Improving Outcomes, Pulmonary

Cold Weather is Coming – add CO Poisoning to the DDX.

It’s Fall in the great Northeast, the leaves are changing, the temperatures dropping, and Caramel Apple Spice and Pumpkin Spice are selling out at your local Starbucks.

It’s a routine shift in the ED, a spattering of belly pain and chest pain, and the next patient up is here for a headache.  They have stable vitals, here last week and felt well after treatment of Compazine, Benadryl, and Decadron.  The prior provider even did labs and a CT which were unremarkable.  The patient reports it gradually worsened while they were watching TV.  No vomiting, no fever, no vision changes, not worse with exertion, and an unconcerning neurological exam.  Now you could just reach for a similar treatment as last week, but you could also…

In one particular study of 483 patients presenting with a headache in the winter months- all of whom had SpCO monitoring/screening- 6.4% of patients had a carboxyhemoglobin over 10%.  Of those diagnosed, 77% were suspected CO poisoning.  Basically, we missed a fair amount.  Also, it is important to note that CO poisoning was more frequently seen in patients that presented after midnight and in the morning hours.  A separate study looking at 1006 New York and New Jersey CO poisoned patients showed that, unsurprisingly, CO exposure was significantly increased in October – March.   Somewhat surprising to me was that the median age of these patients was actually 30 years old!

Lastly, in a survey of 1030 patients, only 44.4% had home carbon monoxide detectors installed, and only 17.2% had carbon monoxide detectors installed in or near the correct place (hint- its supposed to be near sleeping quarters.)
I realize its a bit of a red herring diagnosis, but we see headache patients almost on a daily basis, and perhaps one of us will actually catch the patient that lives alone that has CO poisoning and actually make a difference.  Cold weather will be upon us soon.  Next time a patient “woke up with a headache” and there’s a cold spell, consider carbon monoxide poisoning in your differential.  Consider asking about household members with similar symptoms, and if symptoms have been more frequent lately.

#FOAM on.

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PMID: 24128732

PMID: 19860138

PMID: 22577866

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