HYPERBARIC TREATMENT OF CARBON MONOXIDE TOXICITY

Course overview

CARBON MONOXIDE (CO) IS A TOXIC GAS FORMED FROM THE INCOMPLETE COMBUSTION OF CARBON-CONTAINING SUBSTANCES. COMMON SOURCES ARE ENGINES, NON-ELECTRIC SPACE HEATERS, FURNACES, AND SMOKE FROM FIRES. POISONING CAN ALSO OCCUR FROM INHALATION OR ABSORPTION OF METHYLENE CHLORIDE (DICHLOROMETHANE) THROUGH THE SKIN. THIS CHEMICAL IS COMMONLY USED IN SOLVENTS FOR PAINT REMOVAL AND IS METABOLIZED TO CO IN THE LIVER. CO BINDS WITH A HIGHER AFFINITY THAN OXYGEN FOR THE HEMOGLOBIN MOLECULE IN RED BLOOD CELLS, FORMING CARBOXYHEMOGLOBIN (COHB), WHICH IMPAIRS OXYGEN OFFLOADING RESULTING IN HYPOXIA IN BODY TISSUES, ESPECIALLY THE BRAIN AND HEART. CO ALSO BINDS TO THE CYTOCHROME PROTEINS IN MITOCHONDRIAL IMPAIRING CELLULAR RESPIRATION. ANOTHER MECHANISM OF TOXICITY IS FROM THE PRECIPITATION OF INFLAMMATION IN THE BRAIN RESULTING IN LIPID PEROXIDATION AND THE DELAYED NEUROLOGIC SEQUELAE (DNS). THIS ACTIVITY REVIEWS THE ETIOLOGY, PRESENTATION, EVALUATION, AND MANAGEMENT/PREVENTION OF CO TOXICITY AND USE OF HYPERBARIC OXYGEN TO TREAT IT AND REVIEWS THE ROLE OF THE INTERPROFESSIONAL TEAM IN EVALUATING, DIAGNOSING, AND MANAGING THE CONDITION.