If you’re like me, you enjoy all the wonderful things that winter brings, sledding, building snow people, skiing, drinking hot chocolate, etc. There’s one thing we really don’t take into consideration when cold weather rolls around: carbon. monoxide. The human body is an amazing thing and can endure great stress during the winter, however, it may come as a shock to most of you, the body is unable to withstand extreme temperatures for long periods of time. A solution to the inconveniences of the cold is necessary, and this translates into the prevention of heat loss (eg clothing, gloves) and the heating of the environment in which we find ourselves (furnace, radiator, gas heating). Unfortunately, heating our environment can lead to unintended exposure to a very deadly toxin: carbon monoxide.
What exactly is carbon monoxide (CO)? It is an invisible and odorless gas for humans. This should not be confused with hydrogen sulfide, a deadly gas that smells like rotten eggs. Carbon monoxide is a byproduct of the incomplete combustion of fuel and is often emitted from household items such as vehicle exhaust, stoves, poorly maintained home heaters, radiators and small engines gasoline that you find in generators, snow blowers and lawn mowers. In studies, people are more likely to have their unintentional exposure to CO at home.
Why is carbon monoxide so deadly? Hemoglobin is the molecular structure of our red blood cells that carries oxygen molecules. When we breathe in carbon monoxide, they attach to hemoglobin like oxygen does. Unlike oxygen, however, carbon monoxide does not provide any benefit to our body tissues. On top of that, the carbon monoxide molecules “stay put” and don’t let oxygen attach to hemoglobin. This leads our red blood cells to transport less oxygen to our tissues (brain, heart, muscles, etc.). How long can you hold your breath? It’s a bit more complicated than this hypothetical question, but you get the idea: our bodies need a constant supply of oxygen to survive.
Carbon monoxide exposures account for tens of thousands of emergency room visits each year, with thousands being hospitalized for significant exposures. People younger than 44 make up the majority of these visits, but older patients represent larger percentiles of people requiring hospital admission. We are at an increased risk of exposure here in New England because people who live in colder parts of the country often have higher risk activities that result in exposure.
What can I do to avoid exposure to CO for me and my family?
- The first step is to make sure you have working carbon monoxide detectors on every level of your home. Check annually that they are in working order. These can be picked up at hardware stores anywhere.
- Have your home heating system serviced annually if it uses natural gas, coal, or oil/fuel. According to the CDC, these represent the second highest number of unintentional CO exposures.
- NEVER drive an internal combustion engine car into your garage with the door closed. Keep in mind that even with garage doors open, fumes, including CO, can still enter your home.
- Do not place your combustion generators in your garage or next to your house, whether the garage door is open or not. According to CDC statistics, combustion generators are the number one reason for unintentional CO exposures. Consumer report recommends always placing your generator 20 feet or more from your house, with the exhaust pointing away from the house.
- Make sure your chimney is free of buildup or debris.
- NEVER use a fuel grill indoors for cooking or use your oven to heat your home.
What symptoms could I have if I have exposure to carbon monoxide?
They may be vague, but may include:
- Headache, dizziness, confusion
- Nausea Vomiting
- Rapid heartbeat, chest pain, shortness of breath
- In case of severe exposure, you can unfortunately have a heart attack, convulsions, coma or even die
- Some people may experience “cherry red” lips, but this is not a common finding, nor is it necessary for diagnosis
What should I do if I suspect the presence of carbon monoxide or if my CO detector goes off?
- Gather all of your family members into your home (including pets), get out of your house, and CALL 911 IMMEDIATELY.
- Pets, due to their smaller body size, as well as children will often show symptoms before adults, but it is not foolproof.
- Your local fire department assesses the home (or business) for CO elevations using specialized equipment. If your family has been exposed, they may recommend an evaluation at the nearest emergency department.
What is the EMS team and the emergency department doing to treat CO exposure?
- Whether it is a suspected or confirmed exposure, we often start with supplemental oxygen therapy, i.e. an oxygen mask without a rebreather. Saturating your blood with extra oxygen will help move carbon monoxide molecules out of hemoglobin faster, allowing your red blood cells to once again transport oxygen to your body’s tissues.
- We can check blood work, including a test where we can see what the actual carbon monoxide saturation in your blood is. Other tests we can perform look for evidence of organ damage resulting from a lack of oxygen reaching our tissues. We may also perform an ECG of your heart if you have any signs or symptoms that CO exposure is affecting your heart.
- If you are very ill, we may consider a therapy called hyperbaric oxygen therapy. This treatment involves sitting in a comfortable room where the pressure is increased around you, accelerating the movement of CO molecules even faster. Many cases will not require this therapy. Fortunately, there is a treatment center in Rhode Island: Kent Hospital. Kent wound recovery and hyperbaric medicine The program has been in place for over a decade now and is the only emerging hyperbaric program in Rhode Island. In fact, there are only 2 hyperbaric medicine treatment centers emerging in all of New England, the other being Mass Eye and Ear in Boston. Kent and Mass Eye and Ear take turns for emerging hyperbaric coverage for all of New England.
In conclusion, carbon monoxide is a deadly gas that is most often encountered in the home. Our lifestyle in the Northeastern United States often puts us at increased risk of exposure. It is for this reason that we must be aware of the dangers it represents for us and our family. Fortunately, exposure is often preventable if we follow well-established safety guidelines (CDC). Stay safe there this winter!
Vincent Varamo, DO, is a Board Certified Emergency Physician at Kent Hospital, a University Teaching Institution in Warwick, RI. He has a particular interest in EMS and toxicology.