• 제목/요약/키워드: Carbon Monoxide Poisoning

검색결과 90건 처리시간 0.023초

지연성 뇌병증을 보인 일산화탄소 중독 1례 (A Case of Delayed Carbon Monoxide Encephalopathy)

  • 윤성현;정현민;강환석;김지혜;한승백;김준식;백진휘
    • 대한임상독성학회지
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    • 제11권1호
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    • pp.41-45
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    • 2013
  • Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.

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급성 일산화탄소 중독에 의한 심혈관계 독성의 임상 양상 및 경과 (Cardiovascular Manifestations and Clinical Course after Acute Carbon Monoxide Poisoning)

  • 이인수;정윤석;민영기;김기운;최상천
    • 대한임상독성학회지
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    • 제10권2호
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    • pp.103-110
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    • 2012
  • Purpose: The aim of this study was to evaluate the cardiovascular manifestations and clinical course in patients with acute carbon monoxide poisoning. Methods: A retrospective study was conducted over a 36 month period on consecutive patients who visited an emergency medical center and were diagnosed with acute carbon monoxide poisoning. A standardized data extraction protocol was performed on the selected patients. Results: A total of 293 patients were selected during the study period. Cardiac manifestations were observed in 35.2% (n=103) of the patients: hypotension in 11 patients (3.8%), ECG abnormalities in 44 patients (15.0%) and cardiac enzyme abnormalities in 103 patients (35.2%). Echo cardiography was performed on 56 patients with cardiac toxicity: 12 patients had abnormal results (5 patients with global hypokinesia and 7 patients with regional wall akinesia). Five patients died within 3 hours after ED admission, and the remaining patients were discharged alive. At 3 months after discharge, none of these patients had died.The SOFA scores in the severe cardiac toxicity group and non-severe cardiac toxicity group at the time of arrival were $2.53{\pm}2.29$ and $2.19{\pm}2.12$, respectively (p=0.860). Conclusion: Cardiovascular manifestations occur after acute CO poisoning at arateof 35.2%. Even those with severe cardiovascular toxicity recovered well within 10 days after admission. Therefore, the importance of cardiac toxicity after acute CO poisoning is not significant in itself in the clinical course, and the short-term prognosis of cardiac toxicity is unlikely to be unfavorable in acute CO poisoning.

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일산화탄소중독 이후 발생한 지연무산소뇌병증: 확산텐서영상 및 신경인지기능검사를 이용한 치료 효과의 평가 (Delayed Anoxic Encephalopathy after Carbon Monoxide Poisoning: Evaluation of Therapeutic Effect by Serial Diffusion-Tensor Magnetic Resonance Imaging and Neurocognitive Test)

  • 유호성;김영욱;정부경;김용원
    • 대한신경과학회지
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    • 제36권4호
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    • pp.358-362
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    • 2018
  • Delayed anoxic encephalopathy after carbon monoxide (CO) poisoning is characterized by neurological deterioration that occurs after recovery from acute CO intoxication. There has been no established therapy. We report a patient recovered from acute CO intoxication developed various neurological symptoms. After the administration of high dose prednisolone and anticholinesterase inhibitor, the therapeutic effect was remarkable and confirmed by quantitative analysis of diffusion-tensor imaging (DTI). DTI could be used to evaluate the therapeutic effect for delayed anoxic encephalopathy after CO poisoning.

고압산소치료를 받은 급성 일산화탄소 중독 환자들에서 발생한 지연성 신경정신과학적 후유증 발생과 관계된 인자 (Factors Associated with Delayed Neuropsychological Sequelae in Acute Carbon Monoxide Poisoning Patients Treated by Hyperbaric Oxygen)

  • 이동하;최우익
    • 대한임상독성학회지
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    • 제9권2호
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    • pp.88-94
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    • 2011
  • Purpose: Delayed neuropsychological sequelae (DNS) commonly occurs after recovery from acute carbon monoxide poisoning. The aim of this article is to identify the factors associated with DNS development. Methods: We retrospectively evaluated patients, admitted to the medical center emergency department from June 2005 to March 2011, who were suffering from acute carbon monoxide (CO) poisoning. We categorized the patients into two groups - those with DNS, and those without DNS. Multiple regression analysis was performed to identify the factors related to manifestation of DNS. Results: Of the total one hundred fifty seven patients (157) recruited for the study, twenty two (22) developed DNS. Longer CO exposure times and lower GCS scores were positively associated with development of DNS symptoms. Conclusion: Our study identified two potential factors which are predictive of DNS development in CO intoxication, however, more studies are needed. Adequate follow-up after hospital discharge to monitor for and accurately identify manifestation of DNS, is also important.

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가스보일러 CO중독 위험성 예측 및 근원적 예방기술 개발 (The Risk Assessment of Carbon Monoxide Poisoning by Gas Boiler Exhaust System and Development of Fundamental Preventive Technology)

  • 박찬일;류기윤
    • 한국가스학회지
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    • 제25권3호
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    • pp.27-38
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    • 2021
  • 본 연구에서는 가스보일러 가동 중 배기통이 이탈하는 상황이 발생했을 때, 시스템적으로 인지하고 자동으로 보일러 가동을 중지하여 일산화탄소를 포함한 유해 배기가스가 실내로 유입되는 상황을 근원적으로 차단하는 방안을 제시하였다: (1) 연소에 필요한 공기량을 제어하기 위해 설치된 풍압센서(APS : Air Pressure Sensor)의 출력전압을 측정하여 배기통의 정상상태와 이탈상태를 감시하는 기능을 추가한다. (2) 배기통이 이탈하면 APS의 출력전압이 상시 운전범위에서 일시적으로 상승하게 된다. 보일러 제어부인 PCB가 이 상태를 배기통 이탈로 간주하여 보일러 가동을 멈추면서 배기통 이탈 상태를 실내온도 조절기에 표시하도록 한다. 또한 국토교통부령으로 정한 「건축물의 설비기준 등에 관한 규칙」에서 명시한 공동주택 및 다중이용시설의 환기시설 기준에 따라, 실내공기 교환횟수에 맞는 풍량을 적용하여 실내공기를 환기하는 실험을 실시하였다. 이 실험 결과 실제 일산화탄소가 실내에 누출된 최악의 상태에서, 중독사고 예방이 가능하다는 것을 확인하였다. 다만, 동 규칙에서 정의한 시간당 실내공기 교환횟수를 기존 0.7회에서 0.5회로 2013년부터 완화하여 운영하고 있는데, 실험결과 8시간 가중평균 노출기준인 TWA 30 ppm을 초과하는 농도가 측정되어 기준을 강화할 필요성이 있다. 본 연구 결과에 기초하여 가스보일러 배기압력의 기계적 인지를 통해 배기통 이탈을 감지하는 기술과 일산화탄소 경보기와 연동된 실내공기 환기시스템 기술을 도입한다면 일산화탄소 중독사고가 크게 감소될 것으로 판단된다. 제조 및 검사단계의 문제점을 보완하고, 올바른 설치 및 수리, 사용자의 배기통 이탈에 대한 관심이 더해졌을 때, 일산화탄소 중독으로 인한 인명사고를 예방하는데 효과적인 대책이 될 것으로 사료된다.

Various injury patterns due to combustion (typical but unfamiliar to physicians and easy to miss) in Korea: a case report

  • Hyung Il Kim
    • Journal of Trauma and Injury
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    • 제36권4호
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    • pp.393-398
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    • 2023
  • Patients transported from fire sites may exhibit various injury patterns. Major trauma, skin burn, inhalation burn, and carbon monoxide poisoning are typical injuries. However, most physicians may be unfamiliar that cyanide poisoning can frequently occur due to combustion. Cyanide poisoning is highly significant owing to high mortality and the existence of antidotes. I present a 35-year-old man who was transported from a burning building and suffered severe metabolic acidosis despite no major bleeding as well as mild carbon monoxide poisoning. I suspected cyanide poisoning and administered the antidote; subsequently, the patient showed improvement. The next day, sudden airway obstruction developed, and emergency endotracheal intubation was performed. The inhalation damage was detected only in the lower airway tract and not in the upper airway. Physicians should be aware of cyanide poisoning and inhalation burn to avoid missing treatment opportunities.

일산화탄소중독(一酸化炭素中毒)의 진료대책(診療對策) 수립(樹立)을 위한 추계학적(推計學的) 연구(硏究) (A Stochastic Study for the Emergency Treatment of Carbon Monoxide Poisoning in Korea)

  • 김용익;윤덕로;신영수
    • Journal of Preventive Medicine and Public Health
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    • 제16권1호
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    • pp.135-152
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    • 1983
  • Emergency medical service is an important part of the health care delivery system, and the optimal allocation of resources and their efficient utilization are essentially demanded. Since these conditions are the prerequisite to prompt treatment which, in turn, will be crucial for life saving and in reducing the undesirable sequelae of the event. This study, taking the hyperbaric chamber for carbon monoxide poisoning as an example, is to develop a stochastic approach for solving the problems of optimal allocation of such emergency medical facility in Korea. The hyperbaric chamber, in Korea, is used almost exclusively for the treatment of acute carbon monoxide poisoning, most of which occur at home, since the coal briquette is used as domestic fuel by 69.6 per cent of the Korean population. The annual incidence rate of the comatous and fatal carbon monoxide poisoning is estimated at 45.5 per 10,000 of coal briquette-using population. It offers a serious public health problem and occupies a large portion of the emergency outpatients, especially in the winter season. The requirement of hyperbaric chambers can be calculated by setting the level of the annual queueing rate, which is here defined as the proportion of the annual number of the queued patients among the annual number of the total patients. The rate is determined by the size of the coal briquette-using population which generate a certain number of carbon monoxide poisoning patients in terms of the annual incidence rate, and the number of hyperbaric chambers per hospital to which the patients are sent, assuming that there is no referral of the patients among hospitals. The queueing occurs due to the conflicting events of the 'arrival' of the patients and the 'service' of the hyperbaric chambers. Here, we can assume that the length of the service time of hyperbaric chambers is fixed at sixty minutes, and the service discipline is based on 'first come, first served'. The arrival pattern of the carbon monoxide poisoning is relatively unique, because it usually occurs while the people are in bed. Diurnal variation of the carbon monoxide poisoning can hardly be formulated mathematically, so empirical cumulative distribution of the probability of the hourly arrival of the patients was used for Monte Carlo simulation to calculate the probability of queueing by the number of the patients per day, for the cases of one, two or three hyperbaric chambers assumed to be available per hospital. Incidence of the carbon monoxide poisoning also has strong seasonal variation, because of the four distinctive seasons in Korea. So the number of the patients per day could not be assumed to be distributed according to the Poisson distribution. Testing the fitness of various distributions of rare event, it turned out to be that the daily distribution of the carbon monoxide poisoning fits well to the Polya-Eggenberger distribution. With this model, we could forecast the number of the poisonings per day by the size of the coal-briquette using population. By combining the probability of queueing by the number of patients per day, and the probability of the number of patients per day in a year, we can estimate the number of the queued patients and the number of the patients in a year by the number of hyperbaric chamber per hospital and by the size of coal briquette-using population. Setting 5 per cent as the annual queueing rate, the required number of hyperbaric chambers was calculated for each province and for the whole country, in the cases of 25, 50, 75 and 100 per cent of the treatment rate which stand for the rate of the patients treated by hyperbaric chamber among the patients who are to be treated. Findings of the study were as follows. 1. Probability of the number of patients per day follows Polya-Eggenberger distribution. $$P(X=\gamma)=\frac{\Pi\limits_{k=1}^\gamma[m+(K-1)\times10.86]}{\gamma!}\times11.86^{-{(\frac{m}{10.86}+\gamma)}}$$ when$${\gamma}=1,2,...,n$$$$P(X=0)=11.86^{-(m/10.86)}$$ when $${\gamma}=0$$ Hourly arrival pattern of the patients turned out to be bimodal, the large peak was observed in $7 : 00{\sim}8 : 00$ a.m., and the small peak in $11 : 00{\sim}12 : 00$ p.m. 2. In the cases of only one or two hyperbaric chambers installed per hospital, the annual queueing rate will be at the level of more than 5 per cent. Only in case of three chambers, however, the rate will reach 5 per cent when the average number of the patients per day is 0.481. 3. According to the results above, a hospital equipped with three hyperbaric chambers will be able to serve 166,485, 83,242, 55,495 and 41,620 of population, when the treatmet rate are 25, 50, 75 and 100 per cent. 4. The required number of hyperbaric chambers are estimated at 483, 963, 1,441 and 1,923 when the treatment rate are taken as 25, 50, 75 and 100 per cent. Therefore, the shortage are respectively turned out to be 312, 791. 1,270 and 1,752. The author believes that the methodology developed in this study will also be applicable to the problems of resource allocation for the other kinds of the emergency medical facilities.

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일산화탄소 중독 지연성 뇌손상 소양인 환자 치험 1례 (Case Study of Soyangin Patient with Delayed Encephalopathy after Carbon Monoxide Intoxication)

  • 김수현;박준용;주종천
    • 사상체질의학회지
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    • 제35권3호
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    • pp.1-11
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    • 2023
  • Objective This case report is to show the effectiveness of Sasang Constitutional Medicine treatment on the patient with delayed encephalopathy after acute carbon monoxide intoxication. Methods A 40-year-old female patient diagnosed with delayed encephalopathy after carbon monoxide poisoning 2 weeks ago before visiting our hospital. The patient suffered gait disturbance and cognitive disorder. She was identified as Soyangin and treated with Sasang constitutional Herbal Medicine(Yangkyuksanwha-tang and Hyungbangjihwang-tang). Improvement of symptoms was evaluated through Korean Version of Mini Mental Status Examination score(MMSE-K), Modified Barthel Index(MBI), Manual Muscle Testing(MMT), Range of Motion(ROM) and Hand Function Test. Results After 7 weeks of treatment, total score of MMSE-K increased from 0 to 26, the patient could walk by herself and had no trouble carrying out her daily life. Conclusions This case showed the effectiveness of Sasang constitutional medicine treatment for delayed encephalopathy after acute carbon monoxide intoxication.

급성 일산화탄소 중독 환자들에서 흡연과 지연성 신경정신과학적 후유증 발생의 상관관계 (Association between Smoking and Delayed Neuropsychological Sequelae in Acute Carbon Monoxide Poisoning)

  • 김학면;최성우;나상운;최효정;임훈;김기운;한상수;이영환
    • 대한임상독성학회지
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    • 제16권2호
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    • pp.102-107
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    • 2018
  • Purpose: This study examined the association between smoking and delayed neuropsychological sequelae (DNS) in acute carbon monoxide (CO) poisoning. Methods: Patients admitted to the medical center emergency department from March 2016 to March 2017 because of CO poisoning were examined retrospectively. The patients were divided into two groups: DNS and Non-DNS group. Multiple factors were analyzed to explain DNS, which was assessed by motor disturbances, cognitive impairment, dysphagia, Parkinson-like syndromes, epilepsy, and emotional lability in CO poisoning. Results: A total of 120 patients were included. The factors related to DNS were smoking (pack-years) (p=0.002) and initial carbon monoxide-hemoglobin level (p=0.015). On the other hand, after multivariate logistic regression analysis, smoking (Odds ratio 1.07; 95% CI, 1.02-1.13; p=0.004) was the only factor associated with DNS. Conclusion: Smoking is a very reliable factor for predicting the occurrence of DNS. A history of smoking in patients who suffer from CO intoxication is important. If a patient smokes, treatment should be started actively and as soon as possible.

코로나바이러스감염증-19 대유행 이후 응급실로 내원한 급성 일산화탄소 중독 환자의 특성 변화 (Changes in the characteristics of acute carbon monoxide poisoning patients who visited the emergency department during the COVID-19 pandemic)

  • 심준보;안태규;김현
    • 대한임상독성학회지
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    • 제21권2호
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    • pp.108-116
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    • 2023
  • Purpose: This study investigated the differences between patients with acute carbon monoxide (CO) poisoning who visited the emergency department (ED) before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a single-center retrospective observational study. Patients with CO poisoning who visited the ED during the period from February 2020 to January 2023 were classified as the COVID-19 pandemic group, and those from February 2019 to January 2020 were classified as the non-pandemic group. Patients' medical records were reviewed, their demographic and clinical characteristics were compared, and the length of stay in ED was checked. The time from admission to the ED to the start of hyperbaric oxygenation (HBO) was defined as the door-to-HBO time, and this parameter was compared between both groups. Results: In total, 672 patients were included in this study. The proportion of intentional poisoning was significantly higher in the COVID-19 pandemic group than in the non-pandemic group (p=0.028). The proportion of intentional poisoning significantly increased in the 20- to 29-year-old age group during the COVID-19 pandemic (p<0.001). In addition, it took longer to initiate HBO in the COVID-19 pandemic group than in the non-pandemic group (p=0.001). Conclusion: These findings suggest that pandemics of infectious diseases, such as COVID-19, increase the proportion of intentional CO poisoning, and it may take longer to initiate HBO after visiting the ED. Efforts will be needed to decrease intentional CO poisoning and length of stay in ED.