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Acil Servise Başvuran Hastaların Gizli Karbon Monoksit Zehirlenmesi Açısından Değerlendirilmesi

Yıl 2022, Cilt: 4 Sayı: 3, 367 - 371, 22.09.2022
https://doi.org/10.37990/medr.1103558

Öz

Amaç: Bu çalışmanın birincil amacı, acil servise atipik semptomlarla başvuran hastaları gizli karbonmonoksit (CO) zehirlenmesi açısından değerlendirmek, ikincil amacı ise yüksek CO düzeyi olan hastalarda Karboksihemoglobin (COHb) düzeylerinin invaziv ve non-invaziv değerlerini karşılaştırmaktır.
Materyal ve Metot: Bu prospektif ve tanımlayıcı çalışma, 1 Ocak-31 Mart 2015 tarihleri arasında Acil Servise (AS) başvuran 2775 erişkin hasta üzerinde yapılmıştır. Acil servise non spesifik şikayetler ile başvuran bireylerin noninvaziv multidalga pulse oksimetre cihazı ile COHb düzeyleri ölçülmüş ve önceden oluşturulan ve başvuru tarihi, yaş, cinsiyet, şikayet, sigara öyküsü, gebelik durumu, pulse COHb, kan COHb ve kan metHb parametlerini içeren forma kaydedilmiştir. Sigara içenlerde %10’un, içmeyenlerde %6.6’nın altındaki değerler gizli COHb intoksikasyonu olarak kaydedildmiştir.
Bulgular: %52.8’i erkek olan hastaların %34.4’ü sigara kullanıyordu. Kadın hastalar arasında gebe olanların oranı %13.4 idi. İlk üç şikayet nefes darlığı, göğüs ağrısı ve karın ağrısıydı. Hastaların COHb ortalaması arteriyal kan gazında 1.44±1.65, parmak ölçümünde 1.75±1.63 olarak belirlendi. İki ortalama arasında yüksek düzeyde anlamlı bir ilişki bulundu. Her iki teknikle ölçülen COHb değeri, erkek hastalarda, sigara içenlerde ve gebe olmayanlarda daha yüksekti. Gizli COHb zehirlenmesi oranı sigara içenlerde %1, içmeyenlerde %0.1 olarak belirlendi.
Sonuç: Non-invaziv COHb ölçümünün gizli karbonmonoksit intoksikasyonlarının teşhisine olumlu katkılar sağlayabileceği kanaatine vardık.

Kaynakça

  • Referans1 Doherty S. History, pathophysiology, clinical presentation and role of hyperbaric oxygen in acute CO poisoning. Emerg Med. 2000;12:55-61.
  • Referans2 Gerald Maloney. Carbon Monoxide. In: Tintinalli JE editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011;1410–3
  • Referans3 Özdemir HS, Kaplanoğlu V. Karbonmonoksit zehirlenmesi. Türkiye Klinikleri J Surg Med Sci 2006;2:74-80
  • Referans4 Sever H, İkizceli İ, Avşaroğulları L. ve ark. Nonspesifik Semptomlarla Acil Servise Başvuran Hastalarda Karbonmonoksit Zehirlenmesi. Türkiye Acil Tıp Dergisi 2005; 5: 18- 21.
  • Referans5 Dökmeci İ. Toksikoloji. Nobel Tıp Kitapevi. Ankara. 2001, s 249- 255.
  • Referans6 A Y. Karbon monoksit zehirlenmesi. Satar S (editor). Acilde Klinik Toksikoloji 1Baskı, Adana:Nobel. 2009:577-80.
  • Referans7 Diltoer MW, Colle IO, Hubloue I, Ramet J, Spapen HD, Nguyen N, et al. Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide. European journal of emergency medicine: official journal of the European Society for Emergency Medicine. 1995;2(4):231-5.
  • Referans8 Roth D, Herkner H, Schreiber W, Hubmann N, Gamper G, Laggner AN, et al. Accuracy of noninvasive multiwave pulse oximetry compared with carboxyhemoglobin from blood gas analysis in unselected emergency department patients. Ann Emerg Med 2011; 58:74-9
  • Referans9 Kao LW, Nanagas KA. Carbon monoxide poisoning. Emergency medicine clinics of North America. 2004;22(4):985-1018.
  • Referans10 KW VM. Carbon Monoxide Poisoning. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds). Emergency Medicine:A Comprehensive Study Guide (6th ed ) McGraw-Hill. 2004:1238-42
  • Referans11 Zaouter C, Zavorsky GS: The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter. Respir Physiol Neurobiol. 2012, 182:88-92.
  • Referans12 Kao LW, Nanagas KA. Carbon monoxide poisoning. The Medical clinics of North America. 2005;89(6):1161-94.
  • Referans13 Suner S, Partridge R, Sucov A, Valente J, Chee K, Hughes A, et al. Non- invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. The Journal of emergency medicine. 2008;34(4):441-50
  • Referans14 Chee KJ, Nilson D, Partridge R, Hughes A, Suner S, Sucov A, et al. Finding needles in a haystack: a case series of carbon monoxide poisoning detected using new technology in the emergency department. Clinical toxicology. 2008;46(5):461-9
  • Referans15 Harduar-Morano L, Watkins S. Review of unintentional non-fire-related carbon monoxide poisoning morbidity and mortality in Florida, 1999-2007. Public health reports. 2011;126(2):240-50.
  • Referans16 Barker SJ, Curry J, Redford D, et al. Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study. Anesthesiology. 2006;105:892-897.
  • Referans17 Touger M, Gallagher EJ, Tyrell J. Relationship between venous and arterial carboxyhemoglobin levels in patients with suspected carbon monoxide poisoning. Annals of emergency medicine. 1995;25(4):481-3.

Secret Carbon Monoxide Intoxication Assessments of the Patients Who Presented to Emergency

Yıl 2022, Cilt: 4 Sayı: 3, 367 - 371, 22.09.2022
https://doi.org/10.37990/medr.1103558

Öz

Aim: The primary aim of this study is to evaluate patients who present to the emergency department with atypical symptoms in terms of occult Carbon monoxide (CO) poisoning, and the secondary aim is to compare the invasive and non-invasive values of Carboxyhemglobin (COHb) levels in patients with high CO levels.
Material and Method: This prospective and descriptive study was conducted on 2775 adult patients who visited the Emergency Department (ED) between January 1 and March 31, 2015. The COHb levels of the individuals who applied to the emergency department with non-specific complaints were measured with a non-invasive multiwave pulse oximeter device and the date of application, age, gender, complaint, smoking history, pregnancy status, pulse COHb, blood COHb and blood metHb parameters were recorded in the preformed form. Values under 10% in smokers and under 6.6% in non-smokers were recorded as secret COHb intoxication.
Results: 52.8% of the patients were male and 34.4% were smokers. The rate of pregnant women among female patients was 13.4%. The first three complaints were shortness of breath, chest pain and stomach ache. It was determined that the mean COHb of the patients was 1.44±1.65 in arterial blood gas and 1.75±1.63 in finger measurement. A highly significant positive correlation was found between the two averages. The COHb value measured by both techniques was higher in male patients and in smokers and non-pregnant patients. The rate of latent COHb intoxication was determined as 1% in smokers and 0.1% in non-smokers.
Conclusion: We came to the conclusion that non-invasive COHb measurement can make positive contributions to the diagnosis of secret carbonmonoxyde intoxications.

Kaynakça

  • Referans1 Doherty S. History, pathophysiology, clinical presentation and role of hyperbaric oxygen in acute CO poisoning. Emerg Med. 2000;12:55-61.
  • Referans2 Gerald Maloney. Carbon Monoxide. In: Tintinalli JE editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011;1410–3
  • Referans3 Özdemir HS, Kaplanoğlu V. Karbonmonoksit zehirlenmesi. Türkiye Klinikleri J Surg Med Sci 2006;2:74-80
  • Referans4 Sever H, İkizceli İ, Avşaroğulları L. ve ark. Nonspesifik Semptomlarla Acil Servise Başvuran Hastalarda Karbonmonoksit Zehirlenmesi. Türkiye Acil Tıp Dergisi 2005; 5: 18- 21.
  • Referans5 Dökmeci İ. Toksikoloji. Nobel Tıp Kitapevi. Ankara. 2001, s 249- 255.
  • Referans6 A Y. Karbon monoksit zehirlenmesi. Satar S (editor). Acilde Klinik Toksikoloji 1Baskı, Adana:Nobel. 2009:577-80.
  • Referans7 Diltoer MW, Colle IO, Hubloue I, Ramet J, Spapen HD, Nguyen N, et al. Reversible cardiac failure in an adolescent after prolonged exposure to carbon monoxide. European journal of emergency medicine: official journal of the European Society for Emergency Medicine. 1995;2(4):231-5.
  • Referans8 Roth D, Herkner H, Schreiber W, Hubmann N, Gamper G, Laggner AN, et al. Accuracy of noninvasive multiwave pulse oximetry compared with carboxyhemoglobin from blood gas analysis in unselected emergency department patients. Ann Emerg Med 2011; 58:74-9
  • Referans9 Kao LW, Nanagas KA. Carbon monoxide poisoning. Emergency medicine clinics of North America. 2004;22(4):985-1018.
  • Referans10 KW VM. Carbon Monoxide Poisoning. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds). Emergency Medicine:A Comprehensive Study Guide (6th ed ) McGraw-Hill. 2004:1238-42
  • Referans11 Zaouter C, Zavorsky GS: The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter. Respir Physiol Neurobiol. 2012, 182:88-92.
  • Referans12 Kao LW, Nanagas KA. Carbon monoxide poisoning. The Medical clinics of North America. 2005;89(6):1161-94.
  • Referans13 Suner S, Partridge R, Sucov A, Valente J, Chee K, Hughes A, et al. Non- invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. The Journal of emergency medicine. 2008;34(4):441-50
  • Referans14 Chee KJ, Nilson D, Partridge R, Hughes A, Suner S, Sucov A, et al. Finding needles in a haystack: a case series of carbon monoxide poisoning detected using new technology in the emergency department. Clinical toxicology. 2008;46(5):461-9
  • Referans15 Harduar-Morano L, Watkins S. Review of unintentional non-fire-related carbon monoxide poisoning morbidity and mortality in Florida, 1999-2007. Public health reports. 2011;126(2):240-50.
  • Referans16 Barker SJ, Curry J, Redford D, et al. Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study. Anesthesiology. 2006;105:892-897.
  • Referans17 Touger M, Gallagher EJ, Tyrell J. Relationship between venous and arterial carboxyhemoglobin levels in patients with suspected carbon monoxide poisoning. Annals of emergency medicine. 1995;25(4):481-3.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Özgün Makaleler
Yazarlar

Serdar Derya 0000-0001-5618-8514

Şükrü Gürbüz 0000-0003-2616-0304

Hakan Oğuztürk 0000-0002-9800-1428

Neslihan Yucel 0000-0001-5845-2614

Muhammet Gökhan Turtay 0000-0002-6213-3963

Muhammed Ekmekyapar 0000-0001-7008-2695

Ömür Uyanık 0000-0001-6500-5812

Hasan Gökçe 0000-0003-3198-931X

Yayımlanma Tarihi 22 Eylül 2022
Kabul Tarihi 24 Haziran 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 4 Sayı: 3

Kaynak Göster

AMA Derya S, Gürbüz Ş, Oğuztürk H, Yucel N, Turtay MG, Ekmekyapar M, Uyanık Ö, Gökçe H. Secret Carbon Monoxide Intoxication Assessments of the Patients Who Presented to Emergency. Med Records. Eylül 2022;4(3):367-371. doi:10.37990/medr.1103558

 Chief Editors

Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Turkey

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Turkey

E-mail: medrecsjournal@gmail.com

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