support and assist ventilation as needed.   ●Draw a blood sample for carboxyhemoglobin analysis.   ●Provide 100 percent humidified oxygen; do not delay administration of oxygen while performing blood sampling.   ●Administer normal saline or other crystalline parental fluids at two-thirds to three-quarters of normal maintenance rates.   ●Prepare for the possibility of generalized seizures in severe cases. Give diazepam (valium) in 2 to 10 mg doses to terminate and control seizure activity.   ●Perform electrocardiogram monitoring of the victim.   ●Any victim found unconscious, seizing, or with EKG changes and with an associated history should be treated as a severe carbon monoxide poisoning until proven otherwise.   ●Consider direct transport to a hyperbaric oxygen therapy facility with oxygen being administered in transit for severely poisoned victims.   ●If the victim's history suggests any possibility of CO Poisoning, treat him/her as if they were exposed. CO Detectors According to the state Department of Fire Services, on March 31, 2006, a new Massachusetts law took effect that, upon sale or transfer, every building or structure occupied for residential purposes that contains fossil fuel burning equipment, or incorporates enclosed parking within its structure, requires the installation of carbon monoxide (CO) detectors. CO detectors may be either: (1) battery powered, or (2) AC (alternating current) plug-in with battery backup using an outlet not controlled by a wall switch, or (3) AC hard-wired with a battery backup, or (4) low-voltage power system, or (5) a combination smoke/CO detector. Detectors must be located on each level of the dwelling including habitable portions of basements, cellars, or attics. CO detectors on a level with a sleeping area must be located within 10 feet of any bedroom door. Before any residence may be sold or transferred, the dwelling unit must be equipped with smoke and carbon monoxide detectors and an inspection of the detectors must be made by the fire department and a certificate of compliance issued. When a CO Detector Sounds If no one is feeling ill:   ●Silence the alarm.   ●Turn off all appliances and sources of combustion (i.e. furnace and fireplace).   ●Ventilate the house with fresh air by opening doors and windows.   ●Call the fire department by dialing 911 to investigate the source of the possible CO buildup. Toronto Study Scientists at the Toronto General Hospital announced an effective and simple way of "speeding up" the removal of carbon monoxide from the body. The treatment can be applied by paramedics even before a patient arrives at a hospital. Information from the original news release about the study is reported below: A new treatment for carbon monoxide poisoning may save thousands of lives around the world. This treatment helps victims of carbon monoxide exposure to eliminate the poison from their bodies faster than the current treatment. In a paper published in the American Journal of Respiratory and Critical Care Medicine, Toronto General Hospital researchers describe a simple new way of speeding up the elimination of carbon monoxide, which can be applied by paramedics even while en route to a hospital. The only currently available emergency treatment for carbon monoxide poisoning is giving the patient 100 percent oxygen. A recently developed a device that greatly increases the rate of carbon monoxide elimination is very easy to apply to patients no matter where they are. The device is easily portable, and consists of a few simple additions to the oxygen mask and oxygen tank found in every ambulance. When treating CO poisoning, oxygen is administered via a standard facemask placed on a patient. However, members of the study team found that adding a simple mechanical device which provides a mixture of oxygen and carbon dioxide in a specific way to the mask markedly increases the rate of carbon monoxide elimination. The device is so simple that it can be assembled from a few components available in any SCUBA diving store. The novel treatment has been compared to conventional treatment with 100 percent oxygen in seven men who volunteered for the study. The volunteers were first exposed briefly to carbon monoxide and then received either the conventional treatment or the new treatment. They then returned for a second session and were treated with the other treatment and the rates of carbon monoxide elimination were then compared. The new treatment increased the rate of carbon monoxide elimination by up to three times. The study's team has since confirmed these results with additional tests. A study from the University of Washington in Seattle presented last month at the American Thoracic Society conference in Toronto also confirmed the efficacy of the method. Most ambulance services across the Commonwealth continue to render conventional treatment modalities, as outlined in their specific local and statewide treatment protocols. To my knowledge, no study, like the one listed above, is currently being conducted in the Berkshire County area. Prevention and Conclusion Many lives could be saved and disability prevented if citizens could learn to recognize and prevent the dangers of carbon monoxide poisoning. Preventive efforts such as checking furnace flues, chimneys, and vents could help to alleviate the hazard. The use of good common sense in not using open flames, ovens and other appliances not intended for heating could greatly reduce the number of carbon-monoxide related incidents. It is also recommended that homeowners have their complete heating systems checked before every heating season and install CO alarms in accordance with the Massachusetts General Law regarding carbon monoxide detection. Sources: Los Angeles Fire Department: www.LAFD.com Massachusetts Department of Fire Services: www.mass.gov Occupational Safety & Health Administration: www.osha.org Postgraduate Medicine Online: www.postgradmed.com
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Humane Society Pups Go Downtown in Forever Home Search

By Brittany PolitoiBerkshires Staff

Simone Olivieri, a canine adoption counselor, and Family Dog School instructor Tricia Phillips say the outing is to raise awareness of National Adopt a Shelter Pet Day — and to give Starr and Beethoven a fun outing. 

PITTSFIELD, Mass. — Adoptable pups Beethoven and Starr took a stroll down North Street on Tuesday with hopes of finding forever homes on National Adopt a Shelter Pet Day.

"Pittie smiles" were all around as the 6-year-old siblings sniffed their way down the sidewalk with Berkshire Humane Society staff members. The brindle-coated beauties are cuddle bugs who would like a home — either separate or together — with a comfy couch to lay on and a few good walks a day.

"There are a lot of animals in the shelter right now but there's a lot of dogs," Director of Development and Marketing Nikki Kellogg said.

"People seem to be gravitating towards the cats, there are more cat adoptions so we'd like to get more exposure to the dogs so that people realize that dogs are available for adoption, stop down and see what we have, give a dog a second chance to come home, and just trying to give them exposure and get them out of the shelter for enrichment."

Beethoven, a male, and Starr, a female, are large-sized American pit bull mixes and have been at Berkshire Humane Society since late March. Beethoven could potentially live in a home with another male dog and Starr would do best as the only animal.  

They have lived with children before and could potentially go to a home with kids older than 10.

"They are also good candidates for coming out and bringing everybody and being in this environment away from the shelter because they are so good with people," canine adoption counselor Simone Olivieri said, adding that they have been great with their routine at the shelter.

With a change in diet, their coats have become soft and shiny, the blonder hues highlighted by the sun.

Every day, the lights are dimmed at the facility for an hour and 15 minutes for a nap time when all of the pups are given chew toys and a break from visitors. This has been beneficial for the brother and sister duo.

"The reason is to give them a break so they can rest and nap the same way that toddlers need to nap," Olivieri said.

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