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Carbon Monoxide Poisoning
#1
Don't know if any of you have seen Junior Paramedics, it is on BBC 3 or 4.
There was an episode tonight where they attended a house fire and were treating a male in the ambulance.
While they didn't show the full patient assessment, the guy had clearly inhaled smoke. He was coughing and medic set there was a rattle from one lung but could be asthma.
What surprised me was that no O2 administered that could be seen at any stage, but hey said spO2 was 95%. They seemed to be reading SpO2 from the Defib/monitor rather than a CO monitor but I could be wrong.
After about five minutes while patient was talking fine but coughing at intervals he collapsed....
When he came around, he was complaining of headache.
I was surprised he was put immediatly put on 100% O2 and surely an SpO2 reading shouldn't be considered as accurate if they were considering CO poisoning???
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#2
I suppose we have nothing else to go on......we don't have CO monitors, we only have SPO2 which are part of our machines we use. 

If it was 95% then I presume that would be accurate? It's still measuring the amount of O2 being carried in the blood.......I remember seeing that episode a few months back and I couldn't help but wonder why he "collapsed" at that late stage......I thought it was a bit iffy myself. 
It's not the HSE's opinion, it's not managements opinion, it's mine. All mine.
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#3
Can't be accurate MRX. SpO2 measures the amount of gas carried by Haemoglobin......that's normally oxygen but in a smoke environment it could be carbon monoxide (which Haemoglobin likes more than O2)
We were always trained, 100% O2 if CO2 poisoning was suspected as SpO2 was unreliable.
“The difference between genius and stupidity is; genius has its limits.”
― Albert Einstein
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#4
I thought that too, I understood that you cant differentiate O2 from CO by SpO2 monitoring?
Either way was it not strange that he wasn't given oxygen as a precaution anyway??
Far from an expert but I would have thought that 95% SpO2 and exposure to smoke might warrant to quite a colleague " worth giving him a dart of oxygen"?
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#5
Well well well......every day is a school day! I didn't know that......I would've thought SPO2 was accurate......

As regards O2, there seems to be a shift away from banging on O2 for everybody......when I trained it was 100% O2 via NRB for EVERYTHING!! 

Here's an interesting article........

http://www.emsworld.com/article/10915304...uch-oxygen
It's not the HSE's opinion, it's not managements opinion, it's mine. All mine.
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#6
I think it's gone the other way now where people will keep people off oxygen that should get it while they wait for spo2 while the patient struggles away.
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#7
(14-10-2014, 08:41 AM)coastguardsteve Wrote: I think it's gone the other way now where people will keep people off oxygen that should get it while they wait for spo2 while the patient struggles away.

Ya I've seen a lot of vols making too much emphasis on SpO2 for O2 and holding back O2. If a patient needs it they need it.

When a reliable SpO2 is gotten then drive on to titrate.......and No, I don't think a €20 SpO2 finger bob is a reliable reading......

Brigade, new CPGs for EFR now allow ye to use SpO2 and so yer next refresher should in theory upskill ye.
“The difference between genius and stupidity is; genius has its limits.”
― Albert Einstein
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#8
This is the stuff that causes the problem
http://en.m.wikipedia.org/wiki/Carboxyhemoglobin

Looks just like normal haemoglobin to the SPO2 meter.
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#9
(14-10-2014, 09:27 AM)Hooch Wrote:
(14-10-2014, 08:41 AM)coastguardsteve Wrote: I think it's gone the other way now where people will keep people off oxygen that should get it while they wait for spo2 while the patient struggles away.

Ya I've seen a lot of vols making too much emphasis on SpO2 for O2 and holding back O2. If a patient needs it they need it.

When a reliable SpO2 is gotten then drive on to titrate.......and No, I don't think a €20 SpO2 finger bob is a reliable reading......

Brigade, new CPGs for EFR now allow ye to use SpO2 and so yer next refresher should in theory upskill ye.

We've been using SpO2 for years!
We take a alternative view to CPGs !!
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#10
As you should.... As long as the limitations of spo2 are understood then it is a great piece of kit! it most often errs on the low side so bar CO poisoning a high reading is reliable.... It's the low readings that catch people.... It's the 88% patient with no signs of low perfusion or respiratory distress that get O2 when they prob don't need it due to an error in the probe due to cold, shaking etc
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#11
Also, asthma does not present as a rattle nor will asthma be present in only one lung. Asthma will be heard as a wheeze.
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#12
As 999 said…….I remember when Salbutamol came on the matrix anyone who had lungs seemed to get it…….wet, wheezy, infected, dry, rattles,   etc etc…… 75

Asthma is bronchospasm heard as a wheeze……
It's not the HSE's opinion, it's not managements opinion, it's mine. All mine.
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#13
CO has a greater affinity to bond with haemaglobin than oxygen and readily that's up space on the haemaglobin receptors. The patient will have a nice pink or cherry red skin colour & healthy glow about them.
SPO2 is useless in those cases
Look at the nostrils for signs of severe smoke inhalation and the back of the throat for redness
Oxygen would be the definite course of action unless you feel the need to bag the patient

If getting worse fluid therapy would be the next step and possibly looking at hyperbaric chamber use.
The man who never made a mistake never made anything!
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#14
Talking about this with an ECP he was saying forget the SPO2 if there is smoke in nose and mouth high risk of airway burns. So whack on O2 and he'd be intubating as soon as he could before the trachea swells and he has to go for a cryc
Those who can, do.

Those who can't do, teach.

Those who can't do or teach....... Manage!
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#15
I think the ECP needs to take a chill pill. So would he do an RSI to tube him? In all my years I've never seen it. Either you have a little bit of smoke or you are dead. 
It's not the HSE's opinion, it's not managements opinion, it's mine. All mine.
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#16
(14-10-2014, 05:19 PM)vidar Wrote: Talking about this with an ECP he was saying forget the SPO2 if there is smoke in nose and mouth high risk of airway burns. So whack on O2 and he'd be intubating as soon as he could before the trachea swells and he has to go for a cryc

I assume this is dictated by patient presentation? Especially if it is a slow exposure to Carbon Monoxide poisoning.
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#17
(14-10-2014, 09:12 PM)MRX Wrote: I think the ECP needs to take a chill pill. So would he do an RSI to tube him? In all my years I've never seen it. Either you have a little bit of smoke or you are dead. 

Totally agree with you on that MRX, suppose he may have been talking about a severe case but wouldn't want to be using RSI on every smoke inhalation case
The man who never made a mistake never made anything!
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#18
No he was just saying what worst case would be
Those who can, do.

Those who can't do, teach.

Those who can't do or teach....... Manage!
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