1. Spokane County EMS Carbon monoxide the invisible killer! Shaun Pitts SEI, AEMT

2. So what is CO you ask? Co is produced by burning fuel –Any fuel burning appliance has potential for CO gas Carbon monoxide –Odorless –Colorless –Gas That can cause sudden illness and death!

3. EMS and CO What role besides treatment does EMS play with dealing with CO dangers and poisoning? –Recognition –Education

4. Signs and symptoms Headache Fatigue Shortness of breath Nausea Dizziness Chest pain ALOC This is very hard to diagnose due to these symptoms mimicking a number of other illnesses.

5. So what about on scene clues? Can you give me some on scene clues that CO poisoning maybe be the cause of chief complaint? –Generators inside of home (don’t forget to check basement) –Charcoal grills used in an enclosed space

6. Scene Assessment

7. So how does it work? Red blood cells pick up CO quicker than they pick up oxygen If there is a lot of CO in the air your body may replace O2 with CO.

8. Well why not use your Spo2… An elevated CO level falsely elevates the SaO2 measurements from pulse oximetry. So the need to treat your patient and not your monitor is very important!

9. So who is at risk for poisoning by CO? EVERYONE! Animals (red flag) Certain groups higher risk –Unborn babies –Infants –Chronic heart disease PT –Anemic PT –PT with respiratory problems

10. Treatment Promptly remove the patient from continued exposure and immediately institute oxygen therapy with a nonrebreather mask. ALS: Perform intubation for the comatose patient or, if necessary for airway protection, and provide 100% oxygen therapy.

11. Specialty equipment If possible, obtain ambient CO measurements from fire department or utility company personnel, when present.

12. In hospital treatment

13. Patient #1 Medic 593 called out for an ill person at a local restaurant. –patient sitting in the back of a police car. LE tells you he had been driving erratically and ended up striking a parked car and trash can in the restaurant parking lot.

14. PT #1 cont. Patient is alert but very confused, complaining of a headache, nausea, vomiting, weakness and dizziness. The patient’s physical exam was normal, with no signs of trauma. Possible causes?

15. Causes Hypoglycemia? –232 Overdose? ETOH? –Can’t find anything to support that after searching the patient and his car Hypoxia? –94% room air Without equipment you may just transport treating for a unknown issue….

16. And cause! The patient had a CO level of 40% with a SpO2 of 94% The source of the CO was attributed back to a bad exhaust system on the vehicle the patient had been driving.

17. PT #2 Fire District 1 received an emergency call from two young children who said their mother had passed out.

18. Scene On arrival the children send you to the upstairs bathroom where we found the mother unconscious but breathing, with signs of seizure activity. Causes?

19. Once in the room…. One of the firefighters/paramedics noted a faint odor of exhaust. After 5 minutes in the house, other firefighters started to complain of headaches. So now what? Don’t forget to take the kids!

20. Searching crew searched the house and discovered a running car inside the closed garage, directly below the upstairs bedroom. Initial CO reading was 80% –During transport patient’s CO level had dropped to 37% Remove patient is always step 1!

21. Is it so easy? The treatment for CO poisoning in the field is oxygen. That’s the easy part. It is a matter of detection. Can you tell if it is food poisoning, the flu, a headache or is it actually CO poisoning?

22. Conclusion Education Recognition Evacuation Evaluation

23. Question 1 Carbon monoxide, or CO, is an odorless, colorless gas that can cause sudden illness and death. –True –False TRUE

24. Question 2 What are the symptoms of CO poisoning? –Headache –Dizziness –Chest pain –All of the above ALL OF THE ABOVE

25. Question 3 Red blood cells pick up oxygen quicker than CO. –True –False FALSE

26. Question 4 You can get CO poisoning from use charcoal grills in an in closed space. –True –False TRUE

27. Question 5 How far away should a portable generator be away houses? –1ft –5ft –As far away as possible and make sure it is not near any open doors or windows –3ft AS FAR AWAY AS POSSIBLE!

28. Secret question Name this molecule that is trying to bind with the RBC.

29. Special thanks to Sheila Crow Stitchin’ Dreams Embroidery wcsocrow@yahoo.com For providing our Secret Question prize

30. Questions? Contact: Samantha Roberts 509-242-4264 1-866-630-4033 robertss@inhs.org Fax: 509-232-8344

31. Updates Please EMS Live@Nite presentation, all certificates will be printed by participants or their agency. The certificate template will be available through the health training website at the same location as all presentation downloads. It will be posted the day after each monthly presentation.

34. Answer Oxygen!