Mass Casualty Triage in the Case of Carbon Monoxide Poisoning: Lessons Learned

2017 ◽  
Vol 12 (3) ◽  
pp. 373-378
Author(s):  
Mathieu Pasquier ◽  
Fabrice Dami ◽  
Pierre-Nicolas Carron ◽  
Bertrand Yersin ◽  
Rodrigue Pignel ◽  
...  
Keyword(s):  
Public Health ◽  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Treatment Options ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Major Incident ◽  
Diagnostic Tools ◽  
Co Poisoning ◽  
Triage Algorithm

ABSTRACTCarbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373–378)

scholarly journals Predictive Role of QTc Prolongation in Carbon Monoxide Poisoning-Related Delayed Neuropsychiatric Sequelae

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Shu-Chen Liao ◽  
Yan-Chiao Mao ◽  
Yao-Min Hung ◽  
Ching-Hsing Lee ◽  
Chen-Chang Yang
Keyword(s):  
Carbon Monoxide ◽  
Roc Curve ◽  
Carbon Monoxide Poisoning ◽  
Chang Gung Memorial Hospital ◽  
Qtc Interval ◽  
Continuous Variables ◽  
Co Poisoning ◽  
Qtc Prolongation ◽  
Roc Curve Analysis ◽  
Delayed Neuropsychiatric Sequelae

Objective. Delayed neuropsychiatric sequelae (DNS) are serious complications of carbon monoxide (CO) poisoning that adversely affect poisoned patients’ quality of life as well as socioeconomic status. This study aimed to determine clinical predictors of DNS in patients with CO poisoning. Methods. This retrospective study included all CO-poisoned patients admitted to the emergency department (ED) of Linkou Chang Gung Memorial Hospital in Taiwan from 1 January 2009 to 31 December 2015. The medical records of all patients with CO poisoning were carefully reviewed, and relevant data were abstracted into a standardised form. Univariate and multivariate logistic regression models were used to identify predictors of DNS after CO poisoning. Receiver operating characteristic (ROC) curve analysis was used to determine the ideal cut-off value for continuous variables that predict the development of DNS. Results. A total of 760 patients with CO poisoning were identified during the study period. Among them, 466 were eligible for the analysis of predictors of DNS. In multivariate analysis, Glasgow Coma Scale <9 (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.21–6.21), transient loss of consciousness (OR, 3.59; 95% CI, 1.31–9.79), longer duration from CO exposure to ED presentation (OR, 1.05; 95% CI, 1.03–1.08), and corrected QT (QTc) prolongation (OR, 2.61; 95% CI, 1.21–5.61) were found to be associated with a higher risk of DNS. The area under the ROC curve (AUC) for QTc interval measured within 6 h after exposure best predicted the development of DNS, with a result of 0.729 (95% CI 0.660–0.791). Moreover, the best cut-off value of the QTc interval was 471 ms, with a sensitivity of 53.3% and a specificity of 85.1%. Conclusions. We identified several potential predictors of DNS following CO poisoning. Among them, QTc prolongation found within 6 h after exposure is a novel predictor of DNS, which may be helpful in the future care of patients with CO poisoning.

Brain stem and spinal cord demyelination due to acute carbon monoxide poisoning

2021 ◽  
pp. 247-253
Author(s):  
Yan Lv ◽  
Yv Zhang ◽  
Shuyi Pam ◽  
Keyword(s):  
Spinal Cord ◽  
Carbon Monoxide ◽  
Brain Stem ◽  
Carbon Monoxide Poisoning ◽  
Recovery Period ◽  
Extended Period ◽  
Severe Case ◽  
Co Poisoning ◽  
Secondary Demyelination ◽  
The Brain

Demyelination throughout the brain stem and spinal cord caused by acute carbon monoxide (CO) poisoning has not been previously reported. Magnetic resonance imaging (MRI) has revealed that acute CO poisoning primarily affects the subcortical white matter of the bilateral cerebral hemispheres and basal ganglia. Here we report the case of a patient with delayed neuropsychological sequelae (DNS) due to acute CO poisoning. A 28-year-old man was admitted to our department following a suicide attempt by acute CO poisoning. After a six-month pseudo-recovery period, he was diagnosed with DNS, with MRI evidence of demyelinating change of the bilateral cerebral peduncles. Demyelination was identified throughout the brain stem, expanding from the bilateral cerebral peduncles to the medulla oblongata, occurring approximately six months after poisoning. One and a half years after acute CO poisoning, demyelination of the cervical and thoracic spine was observed, most notable in the lateral and posterior cords. It is evident that previously published research on this topic is extremely limited. Perhaps in severe cases of acute CO poisoning the fatality rate is higher, leading to fewer surviving cases for possible study. This may be because a more severe case of acute CO poisoning would result in the higher likelihood of secondary demyelination. This research indicates that clinicians should be aware of the risk of secondary demyelination and take increased precautions such as vitamin B supplementation and administration of low-dose corticosteroids for an extended period of time in order to reduce the extent and severity of demyelination.

Epidemiological aspects and a current approach to the problem of carbon monoxide poisoning

2020 ◽  
Vol 6 (4) ◽  
pp. 4-9
Author(s):  
Sayit I. Indiaminov ◽  
Antonina A. Kim
Keyword(s):  
Carbon Monoxide ◽  
World Literature ◽  
Carbon Monoxide Poisoning ◽  
Epidemiological Data ◽  
Current Approach ◽  
Co Poisoning ◽  
Fatal Poisoning ◽  
Young Males ◽  
Causes Of Mortality ◽  
Mechanical Asphyxia

Background: Carbon monoxide (CO) poisoning is the leading cause of death from poisoning (accidental and intentional). The number of cases of CO poisoning is increasing day by day. Aims: The aim of the study was to analyze the epidemiological situation of CO poisoning and identify the urgent aspects of this problem. In the article, the author provided a retrospective analysis of 117 cases of CO poisoning, registered in a number of regional branches of the Republican Scientific and Practical Center of the Forensic Medical Examination of Uzbekistan, after he studied and analyzed the world literature on the epidemiology of CO poisoning. It has been revealed that fatal poisoning ranks third after mechanical injuries and mechanical asphyxia and constitutes 6.3% (513 cases) in the range of deaths by violence (8078 cases). Therefore, CO poisoning is considered as one of the most prevailing (51%) causes of mortality. Conclusion: This is a global problem, with young males at risk. Further studies on the current clinical and forensic aspects of CO poisoning are required, and the necessity for regular analysis of epidemiological data for taking comprehensive measures to prevent CO poisoning is emphasized.

scholarly journals Carbon Monoxide Poisoning Effectively Treated with High-flow Nasal Cannula

2019 ◽  
Vol 4 (1) ◽  
pp. 42-45
Author(s):  
Patrick Lee ◽  
Steven Salhanick
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
High Flow ◽  
Nasal Cannula ◽  
The Novel ◽  
Co Poisoning ◽  
High Flow Nasal Cannula ◽  
Disease States ◽  
Cohb Level ◽  
Potential Option

Carbon monoxide (CO) poisoning is typically treated by administration of oxygen via non-rebreather mask (NRB). High-flow nasal cannula (HFNC) is an alternative to NRB in a variety of disease states. We report a case of the novel use of HFNC in the treatment of acute CO poisoning. A 29-year-old man presented with a carboxyhemoglobin (COHb) level of 29.8%. He was treated with HFNC, and COHb levels declined to 5.4% in 230 minutes. Given several theoretical advantages of HFNC relative to NRB, HFNC is a potential option for use in the treatment of CO poisoning.

scholarly journals A Century of Change towards Prevention and Minimal Intervention in Cariology

2019 ◽  
Vol 98 (6) ◽  
pp. 611-617 ◽  
Author(s):  
N.P.T. Innes ◽  
C.H. Chu ◽  
M. Fontana ◽  
E.C.M. Lo ◽  
W.M. Thomson ◽  
...  
Keyword(s):  
Public Health ◽  
Dental Caries ◽  
Social Inequalities ◽  
Disease Risk ◽  
Dental Health ◽  
Treatment Options ◽  
Diagnostic Tools ◽  
Management Options ◽  
Surgical Specialty ◽  
Minimal Intervention

Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature—coupled with limited diagnostic tools and therapeutic treatment options—meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession’s move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession’s greatest challenge is moving this evidence into practice.

Evaluation of oxidative stress and antioxidant parameters in children with carbon monoxide poisoning

2019 ◽  
Vol 38 (11) ◽  
pp. 1235-1243
Author(s):  
O Teksam ◽  
S Sabuncuoğlu ◽  
G Girgin ◽  
H Özgüneş
Keyword(s):  
Oxidative Stress ◽  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Venous Blood ◽  
Treatment Modalities ◽  
Control Group ◽  
Co Poisoning ◽  
Erythrocyte Catalase ◽  
Significant Difference ◽  
Before And After

Objective: In this study, we aimed to investigate oxidative stress and antioxidant parameter levels in patients with carbon monoxide (CO) poisoning. Methods: The study was conducted prospectively between March 1, 2015 and April 30, 2016 in the pediatric emergency department. Eligible patients included children aged 0–18 years old with a diagnosis of CO poisoning. To determination of oxidative stress and antioxidant parameter levels, venous blood with heparinized and urine samples were drawn during the admission and after normobaric oxygen (NBO) and hyperbaric oxygen (HBO) treatment. Results: Forty-seven children with CO poisoning for study group and 29 patients as control group were included to the study. Sixteen patients treated with HBO. Basal plasma malondialdehyde levels were found to be significantly higher in the CO poisoning group when compared with the control group ( p = 0.019). There is no significant difference in oxidative stress and antioxidant parameter levels except erythrocyte catalase enzyme levels in patients treated with NBO when comparing before and after NBO treatment ( p > 0.05). Decreasing of basal erythrocyte catalase enzyme levels were found statistically significant after NBO treatment ( p = 0.04). There was no significant difference in oxidative stress and antioxidant parameter levels in patients treated with HBO before and after therapy ( p > 0.05). Conclusions: CO poisoning is associated with increased lipid peroxidation in children immediately after the poisoning. However, both treatment modalities including NBO or HBO do not have a significant effect on oxidative stress or antioxidant parameter levels.

scholarly journals Storm-Related Carbon Monoxide Poisoning

2013 ◽  
Vol 19 (3) ◽  
pp. 188-199 ◽  
Author(s):  
Scott A. Damon ◽  
Jon A. Poehlman ◽  
Douglas J. Rupert ◽  
Peyton N. Williams
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
The United States ◽  
Attitudes And Beliefs ◽  
Matrix Approach ◽  
Co Poisoning ◽  
Protective Behaviors ◽  
Home Safety ◽  
Severe Storms ◽  
Summer Storm

Carbon monoxide (CO) poisonings in the United States consistently occur when residents improperly use portable gasoline-powered generators and other tools following severe storms and power outages. However, protective behaviors—such as installing CO alarms and placing generators more than 20 feet away from indoor structures—can prevent these poisonings. This study identified knowledge, attitudes, and beliefs that lead consumers to adopt risk and protective behaviors for storm-related CO poisoning and post-storm generator use. Four focus groups (32 participants in total) were conducted with generator owners in winter and summer storm-prone areas to explore home safety, portable generator use, CO poisoning knowledge, and generator safety messages. Discussions were transcribed, and findings analyzed using an ordered meta-matrix approach. Although most generator owners were aware of CO poisoning, many were unsure what constitutes a safe location for generator operation and incorrectly stated that enclosed areas outside the home—such as attached garages, sheds, and covered porches—were safe. Convenience and access to appliances often dictated generator placement. Participants were receptive to installing CO alarms in their homes but were unsure where to place them. These findings suggest a deficit in understanding how to operate portable generators safely and a need to correct misconceptions around safe placement. In terms of behavioral price, the simple installation and maintenance of inexpensive CO alarms may be the most important strategy for ultimately protecting homes from both storm-related and other CO exposures.

Carbon Monoxide Poisoning: Implications for Patient and Family Care in the Emergency Department

2008 ◽  
Vol 1 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Courtney E. Reinisch
Keyword(s):  
Emergency Department ◽  
Carbon Monoxide ◽  
Practice Nurse ◽  
Early Recognition ◽  
Carbon Monoxide Poisoning ◽  
Family Care ◽  
The United States ◽  
Emergency Department Visits ◽  
Advanced Practice ◽  
Co Poisoning

Carbon monoxide (CO) is a colorless, odorless gas that can produce a constellation of noxious symptoms and potentially death when it reaches certain levels. Exposure to CO can be intentional (suicidal) or unintentional (accidental). CO poisoning is responsible for up to 40,000 to 50,000 emergency department visits and 5,000 to 6,000 deaths per year, making it one of the leading causes of poisoning death in the United States. When patients present to the emergency department with a constellation of symptoms, the advanced practice nurse should include environmental exposure in the differential diagnosis. This is especially important when family members present with similar complaints, such as headache or euphoria. Early recognition of CO poisoning is vital to identify individuals in need of prompt treatment and to prevent harmful and potential deadly exposure to others. Since patients often present with constitutional symptoms, including headache (most common), malaise, nausea, and dizziness, providers need to be cautious not to misdiagnose patients as having acute viral syndromes where CO poisoning could be the cause. Vigilance is needed during the winter months in cold climates when unintended poisoning is most common.

Major Incident Experience and Preparedness in a Developing Country

2013 ◽  
Vol 7 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Hesam Seyedin ◽  
Rouhollah Zaboli ◽  
Hamid Ravaghi
Keyword(s):  
Public Health ◽  
Positive Impact ◽  
Lessons Learned ◽  
Major Incident ◽  
Incident Management ◽  
Semistructured Interview ◽  
Framework Analysis ◽  
Health Organizations ◽  
Research Software ◽  
Major Incidents

AbstractBackgroundResearch shows that having previous experience of major incidents has a positive impact on awareness and preparedness of organizations. We investigated the effects of major incident experience on preparedness of health organizations on future disasters in Iran.MethodsA qualitative study using a semistructured interview technique was conducted with 65 public health and therapeutic affairs managers. Analysis of the data was performed used the framework analysis technique, which was supported by qualitative research software.ResultsThe study found that prior experience of major incidents results in better performance, coordination, and cooperation in response to future events. There was a positive effect on policy making and resource distribution and an increase in (1) preparedness activities, (2) raising population awareness, and (3) improving knowledge. However, the preparedness actions were predominantly individual-dependent.ConclusionsOur findings showed that to increase system efficiency and effectiveness within health organizations, an appropriate major incident management system is needed. The new system can use lessons learned from previous major incidents to better equip health organizations to cope with similar events in the future. (Disaster Med Public Health Preparedness. 2013;7:313-318)

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