Manejo hospitalario de la intoxicación por monóxido de carbono en hospitales de la Región de Murcia

Abstract

ABSTRACT The importance of carbon monoxide poisoning is well known for its high incidence and its importance morbidity and mortality. We have carried out a retrospective epidemiological study during the period 2009-2013 by reviews of medical records of the carbon monoxide poisoning treated at the emergency departments of various health areas of the Region of Murcia. We have examined various aspects of the ICO, the demographic characteristics of the region as well as the structure and healthy resources. According to data the profile of a patient with carbon monoxide poisoning is a young woman (around 31 years old) living in a town with a population of over 40,000 inhabitants in the inside region of Murcia and who has been previously healthy and has had an accident at home due to a heater failure during March or November in a morning or evening time and has gone by her own initiative to the emergency services with the symptoms of headache, dizziness, consciousness síncope-, nausea, or vomiting..Regarding her clinical status we have found normotensos (TA 115-64 mmHg) and with a discrete movement/ tendency to the tachycardia (FC 98 lpm) and taquipnea (18 rpm). As well for the complementary tests it is evident that a few additional tests (analytical - except gasometrical- 50%, 60% radiology, ECG 20%) have been carried out and as relevant findings we can emphasize that the glucose has been found high (150 mg / dl) together her with the lactate levels (2.51 mmol / L), coagulation disorders (INR 2.42) and a COHb level of 20.74%. Once the patient has been diagnosed, she receives norm baric oxygen for 3 hours and in less than half of the cases she requires hyperbaric oxygen (31.4%) or hospitalization (11.4%). Once the patient has been discharged, it is not advisable the realization of a later check-up to value the Side collateral neurological syndrome. In conclusion it should be stood out the incidence of the ICO in the Murcia region is lower than in the rest of Spain and the development of a common procedure on handling this process would increase the quality of care. As main conclusions we have that the anamnesis is the main tool for the diagnosis of a suposition of this kind of intoxications. The confirmation of intoxication is done through the analytical determination of COHb levels, although some negative levels do not rule out the presence of intoxication. In relation to the additional tests we have to carried out a minimum set of tests which include a venous blood gas with COHb levels, as well as a chest radiography and electrocardiography. Each patient with a suspicion or diagnostic of intoxication by CO have to (should) receive normobaric oxygen for at least 4 hours and we have to appreciate the need to administer hyperbaric oxygen if the clinical conditions of the patient, safety in transfer and the availability of a hyperbaric chamber exist. Each patient with a confirmed diagnosis of CO intoxication after the hospital discharge must be evaluated by a neurology department to rule out the presence of the late neurological syndrome in a period between 1 to 3 months. The implementation of a consensual and unified method to care to patients with suspected CO intoxication throughout the Region of Murcia to increase the level of quality in health care in this process. Keywords: Carbon Monoxide, Hospital Emergency Services, Poisoning.