Carbon monoxide exposed patients commonly present with nonspecific symptoms that mimic influenza-like illnesses (Table 1). Symptoms typically include headache, dizziness, nausea, vomiting, weakness, and fatigue . The most common symptom reported is headache . Because these symptoms are so nonspecific, the treating physician must retain a high level of suspicion for carbon monoxide poisoning as delays in recognition and treatment are common .
Carbon monoxide is a colorless, tasteless, and odorless gas. It is one of the leading causes of injury and death worldwide. Based on death certificate data, mortality from unintentional, non-fire-related carbon monoxide exposures results in an average of 439 deaths each year in the United States. However, with improved data collection through the Center for Disease Control, estimates may be closer to 2,000 deaths per year. In 2014, the National Poison Data System listed gases/fumes/vapors as the leading cause of death in children five years old or less. Furthermore, carbon monoxide poisoning results in more than 200,000 emergency department visits per year and more than 20,000 hospital admissions.
Carbon monoxide (CO) originates from incomplete combustion of carbon-containing materials. Common external exposure sources include house fires, automobile exhaust, ice resurfacing machines, furnaces, burning of charcoal, wood, and natural gas for heating or cooking, propane-powered equipment, and methylene chloride paint stripper.
Another major source of CO is cigarette smoking. Average carboxyhemoglobin levels (COHb) of 3 .0%–7 .7% are found in heavy cigarette smokers, compared to 1 .3%–2 .0% in nonsmokers.
Carbon monoxide poisoning can occur occupationally (i.e. firefighters, ice resurfacing machine or forklift operators), unintentionally, and as a means of suicide. The incidence of carbon monoxide poisoning increases during power outages caused by natural disasters. Interestingly, since the introduction of the Clean Air Act in 1970, the mortality rate from motor vehicle–related CO poisoning has declined. Carbon monoxide is also produced endogenously through the degradation of hemoglobin by heme oxidase, resulting in detectable carboxyhemoglobin levels in nonexposed individuals.
In industry, the major factor for carbon monoxide exposure is inadequate ventilation where propane-powered vehicles are used. Exposures from forklifts and ice resurfacing machines have been reported. Other work environments that produce large amounts of CO, and therefore heighten the risk of poisoning, are the steel industry, due to coke ovens, and the paint industry, in which inhaled methylene chloride (dichloromethane) is metabolized to CO by the liver. Firefighters and other first responders are also at increased risk for CO poisoning from smoke inhalation and from entering environments with elevated CO levels unknowingly.
Men have higher rates of death from carbon monoxide poisoning, presumably due to higher risk behaviors and environments. The elderly (age ≥ 65) are also at increased risk for death from CO poisoning as they are more likely to dismiss symptoms as being caused by underlying medical conditions more prevalent in this population.
Women and children, however, are more likely to be exposed to carbon monoxide, and most exposures occur in the winter months (November to February).
Source Reference: Excerpted from Hyperbaric Medicine Practice 4th Edition with permission from the publisher. Reference Chapter 13, Carbon Monoxide by Jillian Theobald
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In this third and final installment of How Accidents Happen we continue looking at personnel & management as contributing factors in hyperbaric facility accidents.
In this installment of How Accidents Happen we continue looking at personnel & management as contributing factors in hyperbaric facility accidents.
When one commences a task to reconstruct how an accident happened, personnel and management factors are often “at the head of the class.” Some of the more commonly occurring factors are discussed in this section. It should be noted, however, that this list is not all-inclusive. The factors that can contribute to accidents are many and varied. As technology and operations become ever more complex, our ability to create new ways to “do ourselves in” are amazing.
For some accidents there is a clear “smoking gun.” However, most accidents are caused by a combination of factors, each of which contributes in some manner. Often these factors accumulate over some period of time preceding the accident. This chapter addresses the factors that foster conditions under which accidents are more likely to happen and discusses some of the steps to be taken to avoid them. Also included is a case history illustrating several of the factors.
Type of Acrylic Windows used in Hyperbaric Multiplace and Monoplace Chambers
In today’s clinical and diving hyperbaric chambers, acrylic windows with PVHO-1 defined standard geometries and design criteria are used.1 Acrylic window shapes vary with chamber type and the window requirement of the specific chamber type.
Determining the best interventions, including dressing selection, for patients and their wounds requires looking at the situation holistically. Creating the treatment plan for a chronic wound is dependent upon many diverse patient, wound, economic, and social considerations. The dressing selection goes beyond simply choosing a product to cover the wound. Detailed assessments of the patient and wound should drive the components of goal-directed wound care. The health-care provider must determine the etiology of the wound, patient comorbidities that may impair the wound healing processes (e.g. diabetes and blood glucose levels), nutrition/hydration status, systemic and local tissue oxygenation, and patient/family concerns such as pain and odor issues. Each of these factors contributes to creating an individualized plan of care for choosing the most appropriate products and interventions.
Analysis of hyperbaric facility risks is a difficult process. It begins with identifying the hazards in a hyperbaric facility. These hazards could be from a variety of sources: equipment related (e.g. loss of power, loss of gas supply, control system malfunction); operational (e.g. untrained or unprepared staff); medical (e.g. pressure injuries, medical complica- tions); and environmental (e.g. contaminants, external disaster). The actual risks associated with a hazard depend on the probability, frequency, and severity of the potential losses.
Hyperbaric emergency procedures usually address a variety of problems ranging from mechanical malfunction to medical complications—important events that do not seem to share a common trait but cover a wide range of situations. Such a variable group of events must be discussed in a broad context. This chapter will discuss emergency pro- cedures within the framework of the entire hyperbaric safety program. In this broader context, events that may or may not be emergencies belong together. That is why this dis- cussion will replace the term “emergency procedure” with the term “contingency plan.”