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CO-Oximetry

CO-Oximetry. Use of the Rad-57. CO Poisoning Review. Leading cause of poisoning deaths in United States and other industrialized countries 5000-6000 deaths annually in U.S. 50,000-60,000 ED admissions annually. Pathophysiology of CO Poisoning.

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CO-Oximetry

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  1. CO-Oximetry Use of the Rad-57

  2. CO Poisoning Review • Leading cause of poisoning deaths in United States and other industrialized countries • 5000-6000 deaths annually in U.S. • 50,000-60,000 ED admissions annually

  3. Pathophysiology of CO Poisoning • Impairs oxygen delivery resulting in cellular hypoxia • CO binds to hemoglobin 230-270 times more avidly than oxygen resulting in carboxyhemoglobin (COHb) • CO also binds to Myoglobin and Cytochromes disrupting storage of O2 in certain muscle cells and transfer of energy within cells

  4. Pathophysiology of CO Poisoning • Negative effect on central nervous system effecting cognitive abilities such as perception, reasoning, awareness, and judgment • Negative effects on cardiovascular system by depressing myocardial function • Respiratory system effected by potential damage to alveolar membranes

  5. Flu-like symptoms Headache Dizziness Fatigue Dyspnea Chest pain Palpitations Confusion Agitation Nausea Vomiting Abdominal pain Hypotension with tachycardia Cardiac Dysrhythmia's Myocardial ischemia Pulmonary edema Syncope Seizures Fecal/urinary incontinence Visual abnormalities Memory loss Coma Death Signs and Symptoms of CO Poisoning

  6. Automobile exhaust fumes Propane-powered vehicle fumes House fires Heaters Indoor stoves Camp stoves Boat exhaust fumes Gas-powered electrical generators Cigarette smoke Charcoal-fired cook stoves Ovens Methylene chloride solvent inhalation (paint removers, adhesive removers) Exposure Risks

  7. Normal COHb Levels

  8. Signs and Symptoms vs. Exposure Levels

  9. Signs and Symptoms vs. COHb Levels

  10. Real World Reports • “In the cases I've come across, it's generally been described by the pt's as "flu-like" symptoms (N/V, headache) after low-level exposure of a few hours. I work as a firefighter as well, and after a fire one night where some members were not wearing SCBA during overhaul, two of them were complaining the next day of severe headache and nausea. Neither of them made any connection to the fire until we had a rep come in that afternoon selling CO monitors (similar to SpO2 monitoring) and their levels were much, much higher than average…” -emtjon • Post from EMS forum on Firehouse.com

  11. Real World Reports • “…I've only dealt with a few cases, and the most recent gave me a reading in the high 90's. He was unresponsive as well. As far as skin color, this pt was more pale to normal. I've heard also that the pink/red skin is a very late sign and seen after extended exposure. I'm not sure how accurate that is, just something I've heard…” -tkrueger • “…In more severe cases you may run accross ST elevation on your 12 lead due to lack of 02 being transported….” - Medic115 • Also from Firehouse.com

  12. Rad 57

  13. Downfalls • Very sensitive, can be “spoofed” by strobes and high ambient light. • Cover the probe when “Zero”-ing to the patient

  14. Measure SpCO 0-3% >3% No further medical evaluation of SpCO needed Loss of consciousness or neurological impairment or SpCO >25% Yes No Transport on 100% oxygen for ED evaluation. Consider transport to hospital with hyperbaric chamber SpCO >12 SpCO <12 Transport on 100% oxygen for ED evaluation Symptoms of CO exposure? Yes No Transport on 100% oxygen for ED evaluation No further evaluation of SpCO needed. Determine source of CO if nonsmoker Carbon Monoxide: Suggested Triage Algorithm SpCO TRIAGE ALGORITHM

  15. How its being used locally • VFD: Deployed on VFD BC vehicles (2) • VFD: Rehab Bus (1) • District 6: BC vehicle (1) • District 6: E63 (LP15)

  16. RAD-57 EMS Carry Case • Lightweight: 13 oz. • Small: 6.2” x 3.0” x 1.4”. • Portable: operates on 4 “AA” batteries. • Supplied with high-visibility, water-resistant protective case. • Protective cover. • Extra sensor pocket. • Reference card holder. • Department ID holder. • Pen holder. • Spare battery pocket.

  17. POWER • Press to turn ON. • Press and HOLD to turn OFF. • BATTERY INDICATOR • 4 Green LED’s. • Each represents 25% battery life. • Use only Alkaline batteries. • BATTERY COMPARTMENT • Located in back panel. • Holds 4 “AA” batteries. • Operates up to 8 hours. RAD-57 Operation: Powering Up

  18. RAD-57Operation: Calibration • POWER ON: SENSOR ON FINGER • All LED’s light up. • Calibration mode begins • Spinning zeroes 0 - 0 – 0. • Completed in 20 second (avg.) • DO NOT move sensor during calibration. • Acquires reading and displays. • DISPLAY • Defaults to pulse rate and oxygen saturation reading. • “PI” bar graphdisplays strength of arterial perfusion.

  19. KEY POINTS: • CALIBRATION takes 20 seconds • Look for the three spinning zeroes • No movement during calibration • Shield unit during calibration

  20. Optimal LED path RAD-57Operation: Sensor Placement • SENSOR PLACEMENT IS VERY IMPORTANT • When possible, use ring finger, non-dominant hand. • Insert finger until the tip of finger hits the STOP Block. • Sensor should not rotate or shift freely on finger. • LED’s (red light) should pass through mid-nail, not cuticle. • There is a top and bottom, cable should be on top (nail side).

  21. DISPLAY AFTER INITIAL CALIBRATION • Oxygen Saturation on top in Red • Pulse Rate on bottom in Green • Green PI scale, indicates strength of arterial pulse • Low SIQ LED indicates poor signal quality • Press SpCO to display % carboxyhemoglobin • Press “Bell” to silence alarms RAD-57 Operation: Pulse Rate and Saturation

  22. DISPLAY AFTER INITIAL CALIBRATION Oxygen Saturation on top in Red Pulse Rate on bottom in Green Green PI scale, indicates strength of arterial pulse Low SIQ LED indicates poor signal quality Press SpCO to display % carboxyhemoglobin Press “Bell” to silence alarms 1 1 PI scale 2 Low SIQ LED 3 Alarm LED 2 4 SpCO key, changes display from SpO2 to SpCO 4 3 5 Battery level 5 RAD-57 Operation: Pulse Rate and Saturation

  23. When violated, audible alarm will sound, parameter will flash Alarm indicator • Preset at factory: • Sa02 (oxygen saturation) • Low: 90% • High: none • Pulse Rate • Low: 50 • High: 140 • SpCO (carboxyhemoglobin) • Low: none • High: 10% • Alarms adjust: • Press “Mode/Enter” twice • Press “Next” key to scroll through parameters • Use up and down keys to adjust • Reverts to Factory settings after turned off. Alarm silence RAD-57 Operation: Alarms

  24. PRESS ORANGE SPCO BUTTON Display will toggle to CO mode for 10 seconds Carboxyhemoglobin reading in % on top “CO” displayed on bottom confirming mode ALWAYS confirm high readings by taking several measurements on DIFFERENT fingers and average RAD-57 Operation: Measuring CO • Real-time SpCO indicator continuously reads SpCO • Green: 1-9% • Orange: 10-19% • Red: 20% and above

  25. WILL NOT TURN ON: Check battery compartment Replace batteries CALIBRATION MODE WILL NOT STOP: Shield from flashing lights, strobes or high ambient light Try other digits “NO CBL” MESSAGE: Cable not seated into top of Rad-57 Defective cable “SEN OFF” MESSAGE: Sensor off finger Sensor misaligned “Err” MESSAGE Return for service CONTINUOUS SPEAKER TONE Internal failure, return for service RAD-57 Operation: Troubleshooting

  26. Questions? Captain Hollingsworth – District 6 518-5668 cell 397-6086 office

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