Effects and Prevention of Carbon Monoxide Poisoning

Carbon monoxide poisoning occurs when someone is exposed excessively to carbon monoxide (CO). Carbon monoxide is a poisonous gas, mostly referred to as a Silent Killer.

Exposure to Carbon monoxide is one of the major occupational hazards. Workers are exposed to Carbon monoxide from exhaust discharged from gasoline fuel.

The major route of carbon monoxide poisoning is inhalation.

About Carbon Monoxide

Carbon monoxide (CO) is a colorless, odorless, non-irritant gas. The deadly effect of carbon monoxide was known as long ago as Greek and Roman times when the gas was used for executions. Each year in Britain about 50 people die and 200 are severely injured by carbon monoxide poisoning. Some poisonings are self-harmed but most are accidental. According to one estimate, as many as 25,000 people in the UK have symptoms due to faulty gas appliances. In the 1960s and 1970s, the conversion from coal gas to carbon-monoxide-free natural gas caused a dramatic reduction in poisoning.

Recently, there was a report of suspected carbon monoxide poisoning that killed all the occupants of a particular building in a state in Nigeria. It was reported that a friend met everyone’s death in the morning, and with a generator located close by, it was suspected that the generator was left on all through the night.

Carbon monoxide is a product of incomplete combustion of organic matter. It is often produced by motor vehicles that run on gasoline, diesel, methane, or other carbon-based fuels and from tools, gas heaters, and cooking equipment that are powered by carbon-based fuels such as propane, butane, and charcoal. Exposure to 100 ppm or greater can be dangerous to human health. Carbon monoxide mainly causes adverse effects by combining with hemoglobin to form carboxyhemoglobin (HbCO) in the blood. This prevents hemoglobin from carrying oxygen to the tissues. Additionally, myoglobin and mitochondrial cytochrome oxidase are thought to be adversely affected. Carboxyhemoglobin can revert to hemoglobin, but the recovery takes time as the HbCO complex is fairly stable. Modern automobiles still produce levels of carbon monoxide which will kill in an enclosed space or if the exhaust path is obstructed.

 Causes of Carbon Monoxide Poisoning

Carbon monoxide is produced when fuels such as gas, oil, coal, and wood don’t burn fully. Burning charcoal, running cars, and the smoke from cigarettes also produce carbon monoxide gas.

Carbon monoxide poisoning is also caused when there is excessive exposure to carbon monoxide, either through:

• Being ignorant of the presence of carbon monoxide gas.
• Carelessness and negligence of the effect of the carbon monoxide gas.
• Being assigned to do a job close by where the carbon monoxide gas is being generated without proper personal protective equipment.
• Driving behind a carbon monoxide-poisoning car. Some cars produce very high levels of carbon monoxide while driving. This may be caused by some mechanical faults that have not been taken care of; such cars can be said to be carbon monoxide poisoning cars.

Other causes of carbon monoxide poisoning are:

• Poor functioning heating systems.
• Indoor propane-powered forklifts.
• Indoor burning of charcoal-burning briquettes
• Riding in the back of pick-up trucks.
• Ice skating rinks using propane-powered resurfacing machines.
• Gasoline-powered generators that are not in the correct locations.
• Blocked flues and chimneys – This can stop carbon monoxide from escaping, allowing it to reach dangerous levels.
• Burning fuel in an enclosed or unventilated space – For example, running a car engine, petrol-powered generator, or barbecue inside a garage, or a faulty boiler in an enclosed kitchen.
• Faulty or blocked car exhausts – A leak or blockage in the exhaust pipe, such as after heavy snowfall, could lead to a build-up of carbon monoxide.
• Paint fumes – Some cleaning fluids and paint removers contain methylene chloride (dichloromethane), which can cause carbon monoxide poisoning if breathed in.
• Smoking shisha pipes indoors – Shisha pipes burn charcoal and tobacco, which can lead to a build-up of carbon monoxide in enclosed or unventilated rooms.

Risks of Exposure to Carbon Monoxide

• Children riding in the back of enclosed pickup trucks (Particularly high risk).
• Industrial workers at pulp mills, steel foundries, and plants producing formaldehyde or coke (A hard grey fuel).
• Personnel at fire scenes.
• Using heating sources or electric generators during power outages.
• Those working indoors with combustion engines or combustible gases.
• Swimming near or under the stern or swim-step of a boat with the boat. engine running.
• Back drafting is when a boat is operated at a high bow angle.
• Mooring next to a boat that is running a generator or engine.
• Improper boat ventilation.

Symptoms of CO Poisoning

Acute Symptoms

These symptoms include:

• Headache
• Nausea
• Malaise
• Fatigue

These symptoms are often mistaken for a virus such as influenza or other illnesses such as food poisoning or gastroenteritis.

Increasing exposure produces cardiac abnormalities including:

• Fast heart rate
• Low blood pressure
• Cardiac arrhythmia

Central nervous system symptoms include:

• Delirium
• Hallucinations
• Dizziness
• Unsteady gait
• Confusion
• Seizures
• Central nervous system depression
• Unconsciousness
• Respiratory arrest
• Death

Chronic Symptoms

Long-term exposure to low levels of carbon monoxide can also lead to neurological symptoms, such as difficulty thinking or concentrating and frequent emotional changes – for example, becoming easily irritated, depressed, or making impulsive or irrational decisions.

Chronic exposure to relatively low levels of carbon monoxide may cause persistent headaches, lightheadedness, depression, confusion, memory loss, nausea, and vomiting.

 How Long Does It Take To Die From Carbon Monoxide Poisoning?

COHb (Carbon monoxide hemoglobin) levels between 40% and 70% lead to loss of consciousness and eventually death. Different people have different tolerance levels for carbon monoxide. Generally, carbon monoxide exposure at 100 or higher is known to be dangerous for human health. So, carbon monoxide poisoning varies with concentration and length of exposure.

In the United States, OSHA limits long-term workplace exposure levels to less than 50 PPM averaged over an 8-hour period; in addition, employees are to be removed from any confined space if an upper limit (“ceiling”) of 100 PPM is reached. Subtle cardiovascular or neurobehavioural effects occur at low concentrations, but lengthy exposure or acute exposure to high concentrations often causes coma and death.

Hence, there is no static duration as to how long it will take before someone dies of carbon monoxide poisoning. The time for an individual to die of carbon monoxide poisoning will depend on the concentration of the gas to which he is exposed the duration of exposure and the individual tolerance level. So the time for someone to die is shortened in very high concentrations with someone having a high tolerance level and longer in lower concentrations and in someone with a low tolerance level.

Prevention Of Carbon Monoxide Poisoning

There should be public education about the danger of carbon monoxide, with an emphasis on safety in the home and workplace. Professional education targeted at community workers is also needed. This could be achieved through a media campaign when risk is greatest, during the winter. Because of the high incidence of gas-related poisoning, there is a role the gas industry should play in public education.

Close liaison between public health physicians and leaders of the building, gas, and home heating industries is a prerequisite for an effective prevention strategy. Such collaboration ensures safety through proper standards for home ventilation, central heating installation, and maintenance. Cheap battery-operated carbon monoxide detectors are now widely available.

They should be installed in new homes and in buildings such as garages where workers are at risk from exhaust fumes. Carbon monoxide cars should be taken off our roads. Vehicles should be properly inspected before roadworthiness is approved from the vehicle. Vehicle owners should also ensure timely repair and maintenance of their vehicles.

Finally, carbon monoxide should not be generated in an enclosed environment. If it must, every occupant of that environment should be protected with a respirator.

 World Health Organization Recommendations For Preventing Carbon Monoxide Poisoning

The following guideline values (PPM values rounded) and periods of time-weighted average exposures have been determined in such a way that the carboxyhemoglobin (COHb) level of 2.5% is not exceeded, even when a normal subject engages in light or moderate exercise:

◾100 mg/m3 (87 ppm) for 15 min

◾60 mg/m3 (52 ppm) for 30 min

◾30 mg/m3 (26 ppm) for 1 h

◾10 mg/m3 (9 ppm) for 8 h

For indoor air quality 7 mg/m3 (6 ppm) for 24 h (so as not to exceed 2% COHb for chronic exposure)

Safety Guideline To Protect Yourself Against Carbon Monoxide Poisoning

• Never use ovens or gas ranges to heat your home.
• Never use oversized pots on your gas stove or place foil around the burners.
• Make sure rooms are well-ventilated and don’t block air vents. If your home is double-glazed or draught-proofed, make sure there’s still enough air circulating for any heaters that are in the room.
• Don’t use gas-powered equipment and tools inside your home if you can avoid it. Only use them in a well-ventilated area, and put the engine unit and exhaust outside.
• Always wear a safety mask when using chemicals that contain methylene chloride.
• Don’t burn charcoal in an enclosed space, such as on an indoor barbecue.
• Don’t sleep in a room that has an unfluted gas fire or paraffin heater.
• Fit an extractor fan in your kitchen (if it doesn’t already have one).

Carbon Monoxide Poisoning Treatment

Seek immediate medical attention from a medical practitioner if you have been exposed to carbon monoxide or if you are experiencing any of the symptoms or group of symptoms enumerated above.

Immediate first aid measures:

The initial first aid measure for carbon monoxide poisoning is to immediately remove the person from the exposure without endangering further people. Those who are unconscious may require CPR on site until appropriate medical attention is available.

The main treatment for carbon monoxide poisoning is the use of hyperbaric oxygen therapy.

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