Reminding patients to get their flu shots is a no brainer for providers but it shouldn't be their only concern. Causing the same flu-like symptoms including headache, vomiting, chest pain, weakness and fatigue is carbon monoxide poisoning. Unlike the flu it can take just minutes for a person to die from it, accounting for more than 400 deaths per year. Fire departments across the country respond to thousands of non-fire CO incidents every year most of which occur during the early morning hours.
People can be subjected to carbon monoxide fumes at any time throughout the year whether it's from a car left running in the garage, a lawn mower or even a power washer. The concern however increases during the winter season.
"There is usually seasonality to CO poisoning, often in the fall-early winter when families first turn on malfunctioning heating units," explained David Mathison, MD, a pediatric emergency physician at PM Pediatrics and Children's National based in New Jersey. "There was a horrible case in NJ recently where a dad was caught in a snowstorm with his family in their car. He got out of the vehicle to shovel the snow and was unaware that the snow was blocking the exhaust fumes from the tailpipe."
When a snowstorm causes the power to go out, generators become another big concern as they're commonly used as backup heating. The problem is they're not always used properly. The Occupational Safety and Health Administration advises people keep a generator outside of the home with 3 to 4 feet buffer of space on all sides and away from windows or vents where the fumes could funnel into the house. They should never be used indoors or in enclosed spaces like garages or basements because even open windows do not allow for adequate ventilation and can be a threat to an entire family especially while everyone is asleep.1
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"The presenting symptoms are so vague," said Dale Crockett, MD, an ER Physician at Greater San Antonio Emergency Physicians recalling February of 2014 when he treated a man for vague dizziness, headache and nausea. "It's complaints that we see on a daily basis but for other reasons." Crockett and his team helped diagnose the man, his pregnant wife and young child with CO toxicity sending the fire department to their apartment complex where they found more sick people and a faulty water heater.
"They didn't come in until mid to late afternoon before they showed up so they must've been sitting at home all day thinking they had just caught some bug," said Crockett.
Besides mimicking influenza, CO poisoning can present itself as myocardial infarction, syncope or changes in mental status. Older adults are more likely to develop brain damage from prolonged exposure which places urgency on proper diagnosis. For example if a 75-year-old woman visits the hospital for chest pain, treated and subsequently released, she may return home where the odorless and invisible gas is still waiting for her. Providers should be especially aware if they know their patient lives alone and possible financial implications could cause them to use their oven or a space heater to stay warm.2
Clinicians confirm a carbon monoxide diagnosis with a blood test which measures the amount of hemoglobin that has bonded with CO. Children who take more breaths will often have a higher level than their parent living in the same environment. In most cases, clinicians do not have to account for other variables in children like smoking or working around cars which can also increase a person's hemoglobin.
The colorless gas is also a big concern for pregnant women because the symptoms can be confused with those of normal pregnancy like tiredness and nausea. Fetal blood cells take up carbon monoxide more readily than adult blood cells do according to the Mayo Clinic which is the same reason mothers are urged to quit smoking during pregnancy.3
Treatment and Prevention
"For patients awake/alert, we use a non-rebreather face mask with 100% fractionated oxygen," said Mathison. "This is basically the highest concentration of oxygen we can deliver passively-allowing the patient to breath on his/her own."
In more severe cases hyperbaric therapy is administered to speed the replacement of carbon monoxide with oxygen in the blood. This is also done to protect heart and brain tissue which is most at risk of permanent damage.
Patients are then monitored and sometimes retested to ensure CO levels in the blood are decreasing until they return to normal and the patient can be released from the facility.
The Centers for Disease Control and Prevention recommends home owners have their heating systems, water heater and any other gas, oil or coal burning appliances serviced by a qualified technician every year. They also advise homes have CO detectors and that batteries are checked or replaced regularly.
"It's challenging," noted Crockett. "We just have to remain vigilant."
Chelsea Lacey-Mabe is a staff writer. Contact: email@example.com