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
If you would like to contribute information on this article, contact us at info@iberkshires.com.
Your Comments
iBerkshires.com welcomes critical, respectful dialogue. Name-calling, personal attacks, libel, slander or foul language is not allowed. All comments are reviewed before posting and will be deleted or edited as necessary.
Your articles are always thorough and informative. I enjoy reading them and often learn things I did not know. ;) (What does that strange symbol in the text mean?)
Shawn the info no this article was grea. A lot of older people sometimes have trouble with their expenses and can't afford a CO detector which can be deadly. Thanks for all the articles over the past year and keep up the writing. Until next week and THANKS again...
Lanesborough Town Meeting to Vote Budget, Bylaws & Vehicle Purchases
By Breanna SteeleiBerkshires Staff
LANESBOROUGH, Mass. — Tuesday's annual town meeting includes a $14 million operating budget, new short-term rentals, accessory dwelling units and sign bylaws, and free cash article appropriations.
Voters will gather at Lanesborough Elementary School on June 9 at 6 p.m. to decide on 20 warrant articles.
The fiscal 2027 budget is up a little over 10 percent. Some of the main increases are the Mount Greylock Regional School District and McCann Technical School: the McCann assessment is up more than 30 percent based on factors including enrollment and the school renovation project, and Mount Greylock's is up 11 percent.
Article 11 is for the town to vote to approve from free cash the sum of $16,298.48 for the McCann Technical School roof and window replacement project so as not to impact the budget. Article 3 is appropriate $7,586,284 for Mount Greylock Regional School assessment.
Another notable increase was in life and health insurance, showing an increase of about 26 percent.
Ambulance Director Jen Weber is planning 24-hour coverage, which means more staff and a hike in her budget. One of the articles asks the town to appropriate $234,100 to operate the Ambulance Enterprise Fund for salaries and expenses.
Many town departments are looking for new vehicles. The Fire Department is looking to replace its outdated 1996 fire engine. There are two articles related to the truck at a total of $813,366. Article 12 would transfer $225,000 from free cash into the Fire Truck Stabilization Fund; Article 13 would transfer $605,000 from the fund and authorize the borrowing of $208,366.08.
The total includes a $100,000 contingency cost to cover any additional costs if a 2026 model-year chassis cannot be secured before new emissions standards go into effect in 2027.
The board at its last meeting moved the $225,000 transfer to come before the borrowing article, changing the stabilization number. If the $225,000 is not voted on, then they will amend the next article's number on the floor, subtracting the $225,000. This shows the borrowing number significantly lower.
Article 17 asks for the transfer of $80,000 from free cash to replace a police cruiser.
Police Chief Rob Derksen's aim is to replace one vehicle every other year, meaning the oldest vehicle gets replaced about every 10 years.
He stressed that if delayed this year, the town may have to double up in a future year to get back on schedule, and that paying later usually costs more. The article will ask for $80,000 from free cash, the vehicles used to be funded by the BHRD.
Lastly, the Highway Department is looking to replace a 2014 International dump truck that will be a total of $330,000 and will take two to three years to receive.
Money will be used from last year's approval of $250,000 from free cash for the replacement of a 2012 highway front-end loader that was underspent $49,261. Town meeting is being asked to approve a transfer of $53,274.85 from free cash and the use of $227,464 from funds from the Sale of Town Real Estate to fund the balance.
Other free cash proposals include $1,200 to purchase software to support tracking and ongoing maintenance schedules of town-owned vehicles; $42,000 for the replacement of the Highway Department's storage shed roof, $200,000 to reduce the tax levy.
Cassidy Flynn scattered five hits in a complete-game effort in the circle as Lenox upset top-seeded Hoosac Valley, 3-2, in the quarter-finals of the Division 5 State Tournament. click for more
Brayden Durant struck out seven and walked one in a complete-game effort on the mound Saturday to pitch the Drury baseball team to a 6-0 win over Keefe Tech in the quarter-finals of the Division 5 State Tournament at Joe Wolfe Field. click for more
Jason Codey struck out 13, walked two and allowed just an infield single as the Generals earned a 7-1 win over Wahconah to claim their third straight regional title. click for more
Gracelyn Wright struck out eight, and Genevieve Lagess went 3-for-5 with four runs batted in as the Hurricanes beat Monson, 17-3, to claim their first Western Mass title in four years. click for more
For the boys, Ward Bianchi helped lead the way with a win in the shot put and a second place in the javelin as the Mounties finished 16 points ahead of runner-up Pittsfield (pending the results of the pole vault, which were unavailable at 11 p.m. Friday night). click for more
