| Background:Carbon monoxide?abbreviated as CO?is defined as a colorless,odorless gas that is produced by burning materials containing hydrocarbon.It is also produced when common household appliances such as stove,water heaters and furnaces are not properly ventilated.CO is formed when organic compounds are burnt.[1]Its most common sources are motor vehicle exhaust,smoke from fires,engine fumes,nonelectric heaters and many others.[2]CO emitted by these appliances can buildup and cause poisoning which can lead to brain damage and death.Carbon monoxide poisoning is often associated with malfunctioning or obstructed exhaust systems.Poisoning occurs after prolonged exposure to a potentially lethal dosage of over100 ppm.[1'3]When CO poisoning is suspected clinically,measurement of the blood carboxyhemoglobin?COHb?should typically be performed and an elevated level?>5%for nonsmokers and 10%for smokers?strongly suggests exposure to exogenous CO that requires urgent medical attention.[2'4]Carbon monoxide?CO?poisoning is common in most developing countries.For instance in China,cases are mostly sporadic but considering the population base and the lack of proper awareness in rural settings,the estimated death toll is approximated to be up to thousands every year.[5'6'7]Early symptoms of carbon monoxide poisoning such as headaches,nausea,and fatigue are often mistaken for flu-like illness because this deadly gas goes undetected in homes.[8]A Prolonged exposure can lead to neurological problems or even death.Carbon monoxide poisoning is one of the leading cause of over 20,000 emergency department visits for accident related cases annually in the US.[1'9'12]Since the signs and symptoms of CO poisoning are nonspecific,it is likely that many more cases are unsuspected or attributed to other etiologies,thereby remaining undiagnosed.Therefore,the need for using this noninvasive handheld equipment?the Co-oximeter?as a first hand tool in the emergency diagnosis of CO poisoning remains very important and should require continuous assessment for its effectiveness and accuracy for a prompt and precise emergency intervention.Objectives:1.Find the effectiveness and accuracy of this handheld device?Co-Oximeter?to the pre-hospital arena,assess carboxyhemoglobin levels in emergency medical services?EMS?patients,and correlate these levels with clinical data.2.Find the significance of time and cost of diagnosing CO poisoning between current and past diagnosis criteria?Co-oximeter and non oximeter groups?.Methods:Design of the StudyThe research employed a descriptive cross sectional case control method.Computer files containing Patients'hospital record were the primary sources of data.ProcedureThe participants used in this study were 124 carbon monoxide poisoned patients diagnosed using the CO oximeter?oximeter group?,124 CO poisoned patients diagnosed without the use of the CO-oximeter?non-oximeter group?and 50 non-carbon monoxide poisoned patients?control?in the emergency department of the China-Japan Union hospital from January 2016 to December 2017.The entire studied population was 298subjects divided into case?Co poisoned patients?and controls?None Co poisoned patients?groups respectively.The oximeter group was further subdivided into three groups based on the patient's clinical symptoms,signs and the resulting measurements of pulsed carboxyhemoglobin by the co-Oximeter.Time and cost of diagnosing for both cases?old and new criteria?were compared to see if there were any significant differences in the use of the CO-oximeter.A targeted range for the oximeter group was set to enable a separation of the groups.Patients whose poisoning levels were from 5 to 9.9%?9?were considered mildly poisoned.Patients with poisoning levels from 10 to 29%?92?were considered moderately poisoned while patients with poisoning levels from 30%and above?23?were considered severely poisoned respectively.The patients were also divided into categories of male and female in each group respectively.The controls were patients diagnosed of different illnesses other than Co poisoning and they were tested before and after their treatments.The admission criteria for the cases?oximeter group?were based primarily on CO saturation readings as diagnosed by the CO-Oximeter and accompanying symptoms.The general rule for hospital discharge for both case and control groups were that,patients were clinically stable?relief of or improvement of clinical signs and symptoms?and were in a condition to leave the hospital.On the other hand,criteria set for diagnosing and admitting patients in the non oximeter group was that a patient had clinical signs and symptoms present,showed normal laboratory and imaging results?ECG,CT,potassium,sodium and glucose?but signs and symptoms improved after HBO treatment.Data CollectionData was collected from patients'files and were analyzed and computed.Results were presented as mean±standard deviation?M±SD?for quantitative variables and for qualitative ones as absolute and relative frequencies in categorical variables.All analysis was performed using IBM SPSS 17.0,prism 6 pad graph and excel.MaterialsThe carbon monoxide detector used in this study was the Masimo SET?R?finger-type pulse oximeter Rod-57 manufacture by Masimo Corporation which measures the blood carboxyhemoglobin saturation?COHB%?concentration.According to the measured results of carbon oxyhemoglobin saturation in the blood,it can help in the diagnosis of carbon monoxide poisoning.The materials used to obtain all necessary data were computer files containing patient's admission records and doctors'and nurses notes as well as discharge information.Results:1.Of the 298 patients selected,42.75%?124/298??See table1?comprised of the Oximeter group while 16.77%?50/298?patients were the control group and the remaining42.75%?124/298?was the Non-oximeter group.All patients were selected based on the set inclusion and exclusion criteria.2.The mean age of the CO poisoned patients was 46.73years and among them,15.77%?47/298?were poisoned with coal stove,6.37%?19/298?were poisoned with cooking gas pipeline leakage,3.35%?10/298?were poisoned from eating Chinese hotpot in an enclosed or improperly ventilated room,10.06%?30/298?from furnace,3.35%?10/298?from boiler rooms in public shower houses and 2.68%?8/298?had unknown sources of poisoning?either because the symptoms and signs developed in the later parts of their lives after the primary exposure?.Among the patients affected by the CO poisoning,26.84%?80/298?had signs and symptoms of headache,nausea and vomiting,12.75%?38/298?were confused or unconscious,0.67%?2/298?were in coma and 1.34%?4/298?has chest and other bodily discomforts.Before treatment,there was no statistical difference in gender,age,and onset timebetween the three Oximeter groups?P>0.05?.There was a statistically significant difference in the carboxyhemoglobin mean levels among all groups;mild,moderate and severe group before treatment?6.66±1.41,19.58±5.56,and 34.47±5.40?and after treatments?2.73±1.83,6.44±2.99,and 20.79±3.49??P<0.05?.There was no statistical difference in the mean CO level in the control group?P>0.05?before and after treatment thus signifying consistency and accuracy in the results from the Co-Oximeter.This also suggests that non-invasive carboxyhemoglobin correlates with the severity of the patient's condition and can be used as an indicator of carbon monoxide poisoning?See Table1?.3.In comparing the time taken between the oximeter and non-oximeter groups for a patient to get diagnosed,the finding showed that patients in the non-oximeter diagnosed group took twice the time of the Co-oximeter diagnosed group?see Table 4?.On the other hand,the cost for diagnosing a patient without the CO-oximeter was three times higher than those patients diagnosed with the co-oximeter?335.87±5.352<1162.59±6.752?.This result showed a significant decrease in time and cost for diagnosing patients using the Co-oximeter while there was an increased time and cost for the non-oximeter group that did not use the Co-oximeter for diagnosing patients?p<0.05?.Conclusively,we can say that the use of the Co-oximeter in diagnosing CO poisoning has positive impact on cost and time.Conclusions:1.The quantitative detection of carboxyhemoglobin by non-invasive method?the co-oximeter?in patients with carbon monoxide poisoning has clinical application value and can provide scientific guidance for clinicians in the early diagnosis,severity classification,and evaluation of patients'progress of treatment for acute carbon monoxide poisoning.This detection of carboxyhemoglobin also has scientific guiding significance for the early clinical diagnosis,severity classification and evaluation of treatment effects of acute carbon monoxide poisoning that would help reduce complications,improve diagnosis and timely treatment of acute carbon monoxide poisoning,thereby lowering nursing and other unnecessary examinations costs,and reduce mortality.2.The pulse oximeter can be used to determine the HBCO%concentration.The principle is to use a multi-wavelength sensor through the capillary bed to accurately and non-invasively measure carboxyhemoglobin concentration in the blood at the end of the finger and display the results within a few minutes.It does not require any need for user calibration when testing since it can be done without patient's consent or conscious awareness.3.The findings from this research showed no differences in the CO level in non-poisoned patients before and after treatment.These findings were consistent with the criteria set for the selection of the control group.In addition,using a novel clinical outcome such as CO level before and after treatment by a timely and convenient noninvasive tool such as co-oximeter would assist the clinician in making differential diagnosis timely and precise,thereby initiating treatment and evaluating the benefits of therapy.The study's findings regard the effectiveness and accuracy of co-oximeter as a breakthrough in the field of science which corresponds to previous studies in literature.This finding clearly demonstrates how the time of a single CO poisoned diagnosis process can be reduced from an hour or two to just few minutes with the use of the CO-oximeter.4.Finally,the findings from this study show that the co-oximeter is effective in the early and late diagnosis of CO poisoning.It also showed poisoned patients as well as the severity of poison. |
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