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Poisoning & OD | Part Four | Toxic Gases

Toxic Gas inhalation:

Inert gases: displaces O2 and injury/death is due to asphyxiation. CO2, methane, exane, propane acetylene. Mental, seizures, cardiac dysrhythmias
Irritant gases: irritate tissues. Highly water soluble irritate upper airways. Less water soluble pass through to the lungs and cause sever tissue damage

Immediate reactions: 1-2 hours, red mucous membranes, eye and nasal irritation, cough, sore throat, bronchospastic
Delayed: 6-24, laryngeal edema, hoarseness, stridor, non-cardio PE
Chronic: recurrent pneumonia and lung disease

Systemic Toxins: gases that poison the cells. CO, cyanide, hydrogen interfere with O2 transport and delivery. Other agents can damage the liver and kidneys
Sources of Toxic Gases: accidents and fires are the most common. Leaking tanks, truck rollovers, by-products from fires, chemical reactions

Pathophysiology: determines the effects of gas inhalation:
Water solubility
Depth and rate of breathing
Smell: if it smells, we can detect and avoid it
Concentration of gas
Length of exposure
Differences in host: some people are more sensitive
Smokers: lower resistance to toxic gas
COPDer will have a worse time as well

Management: Protect yourself. Treat the symptoms. Protect ABCs. Hi-flow O2, intubate if necessary, IV, nebulized bronchodilators may help, prompt transport

Carbon Monoxide Poisoning: colorless, flavorless, odorless, non-irritating gas. Gas heaters are among the most common sources of domestic CO exposure. CO binds with hemoglobin 250x more readily and so O2 can’t, suffocating the patient on a cellular level.

Assessment: suspect CO in any fire, smoke or closed space. Pulse ox won’t detect. Signs and symptoms:
Malaise, weakness, headache
Confusion, dizziness
Nausea, shortness of breath
Drowsiness
Unconsciousness
Chest pain, may develop AMI or PE
Cherry red skin – late sign
Rales, rhonchi
Seizures, blisters

Management: Protect yourself. Fresh air, Protect ABCs. Hi-flow O2, ventilate/intubate if necessary, IV, prompt transport

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