This document discusses carbon monoxide poisoning, including its structure, pathophysiology, effects on the human body, sources, prevention, and treatment strategies. Carbon monoxide is an odorless, colorless gas that binds to hemoglobin over 200 times more than oxygen, preventing oxygen from being transported throughout the body and causing hypoxia. Symptoms range from headaches and dizziness at low levels to seizures, loss of consciousness, and death at high levels. Common sources include vehicles, heaters, and cooking equipment. Treatment focuses on high-flow oxygen therapy and hyperbaric oxygen chambers.

1. Pathophysiology of
Carbon Monoxide (CO)
Poisoning
 Frank Dispenza, M.Ed., NREMTP

2. Carbon Monoxide
Poisoning
 Topics to be covered:
 Structure and pathophysiology of
Carbon Monoxide Poisoning.
 Effects on the human body.
 Sources of Carbon Monoxide.
 Prevention strategies.
 Treatment strategies.

3. Carbon Monoxide
Poisoning
1) Carbon Monoxide Facts:
a) Colorless, odorless, tasteless.
b) A gas, slightly lighter than air.
c) Indicated as “CO”. One carbon
atom bound to one oxygen atom.
d) Also known as „carbonous oxide‟.
e) Is a flammable gas. Burns with a
blue flame.

4. CARBON ATOM
OXYGEN ATOM

5. How ‘CO’ is Formed
1) Carbon Monoxide is formed in
a combustion environment
that is too „oxygen-starved‟ to
make Carbon Dioxide.
2) All Carbon Monoxide is
„incompletely formed carbon
dioxide‟.

6. How ‘CO’ is Formed
1) Examples of „CO‟ producing
sources:
a) Motor Vehicles, gasoline powered
tools.
b) Volcanoes.
c) Heaters.
d) Cooking equipment.

7. How ‘CO’ enters the Body
1) Carbon Monoxide is usually
inhaled.
2) „CO‟ is toxic to all forms of life that
depend on oxygen.
3) Poisoning can be „acute‟ (sudden
onset) or „chronic‟ (gradual onset)

8. How ‘CO’ effects the
Body
1) Common Symptoms:
a) Headache / Dizzyness.
b) Loss of Judgment Abilities, Delerium.
c) Nausea.
d) Seizures.
e) Tachycardia.
f) Loss of Conciousness.
g) Death.

9. How ‘CO’
effects
the Body

10. Why ‘CO’ effects the
Body
1) Hemoglobin:
a) The oxygen carrying protein
found in blood that distributes
oxygen to tissues throughout
the body.
b) Hemoglobin is found in blood
and red blood cells.

11. Why ‘CO’ effects the
Body
1) Hemoglobin:
a) Oxygen binds with an Iron (Fe)
molecule found in the
Hemoglobin structure. Oxidized
iron is usually red (rust).
b) Hemoglobin gives blood it‟s red
color.

12. OXYGEN BINDS HERE

13. Why ‘CO’ effects the
Body
1) Hemoglobin:
a) Oxygen binds to the iron
molecule.
b) Blood carries the oxygen
through the body and then
drops it off at the cellular level.
c) The complex is a little
unstable, and O2 leaves it
easily.

14. Why ‘CO’ effects the
Body
1) Hemoglobin:
a) Hemoglobin likes Carbon
Monoxide 230 times more than
it likes Oxygen.
b) Hemoglobin bound to „CO‟ is
known as carboxyhemoglobin.

15. Why ‘CO’ effects the
Body
1) Carboxyhemoglobin:
a) A very stable substance. Does
not want to give up it‟s „CO‟.
b) This means that it is VERY
HARD to get the carbon
monoxide out of hemoglobin.
c) As long as CO is in
hemoglobin, oxygen cannot be
there too.

16. Why ‘CO’ effects the
Body
1) Carboxyhemoglobin
a) The inability of oxygen to get
around the body in the blood
leads to hypoxia (low-oxygen).
b) Symptoms of „CO‟ poisoning are
consistent with that of any other
disease process that deprives
the body of oxygen.

17. Signs & Symptoms
1) Carbon Monoxide is
measured in “ppm” or parts
per million.
2) Here are some symptoms
in relation to dosages in
„ppm‟…

18. Signs & Symptoms
35 ppm…................…Headache & Dizzyness (6 hrs.)
100 ppm…………….………………..Headache (3 hrs.)
400 ppm ……………..............… Frontal H/A (1-2 hrs.)
800 ppm……...Dizzyness, nausea, seizures (45 min.)
…Unconscious in 2 hrs.
1600 ppm ….… H/A, tachycardia, dissyness (20 min.)
…Death in 2 hrs.
3200 ppm……Headache, dizzyness, nausea (5 min.)
…Death in 30 mins.
12,800 ppm………..…Unconscious after 2-3 breaths
…Death in less than 3 mins.

19. Acute Poisoning
1) Central Nervous System and Heart
are most effected.
2) Headache, nausea and fatigue can
mimic influenza and food poisoning.
3) Tachycardia and change in mental
status occur later.

20. Acute Poisoning
1) Cardiac Symptoms:
a) Tachycardia.
b) Hypotension.
c) Malaise.
d) Fatigue.
e) Atrial Fibrillation.

21. Acute Poisoning
1) Central Nervous System:
a) Delirium /Psychosis.
b) Dizziness.
c) Hallucinations.
d) Short term memory loss.
e) Confusion / Depression
f) Hyperglycemia.
g) Seizures.
h) Respiratory Arrest.

22. Acute Poisoning
1) Think of some other illnesses that
have the same signs and
symptoms.
2) Your Alzheimer‟s patient, suicidal
patient, apparent drug overdose
patient, CVA patient, may all be
actually victims of carbon monoxide
poisoning.

23. Epidemiology
1) Most cases go unreported.
2) Most often occurs during winter
months.
3) Faulty ventilation of heat supplying
equipment mostly at fault.
4) Over 50% of all fatal poisonings of
any kind are „CO‟ related.

24. Epidemiology
1) 40,000 people a year seek medical help
for CO poisoning.
2) 6,000 CO related accidental deaths a
year.
3) 2,000 suicides a year.
4) Even though catalytic converters clean
99% of „CO‟ from car exhaust, running a
car in a confined space is still the most
usual suicide method.

25. Epidemiology
1) Burning charcoal or fossil
fuel in a confined space is
fast becoming the new way
of committing „CO‟ suicide.
2) Dangerous levels of „CO‟
exist in suicide scenes
where people have rigged
ways to deliver high
concentrations of carbon
monoxide.
3) Always don protective
gear!

26. Treatments
1) CPR if needed.
2) High-flow Oxygen (via NRB mask).
3) Hyperbaric (above level pressure)
Oxygen via a hyperbaric chamber.
a) Pressure „forces‟ oxygen into
hemoglobin.
4) Treat seizures with benzodiazapine.
5) Treat dysrhythmias with ACLS.

27. Treatments
1) Hyperbaric Chamber:

28. Treatments
1) Hyperbaric Chambers:
a) SEHC – Main
b) St. Joseph‟s (Warren)
c) Trumbull Memorial Hospital (Warren)

29. Treatments
1) Patients need Cardiac Monitor to
detect arrhythmias.
2) IV Access.
3) A good history and physical exam
may give you clues to possible „CO‟
poisoning.
4) „CO‟ detecting device (like a pulse
oximeter).

30. Detectors
1) There are several
different technologies
for detectors:
a) Opto-chemical.
b) Biomemetic.
c) Electromechanical.
d) Semiconductor.

31. Detectors
1) Opto-Chemical
a) Cheap. Low tech.
b) Treated cloth pad turns dark in the
presence of „CO‟.
c) Low cost.
d) You must look at the pad often.
e) Has no alarm device.

32. Detectors
1) Biomemetic (imitates biology).
a) Gell cell sensor has a synthetic
hemoglobin in it.
b) Darkens in presence of „CO‟.
c) Can be hooked up to photoelectric light
sensor and alarm.
d) Lasts about 10 years.

33. Detectors
1) Electromechanical.
a) Produces an electrical current that
precisely relates to „CO‟.
b) Highly accurate.
c) Requires minimal power.
d) Operates at room temperature.
e) Lasts about 5 years on lithium batteries.
f) The dominant detector on the market
today.

34. Detectors
1) Semiconductor.
a) Produces an electrical current that
precisely relates to „CO‟.
b) Highly accurate.
c) Heated Tin Dioxide.
d) 752 degrees operational temp.
e) Resistance to current in the sensing
element can trigger an alarm.
f) Uses a lot of power.

35. Detectors
Placement can be either on the floor or
ceiling as „CO‟ has nearly the same
density as regular air.
According to NFPA: All CO detectors
“shall be centrally located outside of each
separate sleeping area in the immediate
vicinity of the bedrooms,” and each detector
“shall be located on the wall, ceiling or other
location as specified in the installation
instructions that accompany the unit.”

36. Detectors
The alarm points on carbon monoxide
detectors are not a simple alarm level (as in
smoke detectors) but are a concentration-
time function. At lower concentrations (eg
100 parts per million) the detector will not
sound an alarm for many tens of minutes. At
400 parts per million (PPM), the alarm will
sound within a few minutes. This
concentration-time function is intended to
mimic the uptake of carbon monoxide in the
body while also preventing false alarms due
to relatively common sources of carbon
monoxide such as cigarette smoke.

37. Myths and Facts
MYTH or FACT ?
„CO‟ poisoning patients
present with a „cherry red‟
color to their skin.

38. Myths and Facts
MYTH
This is actually a poor
indicator as it is usually found
after death. Patients can
however have a healthy pink
skin color with high
concentrations of „CO‟.

39. Myths and Facts
MYTH or FACT ?
Carbon Monoxide poisoning is
thought to play a major role in
„haunted houses‟.

40. Myths and Facts
FACT
Many people who have complained
of „hauntings‟ have been found to
have high levels of Carbon
Monoxide in their blood (usually
from faulty heating equipment).
Remember that hallucination,
delirium and confusion are all
symptoms of „CO‟ poisoning.

41. Myths and Facts
MYTH or FACT ?
Carbon Monoxide can be used as
fuel.

42. Myths and Facts
FACT
During WW II, „CO‟ was used as a
fuel source for internal combustion
engines. Charcoal or wood burners
were affixed to carburetors and the
„CO‟ produced was used in place of
gasoline. Coal gas (used in
England before the use of natural
gas) is mostly „CO‟.