People poisoned by carbon monoxide. Carbon monoxide poisoning: life-threatening consequences

Carbon monoxide, or carbon monoxide, has the chemical formula CO. It has no color, taste, smell. The characteristic smell attributed to it by non-specialists is actually the smell of impurities, which, like CO, are released during the combustion of organic matter.

Carbon monoxide is formed during the combustion of substances and materials containing carbon. In addition to wood and coal, these include oil and its products, including gasoline and diesel fuel. Accordingly, the cause of poisoning can be staying in the immediate vicinity of the place of combustion of carbonaceous substances, including close to running car engines.

The maximum allowable concentration of carbon monoxide in the atmospheric air for a person is 33 mg/m³. According to hygienic standards, the concentration should not exceed 20 mg/m³. Death is caused by inhalation of air, 0.1% of which is carbon monoxide, within an hour. For comparison, the exhaust of an internal combustion engine contains 1.5–3% of this toxic substance, so CO belongs to the 2.3 hazard class according to the international classification.

Causes of carbon monoxide poisoning

The most common causes of carbon monoxide poisoning are:

• long (over 5 hours) being in close proximity to highways with busy traffic;
• being in an unventilated room in which there is a source of combustion, devoid of the removal of combustion products. It can be a fire, a running car, a stove with a closed chimney, etc.;
• neglect of safety rules and instructions for the devices used when using household and home-made devices that provide for combustion (burners, potbelly stoves and other heating devices).

Cigarette smoke also contains CO, but its concentration is too low to cause serious poisoning.

Carbon monoxide is also formed during gas welding, which uses carbon dioxide. The latter, which is carbon dioxide (CO2), loses an oxygen atom when heated and turns into CO. But when natural gas is burned in serviceable stoves and appliances, CO is not formed. If they are faulty, then carbon monoxide is released in concentrations dangerous to health.

Signs of carbon monoxide poisoning

At concentrations of carbon monoxide less than 0.009%, poisoning occurs only in cases of being in a gassed place for more than 3.5 hours. Intoxication proceeds in a mild form and often goes unnoticed, since its symptoms are mild: psychomotor reactions slow down, blood rush to the organs is possible. People suffering from cardiovascular disease may experience shortness of breath and chest pain.

With an increase in the concentration of CO in the air to 0.052%, an hour of continuous exposure is required for the development of symptoms of intoxication. As a result, headache and visual disturbances are added to the above symptoms.

When the concentration rises to 0.069%, an hour is enough for the headache to become throbbing, dizziness, nausea, incoordination, irritability, short-term memory lapses and visual hallucinations appear.

A concentration of CO equal to 0.094% within two hours leads to hallucinations, severe ataxia and tachypnea.

Higher levels of CO2 in the air lead to rapid loss of consciousness, coma and death. These symptoms of carbon monoxide poisoning at its concentration in the inhaled air of 1.2% occur within a few minutes.

First aid for carbon monoxide poisoning

Carbon monoxide is a volatile compound that quickly dissipates in the atmosphere. The victim must immediately leave the epicenter with the highest concentration of gas. Most often, for this it is enough to leave the room in which the source is located, if the victim cannot do this, he should be taken out (carried out).

It is impossible for a non-specialist to independently assess the severity of the victim's condition, this can only be done based on the results of a blood test. Therefore, even with minor signs of poisoning, it is necessary to seek medical help. In a state of moderate severity, even if the victim is able to move independently, you need to call an ambulance. When calling, the dispatcher must be informed of the exact symptoms, the source of poisoning and the duration of being near it.

While waiting for the arrival of doctors, the victim should be kept calm. Lay down, turning your head to one side, get rid of clothes that interfere with breathing (unbutton your collar, belt, bra), ensure a constant supply of oxygen.

In this condition, hypothermia of the body is dangerous, and it should be prevented by applying heating pads or mustard plasters to the legs.

In case of loss of consciousness, it is necessary to carefully turn the victim on his side. This posture will keep the airways open and eliminate the possibility of choking on saliva, phlegm, or the tongue sunk into the throat.

Treatment for carbon monoxide poisoning

The general principle of medical care in case of poisoning with this product is to saturate the body of the victim with oxygen. For mild poisoning, oxygen masks are used, in most cases this is sufficient.

In more severe cases, apply:

• forced ventilation of the lungs (IVL);
• subcutaneous administration of caffeine or lobelin;
• the introduction of cocarboxylase intravenously;
• administration of Acizol intramuscularly.

In severe poisoning, the patient can be placed in a hyperbaric pressure chamber.

Carbon monoxide poisoning in children

Most childhood carbon monoxide poisoning results from playing with fire. In second place is staying in rooms with faulty stoves.

At the first sign of carbon monoxide poisoning, it is necessary to take the child to fresh air and call an ambulance. The use of oxygen bags in this case is not recommended. Hospitalization is necessary in all cases, even if the degree of poisoning is insignificant. Children are at high risk of serious complications, in particular pneumonia.

Carbon monoxide poisoning in pregnant women

Pregnant women are much more sensitive to elevated concentrations of carbon monoxide in the air than others. Studies conducted in 1993 by foreign scientists showed that symptoms of poisoning can be observed at the maximum allowable concentration or even less. Therefore, expectant mothers should avoid the places of potential risk listed above.

In addition to the usual complications, carbon monoxide poisoning during pregnancy carries with it another danger.

Even small doses of CO that enter the bloodstream can lead to fetal death.

Complications and consequences

When breathing, carbon dioxide passes from the lungs into the blood in the same way that oxygen does, and enters into a chemical reaction with hemoglobin. As a result, instead of normal oxyhemoglobin, carboxyhemoglobin is formed in the following proportion - at a ratio of CO and air of 1/1500, half of the hemoglobin will turn into carboxyhemoglobin. This compound is not only unable to carry oxygen, but also prevents the release of the latter from oxyhemoglobin. As a result, oxygen starvation of the hemic type occurs.

The processes described above cause hypoxia, which negatively affects the work of all internal organs. Asphyxia is especially dangerous for the brain. It can cause both minor impairments to memory and thinking, and serious neurological or even psychiatric diseases.

Recently, British scientists from the University of Leeds, together with French colleagues, found that even minor carbon dioxide poisoning disrupts the heart rhythm, which can lead to serious consequences, including death.

Prevention of carbon monoxide poisoning

The density of atmospheric air at altitudes characteristic of most of the territory of Russia is such that it is heavier than carbon monoxide. It follows from this fact that the latter will always accumulate in the upper part of the room, and outside them rise to the upper layers of the atmosphere. Therefore, once in smoky rooms, you should leave them, keeping your head as low as possible.

You can protect your home from unintended CO2 emissions using a sensor that automatically detects the concentration of this substance in the air and gives an alarm when it is exceeded.

Garages, houses with stove heating and enclosed spaces where appliances and devices that can serve as a source of carbon monoxide are located must be checked at least once a year for compliance with safety regulations. So, in garages, the ventilation system should be regularly checked, and in houses with stove heating, the health of the heating system, especially the chimney and exhaust pipe, should be checked.

When working with devices that involve combustion (for example, with a gas burner or electric welding machine), use ventilation in rooms without ventilation.

Spend as little time as possible near busy freeways.

When spending the night in a garage or a freestanding car, make sure that the engine is turned off.

Video from YouTube on the topic of the article:

is a pathological condition that occurs when inhaling air or smoke saturated with carbon monoxide. The clinical picture is dominated by disorders of the central nervous system, respiratory and cardiovascular insufficiency. A characteristic sign of poisoning is a bright hyperemia of the skin. The diagnosis is established on the basis of anamnesis data, clinical manifestations, determination of the level of carboxyhemoglobin in the blood. As an emergency, oxygen therapy and detoxification measures are carried out. Further symptomatic conservative treatment is carried out.

ICD-10

T58X47

General information

Poisoning with carbon monoxide, or carbon monoxide, develops when its maximum permissible concentration (0.08 mg / liter) in the inhaled air is exceeded. The severity of intoxication directly depends on the content of this chemical compound in the surrounding atmosphere and exposure time. Inhalation of air saturated with carbon monoxide (3-5 mg / l) for half an hour provokes severe poisoning. The intake of a mixture of gases containing 14 mg / l of carbon monoxide into the respiratory organs leads to death within 1-3 minutes. Carbon monoxide poisoning is one of the four most common poisonings, behind alcohol, drug and drug intoxication. Occurs in everyday life and at work.

Causes

Any process of incomplete combustion of organic substances is accompanied by the release of carbon monoxide. Most often, poisoning by combustion products, including carbon monoxide, occurs during a fire. In addition, due to the lack of organoleptic properties of this gas, its leakage becomes imperceptible to humans. Pregnant women, children and people with diseases of the cardiovascular system are most susceptible to harmful effects. The following factors contribute to exceeding the maximum allowable carbon monoxide content in a room:

• Household. In everyday life, carbon monoxide intoxication occurs due to improper use of the stove, gas equipment, and smoldering electrical wiring. Another common cause is being in a closed garage next to a car with a running engine. Often, signs of poisoning are observed in hookah smokers.
• Production. Excessive toxin enters the air during blasting in mines, maintenance of blast and open-hearth furnaces, and the synthesis of certain chemicals. Poisoning usually occurs when sanitary and hygienic requirements are not observed and equipment operation rules are violated.

Pathogenesis

When inhaled, carbon monoxide enters the respiratory system, where it diffuses into the blood. The gas has a high affinity for hemoglobin, myoglobin and iron-containing enzymes of the human body. It easily reacts with hemoglobin, forming carboxyhemoglobin unable to transport oxygen to tissues. Hypoxia develops. The slowing down of the dissociation of the oxygen compound with hemoglobin in the presence of carboxyhemoglobin exacerbates the oxygen starvation of all organs and tissues. At the same time, biochemical processes occurring with the participation of iron-containing enzymes are disrupted. Underoxidized metabolic products accumulate, which have an additional toxic effect on the central nervous system and other organs.

At pathological anatomical examination, the bright red color of the skin, mucous membranes, and internal organs attracts attention. There are signs of edema of the brain, lungs. Congestive plethora of internal organs is revealed. In the heart, lungs, brain, pinpoint hemorrhages, areas of degeneration and necrosis are found.

Classification

The disease can be acute and chronic. Its course depends on the concentration of carbon monoxide in the air and the time of its exposure. With a significant excess of permissible norms for a short period of time, acute poisoning occurs. Long-term regular inhalation of air with a slightly elevated content of carbon monoxide provokes the development of a chronic process. Depending on the severity of clinical manifestations, 3 degrees of poisoning are distinguished:

• Easy degree. It is characterized by transient pathological symptoms that disappear after the cessation of harmful effects. Individual manifestations may persist for days. The concentration of the pathological form of hemoglobin does not exceed 30%.
• Average degree. It develops at 30-40% of carboxyhemoglobin in the blood. Signs of poisoning are pronounced. After the provision of medical care, the symptoms stop. Residual effects disturb the victim for several days.
• Severe degree. The level of carboxyhemoglobin is 40-50%. There are severe lesions of organs and systems, often leading to death. Complications often develop. Symptoms of the disease persist for several weeks.

In addition to the classic form of carbon monoxide intoxication, sometimes there are atypical variants of poisoning, masquerading as other pathological conditions. According to clinical symptoms, experts in the field of toxicology and resuscitation distinguish between fulminant, euphoric, syncopal forms of the disease. A separate item is gunpowder disease, in which the toxic effect of carbon monoxide is observed along with other explosive and powder gases.

Symptoms

Due to the low tolerance of the brain to oxygen starvation in case of carbon monoxide poisoning, neurological symptoms come to the fore. With a mild degree of intoxication, the victim is worried about a pressing headache. It is localized mainly in the temporal and frontal regions. Accompanied by dizziness, nausea, vomiting, tinnitus. Headaches are often accompanied by visual disturbances. Patients complain of double vision, inadequate color perception. The gait becomes shaky, the speed of reactions decreases.

With further exposure to the toxin, the severity is aggravated, tonic and clonic convulsions, hyperthermia appear, consciousness is depressed up to a coma. Subsequently, retrograde amnesia is observed. From the side of the cardiovascular system, tachycardia, rhythm and conduction disturbances of the heart are detected. Often, the patient is disturbed by intense pains of a pressing and compressive nature behind the sternum and in the left half of the chest. With the appearance of bronchitis or toxic pneumonia, shortness of breath, dry cough, and a significant increase in temperature are observed.

The euphoric form of the disease is characterized by psychomotor agitation. The elated mood of the victim and the lack of criticism of his condition is replaced by delirium and hallucinations, followed by a violation of consciousness. The syncopal variant is characterized by a sharp drop in blood pressure, collapse. With a lightning-fast course of poisoning, very quickly after a short episode of convulsions, loss of consciousness and death occurs. Gunpowder disease is manifested by signs of irritation of the mucous membranes of the eyes, nasopharynx, trachea and bronchi, along with symptoms of the harmful effects of carbon monoxide.

There are no specific signs of chronic poisoning by poisonous gas. The variability of symptoms of general intoxication of the body is characteristic. Patients suffer from frequent headaches, dizziness, experience weakness, fatigue and irritability. There is weight loss, hair loss, decreased vision and hearing. The function of the endocrine glands, the immune system is disturbed.

Complications

With the timely removal of the victim from the lesion, signs of mild intoxication disappear on their own, the functions of the main body systems are restored without consequences. Acute moderate and severe poisoning is often complicated by neurological disorders. The victim suffers from headaches for a long time. Perhaps the development of mononeuritis of various localization, paresis, parkinsonism. Complications from the circulatory system are manifested by intracardiac blockades, vascular thrombosis. Breathing air saturated with toxic carbon monoxide during pregnancy leads to fetal malformations. Severe poisoning often causes the death of the victim.

Diagnostics

Of great importance in the diagnosis of carbon monoxide poisoning are anamnestic data and examination of the victim. A characteristic sign of serious intoxication is the bright scarlet color of the skin. Toxicologists and resuscitators do not distinguish pathognomonic physical symptoms of dangerous carbon monoxide poisoning. Physical examination reveals tachycardia, hyperthermia, frequent, in severe cases, intermittent breathing (Cheyne-Stokes), lowering blood pressure. Help to confirm the diagnosis:

• Laboratory tests. In the study of peripheral blood, erythrocytosis and a high level of hemoglobin are observed. The number of leukocytes is also increased, there is a stab shift in the leukocyte formula, while the erythrocyte sedimentation rate is reduced. Determining the level of carboxyhemoglobin and its ratio with normal blood hemoglobin makes it possible to judge the severity of poisoning.
• X-ray examination of the chest. Signs of acute pulmonary emphysema and stagnation in the pulmonary circulation are revealed. Expansion of the roots of the lungs is observed. Fine- and large-focal shadows with blurred contours on both sides are determined. Radiological changes usually resolve completely within 7-10 days.

Treatment for carbon monoxide poisoning

If carbon monoxide poisoning is suspected, it is urgent to evacuate the victim from the danger zone, provide him with fresh air, stimulate breathing, and warm him up. Oxygen therapy is prescribed, an antidote is introduced. If necessary, resuscitation measures are taken. The patient is subject to mandatory hospitalization. The hospital provides detoxification and symptomatic therapy. Intravenous infusions are prescribed, cardiotropic, anticonvulsant drugs, corticosteroids, diuretics, vitamins are administered. In hyperthermic syndrome, craniocerebral hypothermia is performed. Severe poisoning is an indication for hyperbaric oxygen therapy.

Forecast and prevention

The prognosis depends on the severity of the pathological process, the timeliness and quality of medical care. Light poisoning stops without consequences, moderate and severe often leads to complications from the central nervous and cardiovascular systems. It is not possible to predict the recovery of a patient in a coma. A poor prognostic sign is the aggravation of neurological symptoms during the first 48 hours against the background of intensive treatment.

For preventive purposes, fire safety rules must be observed. In order to avoid household and industrial poisoning, do not use faulty gas and stove equipment, electrical appliances. It is not recommended to be in the garage with the car engine running. Production areas must be well ventilated.

One of the strongest poisons that people encounter at home or at work is carbon monoxide (CO). This gaseous substance is heavier than air, transparent, colorless, odorless, is formed in almost all types of combustion and is therefore called carbon monoxide. Its insidiousness also lies in the fact that it easily penetrates through filtering materials and other obstacles: walls, windows, soil, and such protective equipment as filtering respirators do not save from damage.

The presence of CO in the air can only be determined using special instruments. It is also felt if people begin to rapidly develop the characteristic symptoms of intoxication.

Carbon monoxide poisoning is an acute pathological condition that occurs due to the ingestion of CO in a certain concentration in the human body. In the common people, it can be called burning out, and carbon monoxide itself can be called lighting. Its toxic effect on the body is so dangerous that without the provision of qualified assistance, serious consequences, including death, can occur.

CO poisoning is the most common type of intoxication obtained by inhalation. At the same time, the number of cases that ended in death is quite large - 18%. They are in second place after deaths caused by alcohol overdose.

Main sources of CO emission

Carbon monoxide or lighting gas poisoning, with significant health effects, can occur near the following sources:

• stove heating, fireplaces or sauna stoves in case of improper operation;
• a garage with poor ventilation when there is a car with a running engine in it;
• high concentration of exhaust gases in urban air;
• malfunction of household equipment operating on propane;
• filling with low-quality respiratory mixture of breathing apparatus;
• prolonged burning of kerosene in a small, poorly ventilated room;
• fires;
• gasified premises operating gas equipment;
• possible accidents at the enterprises of the metallurgical and chemical industries or large-scale explosions at military ammunition depots.

Why and why is carbon monoxide dangerous?

The strength of carbon monoxide on the human body and the severity of poisoning will depend on several reasons:

1. Actual concentration of carbon monoxide.
2. The duration of the damaging effect.
3. Ambient temperature.
4. The state of health and the immune system, including the presence of anemia, chronic or acute pathologies of the pulmonary and / or cardiovascular system.
5. The level of physical exhaustion of the body immediately at the time of CO action - the more physical activity was before the “contact”, the more severe the consequences will be.

Men are less resistant to CO2 than women. In addition, the category particularly sensitive to the effects of carbon monoxide includes:

1. Heavy smokers and alcoholics - compared to others, they can hardly tolerate even mild poisoning.
2. Pregnant and lactating women.
3. Children and teenagers.

Intoxication and its consequences for the future newborn are especially difficult. The fetus suffers from tissue hypoxia more pronounced and longer than the expectant mother herself.

The accumulation of carbon monoxide in the house, in the air of the work area or in a fire, equal to 14.08 mg / l, causes vomiting, loss of consciousness and death in just 1-3 minutes.

The smallest concentration of carbon dioxide at which the first disturbances occur in the body (the light and color sensitivity of the eyes begins to fall) is 0.006 mg/l at an exposure time of 25 minutes.

The maximum allowable concentration (MPC) or the maximum allowable level of CO is 7.04 mg/l. In 1-2 minutes there will be a dull headache and severe dizziness, and in 10-15 minutes there will be a loss of consciousness. Nevertheless, when providing the necessary assistance with such MPC, the consequences and outcome can still be quite favorable.

The effect of CO on the human body

CO can enter the body only by inhalation - by inhalation. The vast majority of carbon monoxide is also excreted through the lungs, and very small amounts leave the body with sweat, feces and urine. This cleansing takes 12 hours. Only a negligible amount of CO2 that does not have a harmful effect on health can remain dissolved in the blood plasma.

Carbon monoxide poisoning occurs due to the fact that it has a direct toxic effect on the cells of the body:

• the combination of hemoglobin with carbon monoxide leads to the formation of carboxyhemoglobin, which cannot carry oxygen, and as a result, acute transport hypoxia develops, quickly leading to oxygen starvation of the body as a whole;
• the interaction of CO (up to 50%) with other hemoproteins leads to blockade in the respiratory chains of mitochondria, which disrupts the utilization of O2 by the cell and causes acute tissue hypoxia;
• carbon monoxide disrupts the work of skeletal muscles and the heart muscle by blocking myoglobin and the formation of carboxymyoglobin;
• due to reactive developing general hypoxia, multiple microhemorrhages quickly occur, disturbances in the tissues of the gray and white medulla, embryonic tissues are affected;
• supersaturation of blood with free O2 leads to the development of oxidative stress;
• CO directly affects cell membranes, which negatively affects the metabolism of amino acids and catecholamines, thereby accelerating the rate of natural cell death.

Attention. Carbon monoxide intoxication, which caused a violation of the blood supply to the white matter of the brain, can cause delayed progressive demyelinating neuropathy.

Clinic of poisoning

Obvious signs of poisoning begin to appear when CO molecules have captured about 20% of the hemoglobin in erythrocytes. In this case, the symptoms continue to depend on the degree of carbon monoxide poisoning. Moderate severity occurs when the level of carboxyhemoglobin reaches 50%, severe - at 60-70%.

Symptoms of carbon monoxide poisoning (characteristic in order of occurrence)
Easy degree	Average degree +	Severe degree ++
redness of the skin and mucous membranes decreased perception of color and light headache - hoop slight dizziness rolling nausea sore throat obligatory recurrence of symptoms after 3-4 hours	pallor of the skin development of severe weakness "feet wobble" hearing loss pressing pains in the region of the heart, arrhythmia bullous dermatitis, bedsores confusion short faint (required)	vomit shortness of breath cramps and flaccidity of the neck muscles kidney failure development of pulmonary and cerebral edema deep fainting coma with an exit in 5-6 hours in acute intoxication psychosis

The most unfavorable prognostic sign is a coma that lasts more than 48 hours.

The question of the effect of alcohol on the severity of poisoning is not fully understood. On the one hand, lethal concentrations of CO increase if ethanol is present in the blood - thus, drinking alcoholic beverages before the onset of poisoning may be a protective factor. On the other hand, chronic alcoholics are more susceptible to the effects of carbon monoxide.

There is evidence of an increase in the toxic effect of CO on the body, in which barbiturates or narcotic substances are present.

Pathologies that can aggravate the classic clinical picture of poisoning:

1. The brain is the first to respond to reactive oxygen starvation and oxidative stress - epileptic seizures, inadequate mental reactions, the whole spectrum of hallucinations, aggression, “nakedness of desires” are possible.
2. Supersaturation with carboxymyoglobin - hypertension and tachycardia, which, against the background of oxygen hypoxia, can cause cardiac asthma, myocarditis, myocardial infarction.
3. The defeat of the pulmonary system - secondary pneumonia.
4. Damage to the nervous system - quite persistent inflammation of the type of cervical-brachial plexitis, affecting the radial, ulnar or median nerve, as well as long-term polyneuritis of the auditory, optic, sciatic or femoral nerve.

Complications after CO poisoning

The consequences of carbon monoxide intoxication can be:

• memory lapses - lack of memories of the circumstances under which the poisoning occurred;
• obsessive headaches, bouts of nausea and dizziness;
• a series of fainting states;
• symptoms of extrapyramidal insufficiency - changes in muscle tone: twitching, immobilization of certain parts of the muscles (or a combination thereof);
• in the young, twitching involuntary movements that come on suddenly;
• in the elderly - dementia and deep depressive states;
• manifestations of mental illness that proceeded in a latent form.

First aid for carbon monoxide poisoning

In case of carbon monoxide poisoning, first of all, it is necessary to leave the place where it occurred as soon as possible. In the event of an accident or fire, in which large areas are contaminated, PMK gas masks and respirators equipped with filters of 2 and 3 efficiency classes (hopkalite cartridges) are recommended to help those who have been poisoned and take them out of the affected area. Only when they are used is the maximum possible protection achieved.

In any case, it is important to think about your own safety and be sure to make sure that the ambulance team is called, and if not, then call it yourself. The clinical picture of carbon monoxide poisoning is not always true, and additional risks of developing long-term consequences oblige to call a specialist for examination, consultation, and, if necessary, hospitalization of the victim.

Emergency first aid for carbon monoxide poisoning is performed in the following order:

1. If the poisoned person was taken out of the affected area unconscious, put him on his side and check that the airways are free. Unbutton a tight collar, loosen a tightening belt or other items of clothing.
2. Next, smell ammonia and carry out rubbing, which will help stimulate blood circulation. In the absence of a heartbeat, artificial respiration and chest compressions are required - 2:36.
3. If the poisoned person is conscious, you need to put cold compresses (or, conversely, mustard plasters) on the chest and provide the patient with a plentiful hot and sweet drink - for example, tea or coffee.
4. Ensure complete physical and emotional rest. Do not leave the poisoned person alone, conduct calm conversations with him.

If carbon monoxide poisoning occurs, then first aid, including first aid (PMP), which will really help the body, is the introduction of a special antidote called acyzol. It is the speed of its administration from the moment of poisoning that will affect the development of further symptoms.

Treatment for carbon monoxide poisoning

Carbon monoxide poisoning, symptoms and treatment will be dependent, since the nature of the signs will make the primary diagnosis. The main diagnostic manipulation to determine the severity of the lesion is considered to be blood sampling from a vein for its biochemical analysis.

Under the conditions of treatment in a hospital, the algorithm of medical care provides for the following procedures:

• hyperbaric oxygenation in a pressure chamber;
• artificial ventilation of the lungs to accelerate the removal of CO;
• transfusion of red blood cells or whole blood;
• droppers with hypertonic or cardiotonic solutions.

Preventive measures

In factories where there is a high probability of an accidental CO leak, not only are safety instructions signed, but they also regularly conduct practical training so that every person working at the plant knows what to do in case of carbon monoxide poisoning.

Prevention consists of the following activities:

1. In the case of work at an enterprise using CO, strictly observe the established safety standards and rules of conduct in emergency situations.
2. Monitor the health of the heating equipment. In the event of a malfunction, do not continue to use it under any circumstances.
3. Clean chimneys annually.
4. Make sure that there is sufficient air ventilation in rooms where appliances with an open flame are used.
5. Do not turn on the car engine for a long time in the garage.
6. Do not spend a lot of time near highways with heavy traffic.

The last point should be paid special attention to those who live in large metropolitan areas. Adhering to a healthy lifestyle, many people perform daily runs along the paths along the highways or located next to them and below, but at this time irreparable harm is caused to the body. Health jogging should be done in specially equipped places or park areas.

Carbon monoxide poisoning is a common and severe form of intoxication that can cause serious damage to human organs and systems, even death. The consequences of the transferred poisoning often lead to loss of working capacity and disability of the victims. In Russia, carbon monoxide poisoning ranks first among the causes of death from acute poisoning. Deaths occur predominantly at the scene. Timely assistance to the victim, carried out at the scene, during transportation and in hospital conditions, can significantly reduce the risk of severe complications and the number of deaths.

Why is carbon monoxide dangerous?

Carbon monoxide, also known as carbon monoxide or carbon monoxide (CO), is formed during the incomplete combustion of substances containing carbon. Has no color or smell. It is able to penetrate through partitions, walls, soil layers. It is not absorbed by porous materials, therefore filtering gas masks will not protect against carbon monoxide poisoning. Carbon monoxide is a poison of rapid general toxic action, with its concentration in the air of 1.28% or more, death occurs in less than 3 minutes.

The main damaging effects of CO on the body

1. Carbon monoxide blocks the process of delivering oxygen to organs and tissues.

Carbon monoxide is considered a blood poison, as it primarily affects blood cells (erythrocytes). Normally, erythrocytes carry oxygen to organs and tissues with the help of a special protein - hemoglobin. Once in the blood, carbon monoxide binds tightly with hemoglobin, forming a destructive compound - carboxyhemoglobin. In this case, red blood cells lose their ability to carry oxygen and deliver it to vital organs. The whole body begins to experience oxygen starvation (hypoxia).

Nerve cells are most sensitive to lack of oxygen. And therefore, the first symptoms of carbon monoxide poisoning are associated with disruption of the nervous system (headache, dizziness, nausea, impaired coordination, etc.).

1. Carbon monoxide damages the heart muscle and skeletal muscles

Carbon monoxide binds to a protein in skeletal muscle and heart muscle (myoglobin), which is manifested by general muscle weakness and a decrease in the pumping function of the heart (shortness of breath, palpitations, weak pulse).

The effect of carbon monoxide on the body

The main causes of carbon monoxide poisoning

1. Inhalation of vehicle exhaust gases, long stay in closed garages in a car with a running engine;

2. Carbon monoxide poisoning in everyday life: malfunction of heating devices (fireplaces, stoves, etc.), leakage of household propane gas (propane contains 4-11% CO), prolonged burning of kerosene lamps, etc.

3. Poisoning in fires(buildings, transport wagons, elevators, aircraft, etc.)

Signs and symptoms of carbon monoxide poisoning

The manifestation of symptoms in case of carbon monoxide poisoning directly depends on its concentration in the inhaled air and on the duration of its exposure to the human body. So, with a concentration of carbon monoxide in the atmosphere of 0.02-0.03% and an exposure time of 4-6 hours, the following symptoms will appear: headache, dizziness, nausea, and impaired coordination of movements. And at a concentration of 0.1-0.2% and a duration of exposure of 1-2 hours, coma occurs, respiratory arrest and death is possible.

Symptoms of carbon monoxide poisoning

What is affected?	Light and medium degree	Severe degree	Origin mechanism
CNS (central nervous system)	Headache, in the temples and in the forehead, girdle character Dizziness Noise in ears Flickering before the eyes Nausea, vomiting Cloudy mind Movement coordination disorder Decreased visual acuity and hearing Brief loss of consciousness	Loss of consciousness Possible convulsions Possible involuntary urination or defecation	The most sensitive organ to a lack of oxygen is the brain and all adjacent nerve structures. Thus, all primary symptoms like headache, dizziness, tinnitus, nausea are the result of nerve cells suffering from oxygen starvation. All subsequent symptoms such as impaired coordination, loss of consciousness, convulsions are the consequences of a deeper damage to the nervous structures from a lack of oxygen.
The cardiovascular system	heartbeat, Rapid pulse (more than 90 beats per minute), There may be pressing pains in the region of the heart.	The pulse is quickened (130 beats per minute or more), but weakly palpable, High risk of myocardial infarction	The body tries to compensate for the lack of oxygen by working the heart more intensively, pumping as much blood as possible (heartbeat, rapid pulse). Pain is a signal of a lack of nutrition of the heart muscle. Complete disruption of oxygen delivery to the heart muscle leads to a heart attack.
Respiratory system	rapid breathing, Shortness of breath (shortness of breath)	Breathing shallow, intermittent	Rapid breathing is a compensatory mechanism in response to a lack of oxygen. In the severe stage, the center of regulation of respiration is damaged, which is accompanied by superficial and irregular respiratory movements.
Skin and mucous	Facial skin and mucous membranes are bright red or pink	Skin and mucous membranes are pale, with a slightly pinkish tint	The result of increased blood flow to the head area. In the severe stage, the body becomes exhausted and loses the ability to pump blood efficiently. In places of insufficient blood circulation, the skin turns pale.
The content of carboxyhemoglobin in the blood	20-50 %	Over 50%

Symptoms of atypical forms of carbon monoxide poisoning

The form	Symptoms	Origin mechanism
swoon form	Paleness of the skin and mucous membranes Marked decrease in blood pressure (70/50 mm Hg or less) Loss of consciousness	The exact mechanism is unknown. It is assumed that under the influence of a lack of oxygen and the toxic effect of CO, the center of regulation of vascular tone is affected. This leads to a sharp drop in pressure and loss of consciousness.
Euphoric form	Physical and mental arousal Mental disorders: delusions, hallucinations, unmotivated actions, etc. Loss of consciousness Violation of respiratory and cardiac activity	The toxic effect of carbon monoxide on the centers of higher nervous activity.
Fulminant form of carbon monoxide poisoning, occurs when the concentration of carbon monoxide in the air exceeds 1.2% per 1 m³. In a matter of minutes, the concentration of carboxyhemoglobin in the blood of the victim reaches 75% or more percent. Which in turn is accompanied by loss of consciousness, convulsions, respiratory paralysis and the development of death in less than 3 minutes.

What are the consequences of carbon monoxide poisoning?

Carbon monoxide poisoning entails a number of complications from the organs and systems of the body. Allocate early and late complications.

Consequences of carbon monoxide poisoning
What is affected?	Early Complications acute poisoning (first 2 days after poisoning)	Late Complications acute poisoning (2-40 days)	Origin mechanism
Nervous system	Prolonged headaches and dizziness Damage to the peripheral nerves, which is accompanied by impaired motor activity and loss of sensation in the limb Bowel and bladder disorders Hearing and vision disorders Cerebral edema, the first symptoms of fever Exacerbation and development of mental illness	Memory loss Decreased intelligence psychoses Apathy parkinsonism Movement disorders (chorea) paralysis Blindness Dysfunction of the pelvic organs	Damage to the white and gray matter of the brain under conditions of oxygen starvation Direct toxic effect of carbon monoxide on nerve cells. CO binds to a protein in the membranes of nerve cells (myelin), disrupting the conduction of an impulse along the nerve endings.
The cardiovascular system	Sudden death Rhythm disturbance Violation of the coronary circulation	myocardial infarction angina pectoris Myocarditis cardiac asthma	lack of oxygen Direct damaging effect of CO on heart cells CO binding to a protein in cardiac muscle cells (myoglobin)
Respiratory system	Toxic pulmonary edema	pneumonia	Toxic effect of CO on lung tissue Weakening of the defense mechanisms of the lungs Joining the infection

What determines the outcome of poisoning?

• From the concentration of carbon monoxide in the inhaled air
• From the duration of exposure to carbon monoxide on the human body
• From the degree of physical activity of the victim at the time of the action of the poison (the higher the load, the more severe the consequences of poisoning)
• Women are more resistant to carbon monoxide than men
• Poisoning is difficult to tolerate: malnourished people suffering from anemia, bronchitis, bronchial asthma, alcoholics, heavy smokers.
• Children, adolescents and pregnant women are especially sensitive to the action of the poison.

Help with carbon monoxide poisoning

Do I need to call an ambulance?

Not really	Why?
Yes need! And this must be done as soon as they saw the victim.	Only a doctor is able to objectively assess the condition of the victim. Symptoms and signs of poisoning do not always indicate the true severity of poisoning. Perhaps the development of long-term complications, after 2 days or several weeks. Timely drug treatment can reduce the percentage of death and disability as a result of carbon monoxide poisoning.
Indications for hospitalization for carbon monoxide poisoning: All patients with moderate and severe poisoning (with a concentration of carboxyhemoglobin in the blood of more than 25%) Pregnant women (with a concentration of carboxyhemoglobin in the blood of more than 10%) Victims with cardiovascular diseases (with a concentration of carboxyhemoglobin in the blood of more than 15%) Victims who lost consciousness, as well as those with neurological disorders (impaired coordination, delirium, hallucinations, etc.) Victims with low body temperature (below 36.6 °C)

How to help the victim on the spot?

Help Steps		How?	What for?
Stop exposure to CO		Remove to fresh air, or Shut off the CO source, or Put on an oxygen mask or gas mask (with a hopcalite cartridge)	With every minute of carbon monoxide exposure to the body, the possibility of survival is reduced.
Ensure airway patency and adequate oxygen delivery		Remove the victim to the open air, or put on an oxygen mask (if any), or open windows and doors indoors. Examine and clear the airways, Loosen from tight clothing, tie, shirt Lay victim on side	For half an hour in the fresh air, the content of carboxyhemoglobin in the blood decreases by 50%. The position on the side prevents the tongue from sinking
Stimulate breathing and provide blood flow to the head, bring to consciousness		Give a sniff of ammonia (no closer than 1 cm from the nose) Rub the chest, put mustard plasters on the chest and back (if any) Give hot tea, coffee	Ammonia stimulates the respiratory center and brings out of unconsciousness. Rubbing the chest and mustard plasters improve blood circulation in the upper parts of the body, which increases cerebral circulation. Tea and coffee contain caffeine, which has a tonic effect on the nervous system, and also stimulates breathing.
If necessary, perform chest compressions and artificial respiration		One cycle: 2 breaths and 30 chest compressions. See Chest Compression and CPR	Provides blood circulation and oxygen delivery to organs and tissues. Supports the vital functions of the body until the arrival of medical assistance.
Provide peace, protect from unnecessary waste of energy		Lay on side Warm, protect from hypothermia, wrap up. But do not overheat the victim.	Lay down to reduce oxygen consumption. When hypothermia or overheating, the body spends a lot of energy to maintain the necessary balance.
Administer an antidote		Oxygen 12-15 liters per minute, for 6 hours (given with: oxygen mask, oxygen tent, or mechanical ventilation). Acizol, ampoules 6% -1.0 ml, Capsules 120 mg. Treatment: 1 ml intramuscularly, as soon as possible after poisoning. Re-introduction after 1 hour. For prevention: 1 ml intramuscularly, 20-30 minutes before entering the danger zone.	Oxygen competes with CO for a place "on hemoglobin", thus, the more oxygen there is, the more chances it has to displace CO and take its natural place. Acizol- an antidote of carbon monoxide, accelerates the breakdown of the pathological compound - carboxyhemoglobin and promotes the addition of oxygen to hemoglobin. Reduces the toxic effect of CO on cells. It is also used as a prophylactic, several times reduces the harmful effects of carbon monoxide on the body.