Carbon monoxide poisoning
Terms in this set (21)
Inhalation of dangerous amounts of carbon monoxide (CO), a colorless, odorless, tasteless gas that usually results from the combustion of carbon-containing materials
Can be unintentional or intentional (as with suicide)
Also results from inhalation of methylene chloride vapors, a chemical found in industrial chemicals and solvents (paint thinners and removers); converted in the liver to carbon monoxide through dermal absorption, inhalation, or ingestion
The lungs rapidly absorb CO after inhalation.
CO is rapidly diffused across the alveoli and picked up on hemoglobin.
CO has a high affinity for hemoglobin, reversibly binding with hemoglobin and resulting in the formation of carboxyhemoglobin.
Subsequently, oxygenation is impaired and the oxygen-hemoglobin dissociation curve shifts to the left, leading to tissue hypoxia.
CO binds to cardiac myoglobin resulting in cardiac depression and hypotension also contributing to further tissue hypoxia.
CO also rapidly binds to cytochrome C oxidase in the cell, causing toxicity to the mitochondria, inhibiting cellular respiration, and impairing mitochondrial and muscle function.
Inhalation (intentional or unintentional)
Confinement in a closed space with an improperly functioning heater, stove, or running engine
Occupation involving coal mining, auto repair, paint removal, or solvent use
Improper or inadequate venting of devices, such as kerosene heaters, camping stoves, gas-powered generators, and charcoal grills
CO poisoning can affect any age-group.
It's responsible for 5,000 to 6,000 deaths annually. Approximately 500 of these deaths are unintentional; the remaining deaths are intentional.
Dyspnea on exertion
Headache (most common)
Hypotension or hypertension
Cherry-red lips (not a reliable indicator) and skin or pallor
Papilledema; bright red retinal veins; flame-shaped retinal hemorrhages
Diagnostic Test Results-Laboratory
Carboxyhemoglobin levels are elevated.
Arterial blood gas (ABG) analysis reveals a normal or slightly decreased partial pressure of arterial CO2 and metabolic acidosis.
Troponin and creatine kinase levels may be elevated, reflecting myocardial ischemia that's commonly associated with CO exposure.
Complete blood count may reveal mild leukocytosis.
Serum potassium levels may be decreased and blood glucose levels may be elevated (in severe poisoning).
Urinalysis may be positive for albumin and glucose with chronic exposure.
Blood urea nitrogen and creatinine levels may be elevated secondary to myoglobulinuria.
Diagnostic Test Results-Imaging
Chest X-rays are usually normal.
Head computed tomography scanning may be used to identify neurologic complications.
Diagnostic Test Results-Diagnostic Procedures
Electrocardiography shows sinus tachycardia, arrhythmias due to hypoxia, and ischemia or infarction.
Removal from source of CO
Respiratory support, including endotracheal intubation and mechanical ventilation if indicated
Bed rest during the acute phase
As tolerated as condition improves
100% oxygen with a nonrebreather mask; hyperbaric oxygen therapy
I.V. fluid therapy as appropriate to restore volume
Nursing Considerations-Nursing Diagnoses
Impaired gas exchange
Ineffective peripheral tissue perfusion
Risk for ineffective cardiac perfusion
Risk for ineffective cerebral tissue perfusion
Risk for injury
Nursing Considerations-Expected Outcomes
maintain adequate ventilation and oxygenation
identify positive coping strategies
exhibit adequate peripheral tissue perfusion
maintain adequate cardiac output and hemodynamic stability
maintain adequate cerebral tissue perfusion
remain free from injury and complications.
Nursing Considerations-Nursing Interventions
Ensure immediate removal of the patient from the source of CO.
Administer 100% oxygen via a tight-fitting nonrebreather mask. Continue therapy until the patient is asymptomatic and carboxyhemoglobin levels fall below 10%.
Assist with endotracheal intubation and mechanical ventilation as appropriate.
Prepare the patient for hyperbaric oxygen therapy, as appropriate.
Institute continuous cardiac monitoring to evaluate for changes and development of arrhythmias.
Assess level of consciousness and neurologic status. Reorient the patient as necessary.
Help the patient use positive coping strategies.
Offer support and encourage the patient to express his feelings. Answer questions honestly. Provide consistent, clear explanations.
If exposure was intentional, arrange for counseling and institute a no-self-harm contract.
Obtain specimens for laboratory testing, such as ABG analysis, electrolyte levels, and carboxyhemoglobin levels.
Nursing Considerations-Associated Nursing Procedures
Arterial puncture for blood gas analysis
Blood pressure assessment
Carbon monoxide oximetry
Cardiac output measurement with iced injectate
IV bag preparation
IV bolus injection
IV catheter insertion
Intubation with direct visualization
Mechanical ventilation, positive pressure
Protective environment (PE) guidelines
Pulmonary artery pressure and pulmonary artery wedge pressure monitoring
12-lead electrocardiogram (ECG)
Urine glucose and ketone tests
Urine specimen collection, random
disorder, diagnosis, and treatment
the fact that recovery usually occurs in 4 to 8 weeks and that recurrence is very low
possibility of delayed neurologic complications
need to reduce physical activity for approximately 2 to 4 weeks
importance of smoking cessation
importance of adequate ventilation, especially when using fuel-burning devices or working with solvents or paint removers
positive coping strategies
use of home CO monitors
importance of maintaining regular follow-up care with a practitioner to monitor for resolution of the condition
importance of follow-up care for counseling as appropriate (if toxicity was intentional)
need for serial echocardiography to evaluate for improved function.
Patient Teaching-Discharge Planning
Refer the patient and family to local support services, as necessary, to assist with financial concerns.
Refer the patient for professional counseling or mental health care, as appropriate, if exposure was intentional.