CO Exposure Symptoms
True or False: If a patient with possible CO exposure has an SpO2 of 100%, they do not have CO poisoning
False, SpO2 is unreliable in patients with CO poisoning
What is the most important prehospital treatment for a patient with CO poisoning?
High flow oxygen administration
True or False: all frostbite is the same severity
False: Frostbite, similar to burns, is graded based on the depth of tissue damage. The deeper the damage, the more severe the frostbite.
True or False: You should rub skin affected by frostbite to rewarm it.
False, the skin is fragile and this could cause more damage
True or False: If you place a tourniquet and it doesn't control the bleeding, a second tourniquet should be placed distal to the initial one.
False, the second tourniquet should be placed proximal to the initial tourniquet.
True or False: Headache, nausea/vomiting, and dizziness are all early signs of CO exposure
True
True or False: A patient with a SpO2 of 100% should NOT be given oxygen even if they have confirmed CO exposure
False! Remember SpO2 is not reliable in CO poisoning. Administer high flow O2 no matter what the SpO2 reading is.
True or False: All patients with hypothermia will be shivering
False: Patients stop shivering once their body temperature drops to a certain point. The extent of this varies by person.
True or False: You should start CPR on hypothermic patients that still have a pulse but are severely bradycardic.
False, starting CPR on these patients could precipitate ventricular fibrillation. Use caution with patient movement and handling.
True or False: You should place a bite block in the mouth of a patient having a seizure so they don't bite their tongue.
False, never place anything in the mouth of a seizing patient.
What is a normal CO level in a non-smoker?
Typically less than 2%
What is the definitive treatment for severe carbon monoxide poisoning?
Hyperbaric oxygen therapy
Name 3 possible ECG findings in severe hypothermia.
Bradycardia, asystole, and/or ventricular fibrillation
Remove them from the cold environment.
During what range in a pregnancy can a patient experience preeclampsia?
From 20 weeks gestation until 4 weeks postpartum.
List 3 "late" signs of CO poisoning
Confusion, unresponsiveness/altered mental status, cyanosis, cherry red lips, shortness of breath, loss of muscle control
Your EMS crew is first on scene of a reported CO alarm sounding in a residence. You approach the door, but don't immediately see anyone inside. What steps do you take next?
Do not enter the residence. Yell out to see if you can make contact with anyone inside and have them meet you outside. Wait for fire personnel to confirm the residence is safe to enter.
List the 4 cold death criteria
1. Patient is frozen solid preventing the chest from being compressed
2. Ice in the airway
3. Signs of predation
4. Head was submerged under water for >60 minutes(adult) or >90 minutes(child)
Where are the 3 locations where hot packs should be placed while rewarming hypothermic patients?
Axillae, groin, and thorax.
The patient is too small for the Lucas device. Remove it and resume manual compressions immediately.
You are dispatched for reports of a structure fire. When you(EMS) arrive, there is a male in the driveway that appears dirty and he staggers towards you. It appears he was in the house while the fire was burning and you are concerned for CO exposure. Describe the steps you will take during the primary assessment(ABCDE) and what specific findings you are looking for in this patient.
Open for discussion:
Airway
Breathing
Circulation
Disability
Exposure
You are dispatched for a 32 year old male who was found sitting in a running vehicle in his garage with the door shut. He is unresponsive but breathing. He is safely removed from the area where high levels of CO are detected. The patient has a CO reading of 34%. Explain your transport destination decision.
This patient will need hyperbaric therapy ASAP. Depending of the level of care of your unit, you can either transport to a hyperbaric center(ex. St. Luke's), contact flight for life, or transport to the closest facility for stabilization. Contact medical control for guidance as needed.
Differentiate between typical signs and symptoms of mild-moderate and severe hypothermia.
Mild-moderate: temperature 86-95, may have normal mental status, usually will be shivering
Severe: temperature <86, altered mental status, poor muscle control/stiffness, usually no shivering
You arrive on scene of a "man down." You find a patient that appears to have traumatic injuries on the side of the road and it is below freezing outside. The patient is pulseless and not breathing. You are unsure of how long the patient has been there but note no obvious signs of predation and he is not frozen. Does he meet cold death criteria? What are your next steps?
No he does not. The cardiac arrest should be treated as a hypothermic arrest. CPR should be initiated while actively warming the patient. 1 shock can be administered if indicated.
You are on scene with a patient in respiratory arrest. The patient does not have a gag reflex so you decide to place an I-Gel. The patient has a significant amount of stomach contents coming up into the airway. Name and describe the technique that should be used to effectively place the I-Gel.
SALAD technique(Suction Assisted Laryngoscopy and Airway Decontamination)