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A Silent Winter Killer

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We’re having a bit of a cold snap here in northern California right now, and I have a string of shifts in the ER coming up over the next several days. So, I have “raised my antennae” for that common, silent killer of the season – carbon monoxide.

It is likely that every year hundreds of people die in the U.S. due to carbon monoxide (CO) poisoning. In fact, it is the most common cause of poisoning death in this country. There is no way to know just how many people are poisoned by CO each year, as many cases, including fatal cases, likely go undiagnosed.

CO is a colorless, odorless, tasteless gas that is the product of incomplete combustion. It poisons the red blood cells so that they cannot carry enough oxygen to supply our vital organs. The reason we start to see more cases of CO poisoning at this time of year is because folks start turning their gas furnaces on (and, occasionally, these furnaces are faulty, resulting in incomplete combustion and CO production). Sadly, when the temperatures really plummet or power outages occur, we’ll see cases where a family has brought a charcoal grill indoors to supplement heating the home. This is a recipe for disaster as these grills put off a tremendous amount of CO in poorly ventilated areas. Sometimes, these families just don’t wake up. Other causes of CO poisoning include faulty chimneys, faulty gas water heaters, faulty exhaust systems in cars, house fires in which victims were trapped, and intentional/suicidal exposures.

I teach our medical students and residents to keep a high index of suspicion for CO poisoning as it can present quite similarly to another very common problem we see this time of year – the “flu.” Patients with CO poisoning tend to complain of headache, nausea, and vomiting. Our ER is full of folks with headache, nausea and vomiting right now. So, how to tell if it’s CO? A big clue is if an entire family gets sick at the same time. The children often show the first signs due to their higher metabolism, but Mom and Dad are likely to be a bit ill as well. Another clue is if the family pet is throwing up. Dogs and cats don’t get the same winter viruses we do. Other symptoms of CO poisoning include dizziness, confusion and chest pain.

So, how to prevent CO poisoning? Most importantly, get a CO detector installed in your home. They’re available for a reasonable price at most hardware stores. You should put detectors in areas where the risk of CO production is the greatest – rooms with gas burning appliances, fireplaces, etc. And, don’t forget to check these detectors periodically to be sure they’re working, just as you do your smoke detectors.

Other steps: get your furnace and chimney inspected to be sure they are functioning properly; don’t let your car warm up in your garage (even though it’s tempting to climb into a toasty warm vehicle on these cold mornings!); and, of course, never bring any form of charcoal or gas grill indoors to supplement heating your home. This is also important advice for winter campers to heed, as I’m sure Dr. Auerbach (“Medicine for the Outdoors”) would agree – NEVER put a gas or propane-burning piece of equipment inside your tent. Many outdoor lovers have met untimely demises putting their camp stove in the tent “just to warm it up a bit.”

And finally, if you are concerned that you or your family members are suffering from CO poisoning, get out of the house immediately, call 9-1-1 to get the fire department and paramedics on the way (especially if anyone appears extremely ill or difficult to arouse), and get to a local ER for evaluation.

Management of CO poisoning includes use of high concentrations of oxygen, and, sometimes, use of a hyperbaric oxygen chamber (a “dive chamber”). This flushes the CO out of the bloodstream and, over time, out of the tissues. But, even with treatment, victims of significant CO poisoning have a high risk of permanent neurological or psychiatric abnormalities (such as memory difficulty or personality changes). So, as in so many things, “an ounce of prevention is worth a pound of cure.” Why not stop off at your neighborhood hardware store on your way home today and pick up a CO detector?

Stay alert and stay safe,
Dr. Bob
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About the Author

The Stanford Emergency Room is the center of emergency care at Stanford University.

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