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colorless, odorless gas produced by burning material containing carbon can cause brain damage and death produced by common household appliances

Automobile exhaust fumes Burning charcoal Poorly ventilated wood or coal stoves Malfunctioning furnaces

Gas water heaters Kerosene space heaters Propane heaters and stoves Gasoline and diesel powered generators Cigarette smoke Propane-fueled forklifts Gasoline powered concrete saws Indoor tractor pulls Any boat with an engine Spray paint, solvents, degreasers, and paint removers
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Hgb normally carries 98% of the available O2 to the tissues When inhaled, CO readily diffuses across the alveolar membrane where it competes with O2 for the same binding sites on the Hgb molecule CO has an affinity for Hgb that is up to 250 times greater than that of O2
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Decreased O2 delivered to the tissues reduces the ability of Hgb to transport O2 CO combines with Hgb to form carboxyhemoglobin (COHgB), which causes a shift to the left in the O2 dissociation curve Tissue hypoxia results from the decreased O2 carrying capacity of Hgb and not from change in partial pressure of O2, which remains normal
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shows the percent saturation of haemoglobin at various partial pressures of oxygen P value 50 75 dangerous (pH 7.2) P value 75 90 relatively safe (pH 7.4 7.6) P value 90 100 normal
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Temperature
Increasing the

temperature denatures the bond between oxygen and hemoglobin, which increases the amount of oxygen and hemoglobin and decreases the concentration of oxyhemoglobin. The dissociation curve shifts to the right
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pH
A decrease in pH by

addition of carbon dioxide or other acids causes a Bohr Shift. A Bohr shift is characterized by causing more oxygen to be given up as oxygen pressure increases. The dissociation curve shifts to the right.
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Organic Phosphates
2,3-Diphosphoglycerate

(DPG) is the main primary organic phosphate. DPG binds to hemoglobin which rearranges the hemoglobin into the Tstate, thus decreasing the affinity of oxygen for hemoglobin (T and R State). The curve shifts to the right.
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Hemoglobin binds to carbon monoxide preferentially compared to oxygen COHgb will not release the carbon monoxide, and therefore hemoglobin will not be available to transport oxygen from the lungs to the rest of the body In large quantities, the effect of COHgb is death - known medically as carboxyhemoglobinemia or CO poisoning
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Smaller quantities COHb leads to oxygen deprivation of the body causing tiredness, dizziness and unconsciousness COHb increases risk of blood clot. It is thought that through this mechanism smoking increases the risk of having an ischemic stroke

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Severity depends on the percentage of CO inspired, length of exposure, ventilatory rate and general health of the individual. Signs and symptoms are mainly related to cerebral hypoxia, although cherry red skin is commonly noted

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Comparison of Expected findings CO levels 10% Hyperventilation 15 20% Headache, disorientation 20 40% Fatigue, dizziness, visual disturbances, chest pain 40 60% Ataxia, hallucinations, combativeness, coma Over 60% Usually fatal
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Headache Dizziness Nausea Flu-like symptoms, fatigue Shortness of breath on exertion Impaired judgment Chest pain Confusion Depression
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Hallucinations Agitation Vomiting Abdominal pain Drowsiness Visual changes Fainting Seizure Memory and walking problems
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Carboxyhemoglobin levels are normally under 5%; smokers around 5%; urban dwellers may be as high as 10%. Metabolic acidosis may develop, due to impaired O2 transport and delivery to the cells. In severe CO poisoning, serum lactate may be a more reliable than COHgB with respect to the level of CO poisoning.
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Diagnosis is based on history of enclosed space injury.

Enclosed space increases the likelihood of

inhalation injury due to decreased available O2 in enclosed spaces

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Impaired Gas Exchange Ineffective Breathing Pattern Ineffective Airway Clearance Ineffective Individual Coping/Family Coping Fear/Anxiety/Powerlessness

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Prompt administration of 100% high flow O2 Administer parenteral fluids at two thirds to three-fourths normal maintenance for the patients weight. Grief counseling for family members of victims of house fires may be necessary For intentional exposures, mental health counseling should be arranged Assess respiratory status Maintain humidification and O2 therapies
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Assess for hypoxemia and anticipate and prepare for possible intubation In some cases hyperbaric chamber therapy may be indicated Potential complications include neuropsychiatric problems such as parkinsonism, gait disturbances, hearing disturbances, disorientation, speech disturbances and personality changes such as depression, moodiness, irritability, aggressiveness, impulsiveness, and signs of increased ICP.
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