This is the updated version of the Co-Ox/Carbon Monoxide poisoning I have put together for my department.

1. CO-Oximetry Use of the Rad-57 by ACP

4. Background

13. Normal COHb Levels 3-5 Methylene chloride (100 ppm for 8 hours) Up to 20 Cigars 5 Urban commuter 7-9 2-3 packs per day 5-6 1 pack per day Tobacco smokers: 0.4-0.7 Endogenous (normal heme catabolism) COHb (%) Source

14. Signs and Symptoms vs. Exposure Levels Death 1-3 minutes 12,800 H/A, dizziness, nausea. Death within 25-30 minutes. 1-2 minutes 6400 H/A, dizziness, nausea. Death within one hour. 5-10 minutes 3200 H/A, dizziness, nausea. Death within 1 hour. 20 minutes 1600 Dizziness, nausea, convulsions. Unconscious within 2 hours. Death within 2-3 hours. 45 minutes 800 Serious H/A, -other symptoms intensify. Life-threatening >3 hours 1-2 hours 400 Mild headache, fatigue, nausea, dizziness 2-3 hours 200 Symptoms Duration of exposure PPM

15. Signs and Symptoms vs. COHb Levels Death Fatal >60% Dysrhythmias, hypotension, cardiac ischemia, palpitations, respiratory arrest, pulmonary edema, seizures, coma, cardiac arrest Severe 41-50% Confusion, syncope, chest pain, dyspnea, tachypnea, tachycardia, weakness Moderate 21-40% H/A, N/V, dizziness, blurred vision Mild <15-20% S and Sx Severity COHb

18. The Rad Series

24. Carbon Monoxide: Suggested Triage Algorithm SpCO TRIAGE ALGORITHM Measure SpCO 0-3% >3% No further medical evaluation of SpCO needed Loss of consciousness or neurological impairment or SpCO >25% Yes No Transport on 100% oxygen for ED evaluation. Consider transport to hospital with hyperbaric chamber SpCO >12 SpCO <12 Transport on 100% oxygen for ED evaluation Symptoms of CO exposure? Transport on 100% oxygen for ED evaluation No further evaluation of SpCO needed. Determine source of CO if nonsmoker Yes No

25. KEY POINT: Some systems use an SPCO of 11% as threshold for transport.

45. Questions?