Carbon monoxide exposure happens when you breathe in air that contains carbon monoxide (CO). Too much CO exposure can cause CO poisoning. CO is a gas that you cannot see, taste or smell. You may not know when you are breathing it in. You can breathe in a lot of CO over a short period of time. You can also breathe in small amounts over a long period. Most CO poisoning happens by accident, but for some it happens on purpose such as with a suicide attempt.
The air that you normally breathe contains all the oxygen that your body needs to function. In your lungs, oxygen attaches to red blood cells (RBCs) and is carried to your tissues and organs. With CO poisoning, the CO takes up the places on your RBCs where the oxygen should be carried. This results in less oxygen being delivered to your tissues and organs, which can injure them. CO poisoning also causes damage to your blood vessels, making them leak and swell. You may get serious damage to your brain, kidneys, and heart, which can be life-threatening. Receiving treatment within six hours of exposure may help remove CO from your body faster and reduce injuries.
What may cause carbon monoxide poisoning? Small amounts of CO are often found in the air that you breathe. CO is formed when fuels are burned, such as gasoline, kerosene, propane, coal, wood, or charcoal. Incomplete burning of these fuels can cause more CO to be found in the air. Accidental CO poisoning happens most often during winter. This is when most people use heating devices to warm their homes. They are also more likely to stay indoors with their doors and windows shut, preventing CO from escaping. CO may come from any of the following sources:
Environment: Having your house catch fire is the most common source of CO. Smoke from tobacco and exhaust fumes from motor vehicles may lead to increased CO in the air. CO and motor vehicle exhaust levels may be higher near busy intersections and streets. CO poisoning may happen when motor vehicles operate in closed or not well ventilated areas such as garages. A garage is not ventilated if its door is partially closed and air is not freely flowing in it. CO poisoning may also happen when something, such as snow, blocks your motor vehicle’s exhaust pipe.
Household: Devices and equipment intended for use inside your house can produce CO. These include furnaces, water heaters, gas stoves and ovens, and gas or wood-burning heating stoves or fireplaces. Using barbecue grills, lawn mowers, and gas-powered tools in poorly ventilated areas may also cause CO poisoning.
Recreation: Using unvented propane or space heaters, stoves, grills or lanterns inside a camping trailer or tent may lead to CO poisoning. CO poisoning can also come from being near to the exhaust fumes from motor or house boats, and ski-boats.
Work-related: Using any fuel-burning vehicle or tool in an area with poor ventilation can cause CO poisoning. These include gas-powered generators, concrete and chain saws, pressure washers, forklifts, tractors, and floor polishers. Certain paint and varnish removers also contain a chemical which could be a source of CO.
Who may be at risk of carbon monoxide poisoning? Everybody is at risk of breathing in CO. Certain factors may increase your risk for CO poisoning:
Age:
Babies: Babies breathe faster because they need more oxygen compared to larger persons. By breathing faster, they may also breathe in more CO. A pregnant woman who breathes in CO may also pass it onto the baby inside her womb. CO attaches more easily than oxygen to the red blood cells of a fetus (unborn baby). This decreases the amount of oxygen taken to fetal tissues and organs, and may cause death. Some babies that were poisoned before birth survive but are born smaller than normal or have birth defects.
Older adults: Adults 65 years of age and older may be at greater risk. The bodies of older adults do not cope with a decrease in oxygen as well as younger adults. Older adults may also have other medical conditions that are made worse by CO exposure.
Medical conditions: Having certain diseases may increase your risk for getting CO poisoning. These include heart disease, blood vessel disease, sickle cell anemia, thalassemia, and lung problems. Ask your caregiver for more information about these conditions.
Pregnancy: Pregnant women may breathe faster, causing them to breathe in more CO.
Smoking: If you smoke, you are breathing in small amounts of CO with the smoke. This will give you a low level of CO already attached to your RBCs. You may get poisoned faster if you are then exposed to CO from another source.
Work conditions: Having a job in the construction, agriculture, forestry, or fishing industry may increase your risk for CO poisoning. With these jobs, you are more likely to use equipments or chemicals that are sources of CO.
What are the signs and symptoms of carbon monoxide poisoning? You may have no signs and symptoms at first. Early signs and symptoms may make you feel like you have the flu. If you are breathing in CO inside your house, you may feel better when you leave your home. Your signs and symptoms may worsen when you return and spend more time at home. How bad your symptoms are may depend on how long and how much CO you have breathed in. Your symptoms can range from mild to severe (very bad):
Immediate signs and symptoms: You may have any of the following soon after CO exposure:
Mild CO poisoning With small amounts of CO in your body, you may have:
Blurring of vision.
Dizziness.
Headache.
Upset stomach or throwing up.
Moderate CO poisoning As more CO gets into your body, you may have:
Breathing faster than normal or having trouble breathing.
Chest pain or fast heartbeat.
Fainting.
Feeling confused.
Feeling weak or having muscle pain.
Passing dark, red-colored urine.
Severe CO poisoning With a high level of CO in your body, you may have:
Breathing that stops.
Convulsions (seizures), or going into a coma.
Strong or irregular heartbeat, or a heart attack.
Late signs and symptoms: CO poisoning can cause injuries to your brain that may be temporary or permanent. You may have any of the following, 2 to 40 days after your CO exposure:
Changes in your usual behavior.
Increased anxiety (worry) or depression (feeling very sad).
Tremors or shaking of your fingers or hands, making it hard to write.
Trouble with controlling when you pass urine or stool.
Trouble thinking clearly or learning new things.
Trouble with moving, bending your arms or legs, or walking.
Trouble speaking, chewing, or controlling facial muscles.
How is carbon monoxide poisoning diagnosed? Your caregiver will ask about your symptoms and when they started. Tell your caregiver if anyone you live or work with has similar signs and symptoms. Tell your caregiver if you are living or have recently lived near an area with a high volume of motor vehicle traffic. Tell him if you use home heater devices that burn gas, oil, wood, or other fuel. Also, tell your caregiver if you have a pet that recently got sick. Pets may get sick faster when exposed to CO because of their smaller body size. Your caregiver may also need to know if you have used gas-powered tools, or paints or varnishes recently. You may need one or more of the following:
12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
Breath analyzer: This is a special device that measures the amount of carbon monoxide in your breath. Hold your breath for 15 seconds then exhale (breathe out) into the device.
Glucose meter: A glucose meter (also called a glucometer) is a small machine used to test the amount of sugar in your blood. Your finger is pricked so your caregiver can get a small drop of blood. The blood is put onto a testing strip, and put into the glucose meter. A screen on the glucose meter will show the amount of sugar in your blood. This test may be done several times a day. You may be taught how to do this test yourself.
Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.
How is carbon monoxide poisoning treated?
Immediate treatment: The first step of treatment is to get away from the area where the source of CO may be coming from. Everyone else also staying in the area should move out as well, to get away from the CO. You may need to call 911 or seek medical care immediately.
Treatment at the hospital:
Respiratory treatments:
Hyperbaric oxygen therapy: This is also called HBO. HBO is used to get more oxygen into your body. The oxygen is given under pressure to help it get into your tissues and blood. You may be put into a tube-like chamber called a hyperbaric or pressure chamber. You will be able to see your caregivers and talk with them through a speaker. You may need to have this therapy more than once.
Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
Endotracheal (ET) tube: An endotracheal tube may be put into your mouth or nose. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.
Medicines:
Anticonvulsant medicine: Anticonvulsants are given to control seizures.
Clot busters: This medicine helps break apart blood clots, which may increase blood flow to your heart muscle. It is given in your IV and may be given at the same time as other blood thinners. This medicine may decrease the amount of damage to your heart muscle, and may even save your life. You will bleed and bruise more easily after getting clot busters.
Other treatment:
Intravenous therapy: This is a special liquid given to increase your blood pressure. An intravenous (IV) tube is placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
How can I prevent carbon monoxide poisoning?
Home:
Do have your fireplace flue cleaned on a regular basis.
Do have your gas, coal or oil furnace, gas hot water heater, and gas stove and oven checked for problems. Make sure exhaust pipes for these items are not blocked.
Do install a CO detector near your sleeping area. This should be placed five feet above the floor and away from fireplaces or any gas-burning equipment.
Do look for signs that you are being exposed to CO in your home. Look for fallen soot from a fireplace or streaks of soot around gas-burning equipment. Check for moisture on the windows and walls of furnace rooms or rusting of flue pipes.
Do not use your gas kitchen stove or oven to heat your home.
Do not use barbecue grills or heaters that burn fuel, such as propane, inside your home.
Motor vehicles:
Do make sure your vehicle's exhaust pipe is not blocked.
Do not operate vehicles in closed areas.
Do not operate vehicles that have problems with their exhaust systems.
Recreation:
Do stay away from the exhaust fumes coming from vehicles such as motor boats and jet skis. Avoid swimming behind these vehicles.
Do not use built-in propane heaters in trailers or pop-up tents that are not vented.
Do not use portable propane or charcoal cooking devices in enclosed areas, such as cabins, tents or trailers.
Work:
Do not operate motorized equipment in places that do not have good air flow. If this cannot be avoided, make sure to vent the exhaust fumes to the outside.
Do not stand near the exhaust of motorized equipment except in areas with good air flow.
When should I call my caregiver? Call your caregiver if:
You feel dizzy.
You have a headache or starts to vomit (throw up).
Your eyesight becomes blurred.
You have questions or concerns about your condition, treatment, or care.
When should I seek immediate help? Seek care immediately or call 911 if:
You have chest pain or strong, irregular, or fast heartbeat.
You have trouble breathing or need to breathe faster than normal.
You faint or have a convulsion.
You feel weak, have trouble moving, or have very bad muscle pain.
Your urine becomes dark or reddish.
Where can I find more information? Contact any of the following:
American Association of Poison Control Centers 3201 New Mexico Avenue, Suite 330 Washington, DC 20016 Phone: 1-202-3627217 Web Address: http://www.aapcc.org
Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 Phone: 1-404-6393311 Phone: 1-800-3113435 Web Address: http://www.cdc.gov
Environmental Protection Agency Office of Radiation and Indoor Air Indoor Environments Division 1200 Pennsylvania Avenue, NW Mail Code 6609J Washington, DC 20460 Phone: 1-202- Web Address: http://www.epa.gov
CARE AGREEMENT:
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
