Introduction
carbon monoxide (CO) is coal or charcoal is burned in the process of producing a colorless, odorless, tasteless, non - irritating gas, is not easily sensed by human beings carbon monoxide (CO) is coal or charcoal is burned in the process of producing a colorless, odorless, tasteless, non - irritating gas, is not easily sensed by human beings . when air in the carbon monoxide concentration is high, the carbon monoxide is also increased correspondingly, while the oxygen in the blood is extruded to the outside, then cause the vital organs and tissue hypoxia, occurring in the central nervous system, circulatory system on the severity of the symptoms of carbon monoxide poisoning when air in the carbon monoxide concentration is high, the carbon monoxide is also increased correspondingly, while the oxygen in the blood is extruded to the outside, then cause the vital organs and tissue hypoxia, occurring in the central nervous system, circulatory system on the severity of the symptoms of carbon monoxide poisoning .
common household room ventilation is poor, in North China winter is high season common household room ventilation is poor, in North China winter is high season . 1 1.
Genesis
to cause carbon monoxide poisoning of a variety of reasons, in general, inferior coal combustion, smoke, automobile exhaust is a major source of carbon monoxide gas: 1, residents of northern winter heating coal stove with common, due to the blockage of the chimney, smoke and shuttered by to cause carbon monoxide poisoning of a variety of reasons, in general, inferior coal combustion, smoke, automobile exhaust is a major source of carbon monoxide gas: 1, residents of northern winter heating coal stove with common, due to the blockage of the chimney, smoke and shuttered by . 2, gas leaks are also common causes of 2, gas leaks are also common causes of .
3, use a charcoal chafing dish to eat meat, charcoal combustion is not full. It is easy to generate carbon monoxide, plus cold season home more often, bad indoor ventilation, thus prone to poisoning 4, the room has no ventilation devices, poor ventilation and smelting operation,The engine and exhaust gas containing a large amount of carbon monoxide were caused by burn and gunpowder explosion 4, the room has no ventilation devices, poor ventilation and smelting operation,The engine and exhaust gas containing a large amount of carbon monoxide were caused by burn and gunpowder explosion .
5, according to the test when a car engine at idle the engine when, because of incomplete combustion, will often produce a large amount of carbon monoxide in the exhaust gas;In operation, the accelerator is too large, the rotational speed exceeds 3000 revolutions per minute, the oil - to - air ratio has exceeded the normal 1: 12. 5, the oil - less air, as well as the gas containing carbon monoxide gas of a rich pole;Upon activation of the vehicle air conditioner, and can easily lead to elevated carbon monoxide poisoning 6, the chemical industry to synthesize ammonia, methanol, acetone and the like are intended to contact a carbon monoxide, in the event of a leak can also cause poisoning 6, the chemical industry to synthesize ammonia, methanol, acetone and the like are intended to contact a carbon monoxide, in the event of a leak can also cause poisoning .
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Mechanism Of Poisoning
The carbon monoxide respiratory pulmonary alveoli, alveolar can rapidly pass through the wall into the blood circulation, and then penetrate the red cell wall, with the erythrocyte is bound to hemoglobin, forming not oxygen carrying ability of carboxyhemoglobin in carbon monoxide with hemoglobin of The carbon monoxide respiratory pulmonary alveoli, alveolar can rapidly pass through the wall into the blood circulation, and then penetrate the red cell wall, with the erythrocyte is bound to hemoglobin, forming not oxygen carrying ability of carboxyhemoglobin in carbon monoxide with hemoglobin of . about oxygen affinity than the affinity to the hemoglobin and 240 times, its dissociation than oxygenated hemoglobin slow about oxygen affinity than the affinity to the hemoglobin and 240 times, its dissociation than oxygenated hemoglobin slow .
3600 times so that upon inhalation of carbon monoxide, i.e. with the oxygen for hemoglobin, hemoglobin turns to make the most of the carbon monoxide hemoglobin, resulted in the loss of hemoglobin and oxygen carrying ability of the plant and can also hinder oxygen dissociation of hemoglobin, more heavy oxygen (hypoxia) High concentrations of carbon monoxide and cytochrome oxidase also bivalent iron ions in combination, directly suppresses the cells' internal breathing by more heavy oxygen (hypoxia) High concentrations of carbon monoxide and cytochrome oxidase also bivalent iron ions in combination, directly suppresses the cells' internal breathing by .
asphyxiation due to central nervous system and cardiac anoxia is especially sensitive to the damage in carbon monoxide and also the most serious asphyxiation due to central nervous system and cardiac anoxia is especially sensitive to the damage in carbon monoxide and also the most serious .
Clinical Manifestation
The symptoms of acute carbon monoxide poisoning, according to the severity of the air in the carbon monoxide concentration, contact time, the patient's health situation is generally divided into:The symptoms of acute carbon monoxide poisoning, according to the severity of the air in the carbon monoxide concentration, contact time, the patient's health situation is generally divided into:.
Mild Poisoning
Normally air carbon monoxide concentration of less than 0.01%, when the air in the carbon monoxide concentration reached 0. 04% and 0. 06%, it may be suffering from mild poisoning: headache, dizziness, heaviness in head, tinnitus, nausea, vomiting, palpitations, dizziness, transient mental confusion 
Moderate Intoxication
In addition to the above symptoms becoming worse, flush, bright cherry - red oral lips, rapid pulse, hyperhidrosis, gait, drowsiness, coma even In addition to the above symptoms becoming worse, flush, bright cherry - red oral lips, rapid pulse, hyperhidrosis, gait, drowsiness, coma even .
Severe Intoxication
in addition to the coma, with the main performance of various reflected significantly weakened or disappeared, incontinence of faeces and urine, limb coldness, pallor or cyanosis of lips, sweating, fever, hypotension, miosis, or expanded;superficial respiration or Cheyne - Stokes breathing occurrence in addition to the coma, with the main performance of various reflected significantly weakened or disappeared, incontinence of faeces and urine, limb coldness, pallor or cyanosis of lips, sweating, fever, hypotension, miosis, or expanded;superficial respiration or Cheyne - Stokes breathing occurrence . may develop severe complications such as cerebral edema, pulmonary edema, myocardial injury, shock, acidosis and renal insufficiency etc.
Delayed Encephalopathy
The nerve disease, patients with acute carbon monoxide poisoning in the return of consciousness after a lapse of about 2 to 60 days of the "latent phase", one of the following clinical manifestations: 1, mental disorders: The present state of dementia, delirium or decortical state;2, extrapyramidal neurological disorders: Parkinson's syndrome;3. Impairment of pyramidal system nerve: such as hemiplegia, positive pathologic reflex or urinary incontinence and the like;4, d.Focal dysfunction of pallium: Such as aphasia, blindness, etc. or secondary epilepsy coma time, Chang said hypoxia of the severity and prognosis of acute carbon monoxide poisoning and sequela of serious degree coma time, Chang said hypoxia of the severity and prognosis of acute carbon monoxide poisoning and sequela of serious degree .
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Examination And Test
Oxygen Making Carbon Into Haemoglobin Determination In Blood
in normal human blood oxygen making carbon into haemoglobin with a content of 5% to 10%, wherein a small amount of endogenous carbon monoxide from about, mild carbon monoxide poisoning of blood carboxyhemoglobin in may be higher than 10%;midrange poisoning may be higher than 30%;in severe case may be higher than 50% in normal human blood oxygen making carbon into haemoglobin with a content of 5% to 10%, wherein a small amount of endogenous carbon monoxide from about, mild carbon monoxide poisoning of blood carboxyhemoglobin in may be higher than 10%;midrange poisoning may be higher than 30%;in severe case may be higher than 50% . 8 hours after contacting the carbon monoxide is carbon monoxide hemoglobin decreased to normal, and clinical symptoms may not be in a parallel relationship to 8 hours after contacting the carbon monoxide is carbon monoxide hemoglobin decreased to normal, and clinical symptoms may not be in a parallel relationship to .
EEG
According to reports, the 54% 97% of the patients with acute carbon monoxide poisoning can be abnormal EEG, behaves as a low amplitude slow wave, typically in the frontal part and temporal part of the sweep delta theta wave sees, often with clinical disorders of consciousness regarding According to reports, the 54% 97% of the patients with acute carbon monoxide poisoning can be abnormal EEG, behaves as a low amplitude slow wave, typically in the frontal part and temporal part of the sweep delta theta wave sees, often with clinical disorders of consciousness regarding . Some coma patients may also present a special three - phase wave, the similar hepatic coma of wave type), paroxysmal slow wave or as a slow spike and slow wave, but with paroxysmal epileptiform discharges were found in different parts of acute carbon monoxide poisoning in the patients with intelligence impairment, EEG abnormalities may persist Some coma patients may also present a special three - phase wave, the similar hepatic coma of wave type), paroxysmal slow wave or as a slow spike and slow wave, but with paroxysmal epileptiform discharges were found in different parts of acute carbon monoxide poisoning in the patients with intelligence impairment, EEG abnormalities may persist .
Brain Evoked Potentials (VEP)
carbon monoxide poisoning, acute and delayed encephalopathy, visible visual evoked potentials VEP100 much prolonged, abnormal rate was 50% and 68%, and the convalescence respectively can be reduced to 5% and 22% carbon monoxide poisoning, acute and delayed encephalopathy, visible visual evoked potentials VEP100 much prolonged, abnormal rate was 50% and 68%, and the convalescence respectively can be reduced to 5% and 22% . median nerve somatosensory evoked potential (SEP) to see N32 and the like in a long component selectively damaged, two kinds of patients. The abnormal rate of more than 70% and that with the improvement of the recovery
brainstem auditory evoked potential (BAEP) of abnormal degree of consciousness impairment are related to the fluorosis area of three - phase parallel ending brainstem auditory evoked potential (BAEP) of abnormal degree of consciousness impairment are related to the fluorosis area of three - phase parallel ending . brain evoked potentials such as can be used at the same time,Chang can improve the abnormal rate of delayed encephalopathy caused by brain evoked potentials such as can be used at the same time,Chang can improve the abnormal rate of delayed encephalopathy caused by .
in the latent period of patient for dynamic observation, such as the discovery of abnormal brain evoked potential again, the symptoms also often foreshadows a possible occurrence of delayed encephalopathy in acute carbon monoxide poisoning patients in the latent period of patient for dynamic observation, such as the discovery of abnormal brain evoked potential again, the symptoms also often foreshadows a possible occurrence of delayed encephalopathy in acute carbon monoxide poisoning patients . regains consciousness after the event - related potential (P300) study found that 1 / 3 of the P300 latency was significantly prolonged, and neurobehavioral testing in, represent the movement reaction speed of memory and cognitive abnormalities is significantly correlated with regains consciousness after the event - related potential (P300) study found that 1 / 3 of the P300 latency was significantly prolonged, and neurobehavioral testing in, represent the movement reaction speed of memory and cognitive abnormalities is significantly correlated with .
Brain Imaging
Acute craniocerebral CT abnormality mainly bilateral cortical white matter and globus pallidus appears approximately symmetrical to the density - reduced zone is seen later as dilatation of ventricles and widening of cerebral sulci, abnormal rate was 41. 2% and 87. 5% abnormal brain CT scanning. The prognosis is relatively good, with its CT abnormal coma time. Most of them are more than 48 hours, but delayed encephalopathy in the early and without changing the above - described abnormal CT
CT in delayed encephalopathy symptoms typically appear 2 weeks can only be found during the investigation, the better brain evoked potentials and the EEG is sensitive to CT in delayed encephalopathy symptoms typically appear 2 weeks can only be found during the investigation, the better brain evoked potentials and the EEG is sensitive to . CT findings of cerebral cortex has been shown to hold the lower white matter lesions in a patient,Its recovery is more higher than that of delayed encephalopathy in white matter abnormality in the difference, prompting two patients of different pathological changes of white matter CT findings of cerebral cortex has been shown to hold the lower white matter lesions in a patient,Its recovery is more higher than that of delayed encephalopathy in white matter abnormality in the difference, prompting two patients of different pathological changes of white matter .
former well and axonal myelin damage, possibly as much as the loss of myelin sheaths only former well and axonal myelin damage, possibly as much as the loss of myelin sheaths only . display carbon monoxide poisoning in MRI brain lesion was superior to CT, both of which are beneficial to the rest of the brain and differential diagnosis of display carbon monoxide poisoning in MRI brain lesion was superior to CT, both of which are beneficial to the rest of the brain and differential diagnosis of .
Hematuria From CSF Assay
peripheral blood the number of red blood cells, granulocytes and neutrophils increased, moderate or severe poisoning leucocyte is higher than the 18 * 109 / L, showing that the prognosis was grave, 1 / 5 of the patients. The positive rate of glycosuria, 40% of patients with positive urine protein, cerebrospinal fluid pressure and most of the conventional normal
The Blood Testing
Serum ALT activity and nonprotein nitrogen demonstrated a transient augmentations, lactate and lactate dehydrogenase activity in acute poisoning after increased, serum AST activity in the early start on the other hand, there were 24 hours was the highest, and if it exceeds 3 times ULN, often have severe disease or complications exist Serum ALT activity and nonprotein nitrogen demonstrated a transient augmentations, lactate and lactate dehydrogenase activity in acute poisoning after increased, serum AST activity in the early start on the other hand, there were 24 hours was the highest, and if it exceeds 3 times ULN, often have severe disease or complications exist . merged rhabdomyolysis, blood creatine phosphokinase (CPK), blood examination and blood oxygen partial pressure decreased, blood oxygen saturation may be normal blood or normal merged rhabdomyolysis, blood creatine phosphokinase (CPK), blood examination and blood oxygen partial pressure decreased, blood oxygen saturation may be normal blood or normal .
pH decreased blood carbon dioxide partial pressure often compensatory decreased, blood potassium decreased pH decreased blood carbon dioxide partial pressure often compensatory decreased, blood potassium decreased .
Electrocardiogram
some patients showed ST - T change, also of ventricular premature beat and atrioventricular block or sinus tachycardia and transient some patients showed ST - T change, also of ventricular premature beat and atrioventricular block or sinus tachycardia and transient . 2 2.
Diagnostic Principle
in accordance with the history of exposure to carbon monoxide, suddenly collapses, skin and mucosa have a cherry red, diagnosis can usually be established in accordance with the history of exposure to carbon monoxide, suddenly collapses, skin and mucosa have a cherry red, diagnosis can usually be established . history has difficulty when, with a mini - stroke, meningitis, diabetic ketoacidosis should be distinguished from history has difficulty when, with a mini - stroke, meningitis, diabetic ketoacidosis should be distinguished from .
HbCO in determination of the diagnosis that the HbCO in determination of the diagnosis that the .
Treatment Measures
General Treatment
1, breathe the fresh air.2, heat preservation;3, oxygen inhalation, early hyperbaric oxygen therapy, hyperbaric oxygen can be reduced because in addition to carbon monoxide hemoglobin of the half - life, increased tissue ven and purged with carbon monoxide in the residual carbon monoxide, but also can increase the amount of dissolved oxygen, reduce the brain edema and release cytochrome enzyme inhibition;4, shallow breathing or stopped breathing of the patient, it is necessary to immediately carry out artificial respiration;If required, use of artificial hibernation therapy;5, a serious condition, bleeding, blood transfusion 
Preventing And Treating Cerebral Edema
input mannitol or glucose input mannitol or glucose .
Supportive Therapy
. energy supplement and vitamin etc.
Domiciliary Aid
When someone is found or suspected carbon monoxide poisoning, that party shall promptly take the following measures: 1, immediately open the doors, quickly cancer metastasized to the fresh air flow, bed rest, keep quiet and keep warm. 2, to ensure the patency of airway, delirious panelist should head to one side, in case puke inhaled in the respiratory tract asphyxia leads straight 2, to ensure the patency of airway, delirious panelist should head to one side, in case puke inhaled in the respiratory tract asphyxia leads straight .
3, placed the ice bag to alleviate cerebral edema, coma or convulsion, as in the head, placed the ice bag to alleviate edema 3, placed the ice bag to alleviate cerebral edema, coma or convulsion, as in the head, placed the ice bag to alleviate edema . 4, rushed to a hospital hyperbaric oxygen treatment conditions of 4, rushed to a hospital hyperbaric oxygen treatment conditions of .
5, observation of the patient, a series of mild - poisoning, a few hours of ventilation were observed and it can be recovered, and,Severe poisoning. They should also help to first aid center in the hospital on the way, is tight and the monitoring of the poisoned the sobriety, complexion, breathing, heart rate, blood pressure changes of conditions such as in the hospital on the way, is tight and the monitoring of the poisoned the sobriety, complexion, breathing, heart rate, blood pressure changes of conditions such as .
Prevention Method
Since the middle of the 20th century, the city gas water heaters and cooking with gas has been quite popular;Most rural households or coal for honeycomb briquette stove for cooking and heating gas (carbon monoxide) poisoning occasionally, against carbon monoxide poisoning is the best way of preventing: 1, or a gas water heater should not come within the spirit and scope of the activities of the family room;2. It is advisable to constantly maintain good indoor ventilation conditions, especially in winter, rainy day;3, It should be noted that the gas water heater or a correct use method and maintenance, and pay attention to that whether or not a complete combustion state; generating a red flame appeared with incomplete combustion of the phenomenon more, if the blue flame is mostly complete combustion;4, gas with non - flammable material shall be placed on, around, Do not place flammable;5, automatic ignition of the gas with the non - ignited continuously, and wait for a moment, to allow the outflow of the gas after ignition;6, using a gas before coal and smell the odor, it is determined whether there is gas leakage;7, gas water heater may not install a hermetic or bathroom with poor ventilation;8. Check the connection of the gas with a rubber backed - out, aging, fracture, insect bite;9, the living room fireplace should install a chimney, the chimney structure is tight and well ventilated;10, hot pot with charcoal, be sure to note the indoor ventilated to prevent carbon monoxide poisoning 11, air - conditioned car should pay attention to check whether there is leakage at the exhaust system, and if found within the cabin, is provided at the blow - by of the exhaust gas should be immediately removed 11, air - conditioned car should pay attention to check whether there is leakage at the exhaust system, and if found within the cabin, is provided at the blow - by of the exhaust gas should be immediately removed .
in air - conditioned bus stop, don't open too long for an air conditioner;Even while the vehicle is being driven, but also by opening 1 to 2 leaf windows to allow outside air to generate convection in air - conditioned bus stop, don't open too long for an air conditioner;Even while the vehicle is being driven, but also by opening 1 to 2 leaf windows to allow outside air to generate convection . driven or air - conditioned such as feeling dizzy, Shen, myasthenia of limbs, should be promptly opened the window and took a breath of fresh air, and the exclusion of sickness and other causes of the issues involved, taking into consideration the possibility of carbon monoxide poisoning is driven or air - conditioned such as feeling dizzy, Shen, myasthenia of limbs, should be promptly opened the window and took a breath of fresh air, and the exclusion of sickness and other causes of the issues involved, taking into consideration the possibility of carbon monoxide poisoning is .
should be parking, a getting - off time for a break. As the body after it is recovered by driving cold winter and too hot in the summer, do not open air conditioning to sleep in the car and talking cold winter and too hot in the summer, do not open air conditioning to sleep in the car and talking .
Health Diet
carbon monoxide poisoning in what foods to eat. It's good for your health: diet, light diet, high protein and vitamin C, vitamin B and E of vegetables and fruits, tea, porridge, porridge, chicken gruel, soup or the like, the body recovered was a very useful, to be recovered, instead of the normal diet
Complications
Complications of pneumonia and heart edema, etc.
Event Report
In 2012, the University of Leeds research team has found that, even if the jam is generated when a small amount of carbon monoxide, also disrupts a person's heartbeat rhythm, so that the human poisoning In 2012, the University of Leeds research team has found that, even if the jam is generated when a small amount of carbon monoxide, also disrupts a person's heartbeat rhythm, so that the human poisoning . because carbon monoxide is formed and the amount of traffic will influence the speed of the heartbeat, cardiac status, these gases" sodium channel "has been open for a long period of time, and this channel to control the heart rate is" particularly important" because carbon monoxide is formed and the amount of traffic will influence the speed of the heartbeat, cardiac status, these gases" sodium channel "has been open for a long period of time, and this channel to control the heart rate is" particularly important" .
"sodium channel" is too open for a long period of time will cause the heart rhythm disorder, return a likelihood badly to cause arrhythmia, brings a life - threatening "sodium channel" is too open for a long period of time will cause the heart rhythm disorder, return a likelihood badly to cause arrhythmia, brings a life - threatening . University of Leeds research team has come up with an experimental study of a human body and the carbon monoxide gas is encountered in the "sodium channel"shorten the open time of the drug that the University of Leeds research team has come up with an experimental study of a human body and the carbon monoxide gas is encountered in the "sodium channel"shorten the open time of the drug that the .
test success, perhaps can help human find the CO poisoning of the cure for test success, perhaps can help human find the CO poisoning of the cure for . - but also the need for clinical testing, but this is already a "great start" - but also the need for clinical testing, but this is already a "great start" .
at the British Heart Foundation research on this disease given a positive affirmation, referred to as a "promising research" at the British Heart Foundation research on this disease given a positive affirmation, referred to as a "promising research" . the authority of the "American Journal of Respiratory and Critical Care," also published a confirmed such that it is possible to mitigate CO poisoning as" the antidote " the authority of the "American Journal of Respiratory and Critical Care," also published a confirmed such that it is possible to mitigate CO poisoning as" the antidote ".
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