Emergency Care For You

Carbon Monoxide — The Hidden Killer

Liudvikas (Ludi) Jagminas, MD, FACEP, is the chief of service at BID-Plymouth, Massachusetts, Department of Emergency Medicine and vice-chair of Network Development with Beth Israel Deaconess Hospital and Harvard Medical Faculty Physicians.

I was working Christmas week and a husband and his 2 children (ages 8 & 10) came to the emergency department — all complaining of a headache, tiredness and nausea.

The dad said he thought they all had the flu. When I was getting more history he told me he and the kids probably caught what his wife had had. He described similar symptoms to his wife and that all she wanted to do was stay in bed.

I asked him how long he and the kids had these symptoms and he told me they were fine during the week but over the weekend they “got sick” but then Monday after being at work and the kids at school all day they had felt better. But then since they were home for vacation they “all came down with it again”. None of them had any URI symptoms or a fever, so I checked their carbon monoxide levels and they were all high.

I called 911 and had a fire truck and ambulance go out to the home and they checked carbon monoxide levels and found them to be markedly elevated. They brought the man’s wife in to the hospital and her level was so high we sent her to a hyperbaric chamber.

Fortunately, everyone in this situation survived and did well. Others may not be so lucky.

As the weather gets colder, the risk of carbon monoxide poisoning increases.

Carbon monoxide poisoning occurs when carbon monoxide builds up in your bloodstream. When too much carbon monoxide is in the air, your body replaces the oxygen in your red blood cells with carbon monoxide. This can lead to serious tissue damage, or even death.

Carbon monoxide is a colorless, odorless, tasteless gas produced by burning gas, wood, propane, charcoal or other fuel. Improperly ventilated appliances and engines, particularly in an enclosed space, may allow carbon monoxide to accumulate to dangerous levels.

Since carbon monoxide has no odor, color or taste, it cannot be detected by our senses. This means that dangerous concentrations of the gas can build up indoors and humans have no way to detect the problem until they become ill. Furthermore, when people become sick the symptoms are similar to the flu, which can cause victims to ignore the early signs of carbon monoxide poisoning.

The Centers for Disease Control (CDC) estimates that approximately 500 people die from accidental carbon monoxide exposure in the United States every year. In addition, the CDC also estimates that 8,000 to 15,000 people each year are examined or treated in emergency departments for non-fire related carbon monoxide poisoning. The good news is that carbon monoxide poisoning can be prevented with simple actions such installing a carbon monoxide detector and maintaining fuel burning appliances.

Carbon Monoxide sources in the home:

In simple terms, carbon monoxide is produced whenever a material burns. Homes with fuel-burning appliances or attached garages are more likely to have carbon monoxide problems. Common sources of carbon monoxide in our homes include fuel-burning appliances and devices such as:

  • Furnaces or boilers
  • Gas stoves and ovens
  • Fireplaces, both gas and wood burning
  • Water heaters
  • Clothes dryers
  • Wood stoves
  • Power generators
  • Motor vehicles
  • Power tools and lawn equipment
  • Tobacco smoke

Protecting your family:

Install a carbon monoxide detector today. Put one in the hallway near each sleeping area in your home. Check the batteries every time you check your smoke detector batteries — at least twice a year. If the alarm sounds, leave the house and call 911 or the fire department. Carbon monoxide detectors are also available for motor homes and boats.

It is important to know what appliances in your home are fuel-burning and make sure that they are maintained properly. All of these appliances should be vented to the outside. You should have your fuel-burning appliances (ex. furnace) checked by a qualified heating contractor every year to look for potential problems. It is also a good idea to know the signs of a potential CO problem:

  • Streaks of soot around fuel-burning appliances, or fallen soot in a fireplace
  • Absence of an upward draft in your chimney
  • Excess moisture and condensation on windows, walls and cold surfaces
  • Rusting on flue pipes or appliance jacks
  • Orange or yellow flame in combustion appliances (the flame should be blue)
  • Damaged or discolored bricks at the top of the chimney 

Never use appliances intended for outdoor use inside. Examples include barbecue grills, camp stoves, portable generators or gas-powered lawn equipment. Do not use an oven to heat your home. Not only is it a fire risk, it is also a carbon monoxide hazard. Do not run or idle your vehicle in an attached garage. Instead, back your vehicle out right away. Check that your vehicle’s exhaust pipe is not blocked, for example, by snow during the winter.

What are the symptoms of Carbon Monoxide poisoning?

Identifying carbon monoxide poisoning can be difficult because the symptoms are similar to the flu. Carbon monoxide is often called the “silent killer” because people will ignore early signs and eventually lose consciousness and be unable to escape to safety.

For most people, the first signs of exposure include mild headache and breathlessness with moderate exercise. Continued exposure can lead to more severe headaches, dizziness, fatigue and nausea. Eventually symptoms may progress to confusion, irritability, impaired judgment and coordination, and loss of consciousness.

You can tell the difference between carbon monoxide poisoning and the flu with these clues:

  • You feel better when you are away from home
  • Everyone is the home is sick at the same time (the flu is typically passed from person to person)
  • The family members most effected spend the most time in the house
  • Indoor pets appear ill
  • You don’t have a fever or body aches, and you don’t have swollen lymph nodes that are common with the flu and some other infections
  • Symptoms appear or seem to get worse when using fuel-burning equipment

What should I do if the carbon monoxide alarm sounds?

  • Immediately move outside to fresh air. 
  • Call your emergency services, fire department, or 911. 
  • After calling 911, do a head count to check that all persons are accounted for. DO NOT reenter the premises until the emergency services responders have given you permission. You could lose consciousness and die if you go in the home. 
  • If the source of the carbon monoxide is determined to be a malfunctioning appliance, DO NOT operate that appliance until it has been properly serviced by trained personnel. 

About the Author: Liudvikas (Ludi) Jagminas, MD, FACEP, is the chief of service at BID-Plymouth, Massachusetts, Department of Emergency Medicine and vice-chair of Network Development with Beth Israel Deaconess Hospital and Harvard Medical Faculty Physicians.