Mr. X was a 50 something white male who worked for a prominent firm in a large Intermountain West city. He lived in an elegant old home in a very tony neighborhood.
One January morning, he came to work and told his secretary that he wasn't feeling well. He complained of a headache, nausea, feeling dizzy and spacy. She urged him to call his doctor but by the end of the day he felt much better so he went home.
For several days, he would come to work feeling poorly but then normal by the end of the day. He thought he was fighting off a flu bug. One morning he did not show up for work. His secretary could not reach him. She called 911 requesting a welfare check. Police and paramedics responded to his home, where they found him in bed, dead. The cause of death was Carbon Monoxide Poisoning. The source was a malfunctioning gas furnace.
Carbon Monoxide (CO) is a colorless, odorless, tasteless gas, which is formed by the incomplete burning of substances containing carbon.
Our blood contains a molecule called heme, which transports oxygen from our lungs to all our tissues. CO has 200 times the affinity for heme as oxygen. When we breathe air polluted with CO, the heme molecule preferentially picks up CO and delivers it to the body in place of oxygen. Not only are the tissues deprived of oxygen but CO also causes significant cellular toxicity.
CO is dose dependent; the more CO you breathe, either by increased concentration in the air, or increased duration of exposure to CO polluted air, the more damage CO does. In large enough doses, CO is fatal. But non-fatal exposures can cause permanent brain, nerve, and heart damage, chronic respiratory problems, and mental health issues such as depression and psychosis. Children, pregnant women, their fetuses, and the elderly are especially vulnerable.
The list of CO producers is long and includes motor vehicles, gas furnaces and boilers, fuel burning appliances such as ovens, cooktops, dryers, space heaters, generators, camp stoves, barbeques, cigarettes, pipes and cigars, motorized yard equipment, and gas or wood burning fireplaces and stoves.
In order to get toxic levels of CO in the air you need an inefficient or malfunctioning carbon burning apparatus and a poorly ventilated space. This space can be a home, office, garage, tent, motorhome, barn, houseboat, airplane, public building, etc.
What should you do to avoid Carbon Monoxide poisoning?
Keep CO out of your space. Inspect all fuel burning appliances frequently. Check pilot lights and burners to make sure they have 90% blue flames and look for excessive ash or soot around the pilot lights. Make sure you are not see increased appliance warm up times and check pipes for cracks and corrosion. Schedule professional maintenance once a year to assure your gas appliances and HVAC systems are functioning properly. Check fireplaces vents and flues and keep them clear and free of ash and soot. Periodically check outside vents to make sure they are not obstructed by lint, snow, leaves, or animal nests, and make sure outside vents are never blocked by household stuff. Do NOT operate fuel burning appliances such as camp stoves, space heaters, charcoal grills, etc. in-doors or in enclosed or poorly ventilated spaces. During power outages use extreme caution with generators, and NEVER use a gas oven to heat the house. Make sure Garage doors are open before you start your hydrocarbon fuel powered vehicle.
Carbon Monoxide detectors are inexpensive, widely available, and easy to install. They do not have to be hard wired as there are plug in and battery powered models available. CO Detectors should be installed throughout the house, especially in bed rooms. They also belong in RV's, boats, cabins, garages, etc. Read the operating instructions so you know how the detector works, how and where to install it, its maintenance requirements, and what it means if it beeps or alarms.
Mr. X. had the classic story for CO poisoning: flu-like symptoms that resolved after leaving the exposure area. Pay special attention to this history if there are several occupants that complain of the same symptoms at the same time.
The signs, symptoms, and severity of CO poisoning are dependent on both the concentration of CO in the air and the duration of exposure. At low blood levels of CO symptoms are nonspecific, and include headache, fatigue, nausea, a sense of spaciness or difficulty concentrating, and dizziness. As CO builds up in the blood, symptoms advance in severity to severe headache, frank confusion, trouble with speech and balance, vomiting, chest pain, and shortness of breath. When CO reaches near fatal levels one sees seizures and coma, and finally if the exposure is not ended and treated, death.
If you believe that you are being exposed to CO call 911 and immediately evacuate the premises. Make sure everyone gets out. If it is possible, evacuate pets too. Do not waste time waiting for help, turning things off, opening windows, making phone calls, grabbing valuables etc. JUST GET OUT. In fact, the fire department requests that you do nothing to mitigate the source of CO as it makes it more difficult for them to identify the source and remedy the problem. The dispatcher at 911 will contact both the Fire Department and County Utilities who will respond immediately to your location. Anyone who is symptomatic should be taken at once to an emergency department. The initial antidote to CO poisoning is 100% oxygen by non-rebreather face mask and this should be started as quickly as possible. Life threatening injuries or illnesses should be addressed and stabilized. Blood should be tested for Carbon Monoxide exposure in all symptomatic people. Additional therapy depends on the severity of the exposure. As soon as you leave CO polluted air, your blood levels of CO will start dropping so do not wait until later to be tested. It is possible to have a significant CO exposure but a normal blood test if you have been out of the exposure area long enough. If your blood test is negative, or you are asymptomatic and did not get tested, DO NOT go back into the exposure area until it is tested, cleared, and pronounced safe for occupation by the fire department and county utilities.