Routine Screenings Uncover Hidden Carbon Monoxide Poisoning

Screening all emergency room patients for carbon monoxide (CO) poisoning is a potentially life-saving practice that can be achieved even in a high-volume urban hospital, claims a new study.

Emergency physicians at Rhode Island Hospital (Providence, USA) screened 14,438 patients visiting the hospital's emergency department for exposure to CO, a highly toxic gas that can cause brain and heart damage and even death. The emergency room staff used a portable, non-invasive pulse CO-oximeter (a device similar to the standard pulse oximeter) to screen patients who presented to the emergency department for various concerns over a three-month span. These measurements were documented along with initial vital signs and oxygen saturation as part of the standard triage process.

The researchers identified 28 cases of CO poisoning, 11 of which were unexpected and identified only with routine screening. None of these patients exhibited the usual signs of CO poisoning, such as headaches, dizziness, and flu-like symptoms. Nearly a third of the patients required hyperbaric oxygen treatment, in which 100% oxygen is delivered under high pressure in a specialized chamber to reduce the amount of CO in the blood and return oxygen levels to normal. Overall, four of the 11 patients were smokers. Patients diagnosed with CO poisoning were interviewed by the researchers to determine how they used the information they were provided in the emergency department after being discharged. Those judged to have environmental CO poisoning were also contacted by telephone and asked if they discovered the source of CO, whether the fire department was contacted, the incidence of recurrent similar symptoms, and whether a smoke or CO detector was purchased. The study was published early online on January 26, 2008, in The Journal of Emergency Medicine.

"There is a clear and significant benefit to universal screening for carbon monoxide, especially during the winter months, when carbon monoxide poisoning is most common,” said lead author Selim Suner, M.D., M.S., director of emergency preparedness and disaster medicine at Rhode Island Hospital. "Unless you have a carbon monoxide detector, it's extremely difficult to know if you're being exposed to toxic levels of this gas. If we can identify these cases of unsuspected poisoning early on, we can administer treatment and prevent them and others from being further exposed.”

CO exposure is the leading cause of accidental poisoning deaths in the United States, responsible for an estimated 15,000 emergency department visits and 500 unintentional deaths each year, mostly in winter. CO is an odorless, colorless gas produced by common household appliances that burn fuel, such as gasoline, oil, and wood. When not properly ventilated or used incorrectly, CO emitted by these appliances can build up to dangerous levels. CO poisoning can be very difficult to diagnose, since its symptoms resemble those of the flu and other common illnesses. Pregnant women, children, and the elderly are most susceptible to carbon monoxide poisoning.


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