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Non-Invasive Carboxyhemoglobin Monitoring: Screening Emergency Medical Services Patients for Carbon Monoxide Exposure

Published online by Cambridge University Press:  28 June 2012

Douglas Nilson ,
Robert Partridge ,
Selim Suner  and
Gregory Jay
Douglas Nilson*
Affiliation:
Department of Emergency Medicine, Brown Medical School, Providence, Rhode Island, USA Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
Robert Partridge
Affiliation:
Department of Emergency Medicine, Brown Medical School, Providence, Rhode Island, USA Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
Selim Suner
Affiliation:
Department of Emergency Medicine, Brown Medical School, Providence, Rhode Island, USA Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA Department of Surgery, Brown Medical School, Providence, Rhode Island, USA Division of Engineering, Brown University, Providence, Rhode Island, USA
Gregory Jay
Affiliation:
Department of Emergency Medicine, Brown Medical School, Providence, Rhode Island, USA Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA Division of Engineering, Brown University, Providence, Rhode Island, USA
*
Brown Emergency Medicine Residency Program, Rhode Island Hospital, 593 Eddy Street, Claverick Building 274, Providence, Rhode Island 02903, USA E-mail: dougnilson@gmail.com
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Abstract

Introduction:

Carbon monoxide (CO) toxicity is a significant health problem. The use of non-invasive pulse CO-oximetry screening in the emergency department has demonstrated that the rapid screening of numerous individuals for CO toxicity is simple and capable of identifying occult cases of CO toxicity.

Objective:

The objective of this study was to extend the use of this handheld device to the prehospital arena, assess carboxyhemoglobin (SpCO) levels in emergency medical services (EMS) patients, and correlate these levels with clinical and demographic data.

Methods:

This was a retrospective, observational, chart review of adult patients transported to hospital emergency departments by urban fire department EMS ambulances during a six-week period. Each ambulance used a non-invasive pulse CO-oximeter (Rad-57, Masimo Inc.) to record patients' COHb concentrations (SpCO) along with the standard EMS assessment data. Spearman's Rank Correlation tests and Student's t-tests were used to analyze the data and calculate relationships between SpCO and other variables (age, gender, respiratory rate, heart rate, mean arterial pressure, and oxygen saturation measured by pulse oximetry).

Results:

A total of 36.4% of the patients transported during the study had SpCO documented. Of the 1,017 adults included in this group, 11 (1.1%) had an SpCO >15%. There was no correlation between SpCO and heart rate, ventilatory rate, mean arterial pressure, and oxygen saturation.

Conclusions:

Screening for CO toxicity in the EMS setting is possible, and may aid in the early detection and treatment of CO-poisoned patients.

Keywords

carbon-monoxide toxicitycarboxyhemoglobinemergency medical servicesmonitoringpatient
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 3 , June 2010 , pp. 253 - 256
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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References

1.Suner, S, Partridge, R, Sucov, A, Valente, J, Chee, K, Hughes, A, Jay, G: Noninvasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. J Emerg Med 2008;34(4):441–450.CrossRefGoogle ScholarPubMed
2.Chee, KJ, Nilson, D, Partridge, R, Hughes, A, Suner, S, Sucov, A, Jay, G: Finding needles in a haystack: A case series of carbon monoxide poisoning using a new technology in the emergency department. Clin Toxicol (Phila) 2008;46(5):461–469.CrossRefGoogle Scholar
3.(US) Centers for Disease Control and Prevention (CDC): Unintentional non-fire-related carbon monoxide exposures-United States, 2001-2003. MMWR 2005;54:36–39.Google Scholar
4.Walker, E: Carbon monoxide poisoning is still an under recognized problem. BMJ 1999;319:1082–1083.CrossRefGoogle Scholar
5.Kirkpatrick, J: Occult carbon monoxide poisoning. Western J Med 1987;146:52–56.Google ScholarPubMed
6.CDC: Carbon monoxide poisoning after Hurricane Katrina—Alabama, Louisiana, and Mississippi, August-September. MMWR 2005;54:996–998.Google Scholar
7.Broder, J, Mehrotra, A, Tintinalli, J: Injuries from the 2002 North Carolina ice storm, and strategies for prevention. Injury 2005;36:21–26.CrossRefGoogle ScholarPubMed
8.Ghim, M, Severance, HW: Ice storm-related carbon monoxide poisonings in North Carolina: A reminder. Southern Medical Journal 2004;97:1060–1065.CrossRefGoogle ScholarPubMed
9.Keles, A, Demircan, A, Kurtoglu, G: Carbon monoxide poisoning: How many patients do we miss? Eur J Emerg Med 2008;15(3):154–157.CrossRefGoogle ScholarPubMed
10.Cobb, N, Etzel, RA: Unintetional carbon monoxide-related deaths in the United States, 1979 through 1988. JAMA 1991;266:659–663.CrossRefGoogle ScholarPubMed
11.Ernst, A, Zibrak, JD: Carbon monoxide poisoning. N Eng J Med 1998;339(22):1603–1608.CrossRefGoogle ScholarPubMed
12.Henry, CR, Satron, D, Lindgren, B, et al: Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA 2006;295:398–402.CrossRefGoogle ScholarPubMed
13.Crawford, DM, Hampson, NB. Fire and ice: Diagnosis of carbon monoxide poisoning in a remote environment. Emerg Med J 2008; 25(4):235–236.CrossRefGoogle Scholar
14.Nagano, T, Iseki, K, Niki, T, Suzuki, A, Kawamae, K [Experience in employing pulse CO-oximetry]. Masui 2008; 57(5):621–623 (Japanese).Google ScholarPubMed