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Hurricane Harvey : clinical guidance for carbon monoxide (CO) poisoning
  • Published Date:
    September 2, 2017
  • Language:
    English
Filetype[PDF-60.96 KB]


Details:
  • Corporate Authors:
    Centers for Disease Control and Prevention (U.S.)
  • Series:
  • Description:
    September 02, 2017, 2130 ET (9:30 PM ET)

    CDCHAN-00406

    Summary: Carbon monoxide (CO) is an odorless, colorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air. During a significant power outage, persons using alternative fuel or power sources such as generators or gasoline powered engine tools such as pressure washers might be exposed to toxic CO levels if the fuel or power sources are placed inside or too close to the exterior of the building causing CO to build up in the structure. The purpose of this HAN advisory is to remind clinicians evaluating persons affected by the storm to maintain a high index of suspicion for CO poisoning. Clinicians are advised to consider CO exposure and take steps to discontinue exposure to CO. Clinicians are also advised to ask a patient with CO poisoning about other people who may be exposed to the same CO exposure, such as persons living with or visiting them so they may be treated for possible CO poisoning.

    Background: Hurricane Harvey made landfall between Port Aransas and Port O’Connor, Texas on August 25, 2017, causing 300,000 persons to lose power. When power outages occur during emergencies such as hurricanes or winter storms, the use of alternative sources of fuel or electricity for heating, cooling, or cooking can cause CO to build up in a home, garage, or camper and poison the people and animals inside. Although CO poisoning can be fatal to anyone, children, pregnant women, and older adults as well as persons with chronic illness are particularly vulnerable to CO poisoning. The symptoms and signs of CO poisoning are variable and nonspecific. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and altered mental status. Symptoms of severe CO poisoning include malaise, shortness of breath, headache, nausea, chest pain, irritability, ataxia, altered mental status, other neurologic symptoms, loss of consciousness, coma, and death. Signs and clinical manifestations of severe CO poisoning include tachycardia, tachypnea, hypotension, various neurologic findings including impaired memory, cognitive and sensory disturbances, metabolic acidosis, arrhythmias, myocardial ischemia or infarction, and noncardiogenic pulmonary edema, although any organ system might be involved.

    An elevated carboxyhemoglobin (COHgb) level of 2% or higher for non-smokers and 9% or higher COHgb level for smokers strongly supports a diagnosis of CO poisoning. The COHgb level must be interpreted in light of the patient’s exposure history and length of time away from CO exposure, as levels gradually fall once the patient is removed from the exposure.

    With a focused history, exposure to a CO source may become apparent; items in the history that might trigger a higher index of suspicion for CO poisoning in this setting include lack of a fever, recurrent symptoms, and multiple family members affected by similar symptoms. Appropriate and prompt diagnostic testing and treatment are crucial to reduce morbidity and prevent mortality from CO poisoning.

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