Carbon monoxide poisoning in Jerusalem: epidemiology and risk factors
TL;DR: A retrospective descriptive analysis of patients with CO poisoning who presented to the Hadassah hospitals in Jerusalem from 1994 to 2006 found that males exposed to CO may have a more severe intoxication.
Abstract: Objectives. To describe the epidemiology of carbon monoxide (CO) poisoning in Jerusalem and identify risk factors for such poisoning. Design. A retrospective descriptive analysis of patients with CO poisoning who presented to the Hadassah hospitals in Jerusalem from 1994 to 2006. Patients. All patients with suspected CO poisoning were examined and those with confirmed cases [carboxyhemoglobin (COHb) level >5%] were included. Sources of exposure, seasonal variation, and demographic characteristics were analyzed. Results. There were 292 patients (49% males) with 40 family clusters that accounted for 149 patients (51%); 230 patients (79%) presented during the winter months. All but one had unintentional CO intoxication. The main sources of exposure were faulty gas heaters (n = 135), fire (n = 102), and other residential heating systems (n = 40). The estimated annual incidence of CO poisoning decreased from 6.45 per 100,000 in 1994–2000 to 3.53 per 100,000 in 2001–2006. High-risk intoxication (COHb level >25%...
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TL;DR: In this article, the emergency physician plays a unique role in the management of these patients, one that differs from that of the primary care physician, the neurologist, and other specialists Diagnostic nomenclature used in the ED is necessarily less specific, as care is more appropriately focused on the relief of symptoms and the identification of lifethreatening causes.
27 citations
TL;DR: The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions.
Abstract: Background Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England. Methods Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO and X47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26). Results There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colder winter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged .80 years. Conclusion The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight
26 citations
01 Jan 2009
TL;DR: The most frequently encountered pitfalls in the management of patients with headache in emergency medicine practice, and those with the greatest likelihood to adversely affect patient outcomes, are discussed.
Abstract: Headache, or cephalgia, is the fifth most common primary complaint of patients presenting to an emergency department (ED) in the United States, representing more than 3 million patients each year, or 2% of all ED visits. An additional number seek treatment at ambulatory care clinics, where diagnostic capabilities may be more limited. When headache coexists with certain other presenting signs and symptoms, such as alteration of mental status or hypoxia, these features may overshadow the headache and will likely direct the diagnostic and therapeutic approach. This article focuses on patients for whom headache is their most prominent presenting complaint. The role of the emergency physician (EP) is unique in the evaluation and treatment of headache, one that differs from that of the primary care physician, the neurologist, and other specialists. The EP has 2 major responsibilities: to relieve headache pain and to ensure that life-threatening and disabling underlying causes are uncovered and treated. As with other cardinal presentations, these 2 priorities are addressed simultaneously. Because most patients with headache are subsequently discharged home, appropriate follow-up planning and patient education are also important aspects of emergency care. The pitfalls that follow are those most frequently encountered in emergency medicine practice and those with the greatest likelihood to adversely affect patient outcomes.
21 citations
Dissertation•
20 Mar 2014
TL;DR: Un estudio epidemiologico de las intoxicaciones clinicas por monoxido de carbono plantea un estudios de concomitancia con otros toxicos, conocimiento de los profesionales de urgencias sobre las intoxicationes por CO.
Abstract: Se plantea un estudio de las intoxicaciones clinicas por monoxido de carbono con los siguientes objetivos: 1. Estudio epidemiologico de las intoxicaciones: distribucion por meses, dias de semana y hora. Evolucion anual. Relacion con numero de urgencias totales y con numero de intoxicaciones totales atendidas. 2. Perfil del paciente con intoxicacion por CO: edad, sexo, antecedentes personales, motivo de la intoxicacion, concomitancia con otros toxicos. 3. Constantes medicas al ingreso. 4. Manifestaciones clinicas presentadas en las intoxicaciones. 5. Niveles de COHb, correlacion con la clinica. Alteraciones gasometricas. 6. Alteraciones analiticas presentadas. 7. Toxicidad cardiologico: alteraciones ECG encontradas, marcadores de dano miocardico. 8. Toxicidad neurologica: manifestaciones clinicas, alteraciones en TAC. 9. Tratamiento administrado en el Servicio de Urgencias. Intervalo de tiempo hasta inicio de tratamiento (calidad). 10. Presencia de Sindrome Neurologico Tardio: incidencia, intervalo lucido, clinica presentada, secuelas. 11. Origen de la intoxicacion por CO. Medidas preventivas aplicadas en los lugares de intoxicacion 12. Conocimiento de los profesionales de urgencias sobre las intoxicaciones por CO. 13. Intoxicaciones inadvertidas por CO.
12 citations
Cites background from "Carbon monoxide poisoning in Jerusa..."
...180 Intoxicaciones advertidas y ocultas por monóxido de carbono En relación al género, 34 de nuestros pacientes eran hombres y 35 mujeres, cifras similares a las descritas en la literatura (22,31)....
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...Diversos estudios apuntan también al predominio de las intoxicaciones graves y con ingreso hospitalario entre los varones (23,31)....
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TL;DR: Measurement of TBCO by AGS-GC-MS suggests the presence of more dissolved CO than previously known, which might help explain the incongruences with symptoms and decrease misdiagnoses.
Abstract: As one of the most abundant toxic contaminants in the atmosphere, carbon monoxide (CO) plays a significant role in toxicology and public health. Every year, around half of the accidental non-fire-related poisoning deaths are attributed to CO in the USA, UK and many other countries. However, due to the non-specificity of the symptoms and often encountered inconsistency of these with the results obtained from measurements of the biomarker for CO poisonings, carboxyhemoglobin (COHb), there is a high rate of misdiagnoses. The mechanism of toxicity of CO includes not only the reduced transport of oxygen caused by COHb but also the impairment of cellular respiration and activation of oxidative metabolism by binding to other proteins. Therefore, in this study we propose the measurement of the total amount of CO in blood (TBCO) by airtight gas syringe-gas chromatography-mass spectrometry (AGS-GC-MS) as an alternative to COHb for the determination of CO exposures. The method is validated for a clinical range with TBCO concentrations of 1.63-104 nmol/mL of headspace (HS) (0.65-41.6 μmol/mL blood). The limit of quantification was found between 2 and 5 nmol/mL HS (0.8 and 2 μmol/mL blood). The method is applied to a cohort of 13 patients, who were exposed to CO under controlled conditions, and the results are compared to those obtained by CO-oximetry. Furthermore, samples were compared before and after a "flushing" step to remove excess CO. Results showed a significant decrease in TBCO when samples were flushed (10-60%), whereas no constant trend was observed for COHb. Therefore, measurement of TBCO by AGS-GC-MS suggests the presence of more dissolved CO than previously known. This constitutes a first step into the acknowledgment of a possibly significant amount of CO present not in the form of COHb, but as free CO, which might help explain the incongruences with symptoms and decrease misdiagnoses.
11 citations
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TL;DR: The authors present a case of acute carbon monoxide (CO) poisoning, with associated cerebral, spinal and peripheral nerve lesions, and the spinal cord lesion is of hemorrhagic type as shown by MRI.
Abstract: Carbon monoxide intoxication continues to be one of the most common causes of morbidity due to poisoning in the United States.1,2 It may be intentional or accidental, and exposure may be lethal. Approximately 600 accidental deaths due to carbon monoxide poisoning are reported annually in the United States,3 and the number of intentional carbon monoxide–related deaths is 5 to 10 times higher.1 The rate of accidental death caused by carbon monoxide from motor vehicles is higher in the northern United States and peaks during the winter months.4 The intentional deaths occur year-round without significant peaks.1 The severe winter of . . .
815 citations
TL;DR: Carbon monoxide intoxication continues to be one of the most common causes of morbidity due to poisoning in the United States as discussed by the authors, and it may be intentional or accidental, and exposure may be lethal.
Abstract: Carbon monoxide intoxication continues to be one of the most common causes of morbidity due to poisoning in the United States.1,2 It may be intentional or accidental, and exposure may be lethal. Approximately 600 accidental deaths due to carbon monoxide poisoning are reported annually in the United States,3 and the number of intentional carbon monoxide–related deaths is 5 to 10 times higher.1 The rate of accidental death caused by carbon monoxide from motor vehicles is higher in the northern United States and peaks during the winter months.4 The intentional deaths occur year-round without significant peaks.1 The severe winter of . . .
510 citations
Journal Article•
TL;DR: There are approximately 50,000 ED visits for CO poisoning in the USA annually, 3-5 times the numbers previously estimated, and enhanced prevention efforts are warranted.
Abstract: PURPOSE: While carbon monoxide (CO) poisoning is common in the USA, its incidence is uncertain. Fatal poisonings are counted with relative accuracy from death certificate data, but estimates of the more common nonfatal poisonings are either old or limited. This study was performed to estimate the number of emergency department (ED) visits annually in the USA for carbon monoxide poisoning. BASIC PROCEDURES: ED visit rates in five states (Idaho, Maine, Montana, Utah, and Washington) from three prior studies, each using different methodology, were used to extrapolate independent estimates of national ED visits. MAIN FINDINGS: After correcting for regional differences in CO poisoning incidence, estimates of national ED visits per year ranging from 32,413 to 56,037 were obtained. Excluding the estimate derived from the Maine rate because it did not include intentional and fire-related poisonings, the national average is 50,558 +/- 4,843 visits per year. CONCLUSIONS: There are approximately 50,000 ED visits for CO poisoning in the USA annually, 3-5 times the numbers previously estimated. As this disease can result in significant long-term morbidity even when treated, enhanced prevention efforts are warranted. Language: en
150 citations
Journal Article•
TL;DR: Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning than females, and most (64%) of the nonfatal CO exposures occurred in homes.
Abstract: Carbon monoxide (CO) is a colorless, odorless, poisonous gas that results from incomplete combustion of fuels (e.g., natural or liquefied petroleum gas, oil, wood, coal, or other fuels). CO sources (e.g., furnaces, generators, gas heaters, and motor vehicles) are common in homes or work environments and can put persons at risk for CO exposure and poisoning. Most signs and symptoms of CO exposure are nonspecific (e.g., headache or nausea) and can be mistakenly attributed to other causes, such as viral illnesses. Undetected or unsuspected CO exposure can result in death. To examine fatal and nonfatal unintentional, non-fire-related CO exposures, CDC analyzed 2001-2003 data on emergency department (ED) visits from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) and 2001-2002 death certificate data from the National Vital Statistics System (NVSS). During 2001-2003, an estimated 15,200 persons with confirmed or possible non-fire-related CO exposure were treated annually in hospital EDs. In addition, during 2001-2002, an average of 480 persons died annually from non-fire-related CO poisoning. Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning. Most (64%) of the nonfatal CO exposures occurred in homes. Efforts are needed to educate the public about preventing CO exposure.
124 citations
TL;DR: Abstract See related editorial, "Should the Pressure Be Off or On in the Use of Oxygen in the Treatment of Carbon Monoxide-Poisoned Patients?"
116 citations