Download PDF
NOTARZT 2019; 35(02): 99-107
DOI: 10.1055/a-0821-9033
Zusatzweiterbildung Notfallmedizin
Georg Thieme Verlag KG Stuttgart · New York

Versorgung von Patienten mit Kohlenmonoxidvergiftung

Initial Care of Patients with Carbon Monoxide Poisoning
Daniela Lenard
,
Hans-Jörg Busch
,
Enrico Staps
Further Information

Publication History

Publication Date:
09 April 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Kohlenmonoxid ist ein ubiquitär vorkommendes Gas und findet weitreichend Anwendung. Kohlenmonoxidvergiftungen sind gerade im präklinischen Umfeld eine diagnostische Herausforderung, dabei mit mehreren Tausend Klinikvorstellungen im Jahr ein relevantes Krankheitsbild für den Rettungs- und Notarztdienst. Der Beitrag stellt die Versorgung von Patienten mit CO-Vergiftung anhand eines Fallbeispiels vor.

Abstract

The intoxication with carbon monoxide is the most lethal intoxication after an exposition to gas. Carbon monoxide is a ubiquitous gas that originates from a partial combustion of carbonic compounds. It is important to note that every member of the rescue service will come in contact with this scenario. The emergency calls range from the obvious – in connection with a blazing fire – to the more obscure, e.g. the wood pellet storage. The major challenge for the emergency care provider is thus to stay alert and recognize the chameleon “carbon monoxide intoxication” for what it is. To aid them along the way and also to prohibit a danger to the care provider himself as much as possible, carbon monoxide warning devices are implemented into the protective gear. The knowledge of how they work and what their alarms mean may be lifesaving, when recognition of a potential danger due to the multiform symptoms of an intoxication victim may be impaired. Its potency for disguise is due to the complex pathophysiology of the effect of carbon monoxide on the human body. Apart from its much known and much discussed hypoxic and hypoxaemic effects by binding onto haemoglobin and myoglobin with a vastly higher affinity then oxygen, other mechanisms such as oxidative stress and inflammation to especially myocardial and neuronal tissue seem to be responsible for the wide array of symptoms in connection with the carbon monoxide intoxication. The treatment, in contrast, is simple: a continuous high-flow oxygen application and a treatment tailored to the symptoms. A further challenge derives from the choice of the target hospital. Current literature shows a beneficiary effect of hyperbaric therapy if administered within 6 hours of detection of the intoxication. This remains to be verified by further studies. Therefore, the decision for an hyperbaric therapy stays an individual decision.

Kernaussagen

  • Die Vermutung als Ursache einer gesundheitlichen Störung bzw. die Detektion von Kohlenmonoxid an der Einsatzstelle ist von herausragender Wichtigkeit in Bezug auf die Sicherheit des Rettungsdienstpersonals und die adäquate Therapie der Patienten.

  • Leichte bzw. unspezifische Symptome wie Kopfschmerzen, Verwirrung, Übelkeit, Schwindel, Erbrechen u. a. können auf eine Kohlenmonoxidvergiftung hindeuten. Dies ist besonders bei Patienten von Bedeutung, die selbst eine Notfallaufnahme aufgrund der o. g. Beschwerden aufsuchen. Hier kann schnell eine Kohlenmonoxidvergiftung übersehen werden.

  • Der Verdacht auf eine Kohlenmonoxidvergiftung liegt, ungeachtet des COHb, vor, wenn – gesichert oder anamnestisch hoch wahrscheinlich – eine Kohlenmonoxidexposition stattgefunden hat und Symptome vorliegen, die mit einer Kohlenmonoxidvergiftung vereinbar sind.

  • Nach überlebter schwerer Kohlenmonoxidvergiftung besteht ein erhöhtes Risiko für Delayed neuropsychological Sequelae (DNS) und eine erhöhte kardiale Letalität.

  • Eine hyperbare Sauerstofftherapie (HBOT) scheint bei schwerer Vergiftung einen Benefit in Bezug auf das neurologische und kardiale Outcome zu haben.

Schlüsselwörter

Kohlenmonoxidvergiftung - unklare Bewusstlosigkeit - Intoxikation - hyperbare Oxygenierung

Key words

carbon monoxide intoxication - unclear unconsciousness - intoxication - hyperbaric oxygen therapy
 

  • Literatur

  • 1 Kaiser G, Schaper A. Akute Kohlenmonoxidvergiftung. Notfall Rettungsmed 2012; 15: 429-435
    CrossrefPubMedGoogle Scholar
  • 2 Eichhorn L, Thudium M, Jüttner B. The diagnosis and treatment of carbon monoxide poisoning. Dtsch Arztebl Int 2018; 115: 863-870
    CrossrefPubMedGoogle Scholar
  • 3 Rose JJ, Wang L, Xu Q. et al. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Respir Crit Care Med 2017; 195: 596-606
    CrossrefPubMedGoogle Scholar
  • 4 Hoetzel A. Carbon monoxide – poison or potential therapeutic?. Anaesthesist 2006; 55: 1068-1079
    CrossrefPubMedGoogle Scholar
  • 5 Eichhorn L, Michaelis D, Kemmerer M. et al. Carbon monoxide poisoning from waterpipe smoking: a retrospective cohort study. Clin Toxicol (Phila) 2018; 56: 264-272
    CrossrefPubMedGoogle Scholar
  • 6 Frankfurter Rundschau. Kohlenmonoxid-Vergiftung. Drei Tote in Wiesbaden. Im Internet: https://www.fr.de/rhein-main/alle-gemeinden/wiesbaden/kohlenmonoxid-vergiftung-drei-tote-in-wiesbaden-a-893963?GEPC=s5 Stand: 30.12.2018
    PubMedGoogle Scholar
  • 7 Simon C, Meininger D. Akzidentelle Kohlenmonoxidintoxikation bei einer Familienfeier. Notarzt 2017; 33: 14-19
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Vermesi I, Restuccia F, Walker-Ravena C. et al. Carbon monoxide diffusion through porous walls: a critical review of literature and incidents. Imperial College London, 2015, Technical Notes of the Fire Protection Research Foundation. Im Internet: http://www.nfpa.org/news-and research/fire-statistics-and-reports/research-reports/detection-and-signaling/carbon-monoxide- diffusion-through-porous-walls; Stand: 30.12.2018
    PubMedGoogle Scholar
  • 9 Kaiser G, Müller D. Einsatz von Kohlenstoffmonoxidwarngeräten im Rettungsdienst: Hinweise und Empfehlungen zur Handhabung und Festlegung von Warnschwellen. Notfall 2014; 17: 141-146
    PubMedGoogle Scholar
  • 10 Gauthier S, Grass H, Lory M. et al. Lethal carbon monoxide poisoning in wood pellet storerooms – two cases and a review of the literature. Ann Occup Hyg 2012; 56: 755-763
    PubMedGoogle Scholar
  • 11 Hampson NB, Piantadosi CA, Thom SR. et al. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med 2012; 186: 1095-1101
    CrossrefPubMedGoogle Scholar
  • 12 Rose JJ, Wang L, Xu Q. et al. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Respir Crit Care Med 2017; 195: 596-606
    CrossrefPubMedGoogle Scholar
  • 13 Wolf SJ, Maloney GE, Shih RD. et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med 2017; 69: 98-107
    CrossrefPubMedGoogle Scholar
  • 14 Roderique JD, Josef CS, Feldman MJ. et al. A modern literature review of carbon monoxide poisoning theories, therapies, and potential targets for therapy advancement. Toxicology 2015; 334: 45-58
    CrossrefPubMedGoogle Scholar
  • 15 Rydzewski J, Nowak W. Photoinduced transport in an H64Q neuroglobin antidote for carbon monoxide poisoning. J Chem Phys 2018; 148: 115101
    CrossrefPubMedGoogle Scholar
  • 16 Drinhaus H, Nüsgen S, Hinkelbein J. Notärztliche Tätigkeit im Brandeinsatz. Anaesthesist 2016; 65: 50-56
    CrossrefPubMedGoogle Scholar
  • 17 Kalay N, Ozdogru I, Cetinkaya Y. et al. Cardiovascular effects of carbon monoxide poisoning. Am J Cardiol 2007; 99: 322-324
    CrossrefPubMedGoogle Scholar
  • 18 Rehberg S. Differenzierter Einsatz kardiovaskulär wirksamer Substanzen. Intensivmedizin up2date 2018; 14: 147-164
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Satran D, Henry CR, Adkinson C. et al. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol 2005; 45: 1513-1516
    CrossrefPubMedGoogle Scholar
  • 20 Henry CR, Satran D, Lindgren B. et al. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA 2006; 295: 398-402
    CrossrefPubMedGoogle Scholar
  • 21 Lettow I, Hoffmann A, Burmeister HP. et al. Delayed neuropsychological sequelae after carbon monoxide poisoning. Fortschr Neurol Psychiatr 2018; 86: 342-347
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Weaver LK, Valentine KJ, Hopkins RO. Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen. Am J Respir Crit Care Med 2007; 176: 491-497
    CrossrefPubMedGoogle Scholar
  • 23 Park E, Ahn J, Min YG. et al. The usefulness of the serum s100b protein for predicting delayed neurological sequelae in acute carbon monoxide poisoning. Clin Toxicol 2012; 50: 183-188
    CrossrefPubMedGoogle Scholar
  • 24 Weaver LK, Valentine KJ, Hopkins RO. Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen. Am J Respir Crit Care Med 2007; 176: 491-497
    CrossrefPubMedGoogle Scholar
  • 25 Rose JJ, Nouraie M, Gauthier MC. et al. Clinical outcomes and mortality impact of hyperbaric oxygen therapy in patients with carbon monoxide poisoning. Crit Care Med 2018; 46: e649-e655
    CrossrefPubMedGoogle Scholar
  • 26 Huang CC, Ho CH, Chen YC. et al. Hyperbaric oxygen therapy is associated with lower short and long-term mortality in patients with carbon monoxide poisoning. Chest 2017; 152: 943-953
    CrossrefPubMedGoogle Scholar
  • 27 Pace R, Bon Homme M, Hoffman RS. et al. Effects of hydroxocobalamin on carboxyhemoglobin measured under physiologic and pathologic conditions. Clin Toxicol (Phila) 2014; 52: 647-650
    CrossrefPubMedGoogle Scholar
  • 28 Chiew AL, Buckley NA. Carbon monoxide poisoning in the 21st century. Crit Care 2014; 18: 221
    CrossrefPubMedGoogle Scholar