Global & Disaster Medicine

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CDC: After Hurricane Florence—Clinical Guidance for Carbon Monoxide Poisoning

CDC

CDC Health Alert Network (HAN) Health Advisory: Hurricane Florence—Clinical Guidance for Carbon Monoxide (CO) Poisoning

CDC issued the following Health Alert Network (HAN) Health Advisory on September 16, 2018. You are receiving this information because you subscribe to COCA email updates. If a colleague forwarded this email to you, yet you would like to receive future updates directly from COCA, click here.

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Distributed via the CDC Health Alert Network
September 16, 2018 1345 ET (1:45 PM ET)
CDC HAN-00415

Hurricane Florence—Clinical Guidance for Carbon Monoxide (CO) Poisoning

Summary
The Centers for Disease Control and Prevention (CDC) is reminding clinicians seeing patients from the areas affected by Hurricane Florence to maintain a high index of suspicion for CO poisoning. Other people who may be exposed to the same CO source may need to be identified and assessed.

The signs and symptoms of CO exposure are variable and nonspecific. A tension-type headache is the most common symptom of mild CO poisoning. Other symptoms may include dizziness, flu-like symptoms without a fever, drowsiness, chest pain, and altered mental status.

Clinical manifestations of severe CO poisoning include tachycardia, tachypnea, hypotension, metabolic acidosis, dysrhythmias, myocardial ischemia or infarction, noncardiogenic pulmonary edema, neurologic findings including irritability, impaired memory, cognitive and sensory disturbances, ataxia, altered or loss of consciousness, seizures, coma, and death, although any organ system might be involved.

Although CO poisoning can be fatal to anyone, children, pregnant women, the unborn, persons with sickle cell disease, older adults, and persons with chronic illness (e.g., heart or lung disease) are particularly vulnerable.

Background
High winds and heavy rain from Hurricane Florence began affecting the southeastern U.S. around September 12, 2018. Impact on the southeast coast and inland led to thousands of people without power.  Those without power may turn to alternate power sources such as gasoline generators and may use propane or charcoal grills for cooking. If used or placed improperly, these sources can lead to CO build up inside buildings, garages, or campers and poison the people and animals inside.

With a focused history of patient activities and health symptoms, exposure to a CO source may become apparent. Appropriate and prompt diagnostic testing and treatment are crucial to reduce morbidity and prevent mortality from CO poisoning. Identifying and mitigating the CO source is critical in preventing other poisoning cases.

Recommendations for Clinicians

  1. Consider CO poisoning in patients affected by Hurricane Florence, particularly those in areas currently without power. Assess symptoms and recent patient activities that point to likely CO exposure. Evaluation should also include examination for other conditions, including smoke inhalation, trauma, medical illness, or intoxication.
  2. Administer 100% oxygen until the patient is symptom-free or until a diagnosis of CO poisoning has been ruled out.
  3. Perform COHgb testing when CO poisoning is suspected. Venous or arterial blood may be used for testing. A fingertip pulse multiple wavelength spectrophotometer, or CO-oximeter, can be used to measure heart rate, oxygen saturation, and COHgb levels in the field, but any suspicion of CO poisoning should be confirmed with a COHgb level by multiple wavelength spectrophotometer (CO-oximeter). A conventional two-wavelength pulse oximeter is not accurate when COHgb is present. For more information, see https://www.cdc.gov/disasters/co_guidance.html.
  4. An elevated carboxyhemoglobin (COHgb) level of 2% or higher for non-smokers and 9% or higher COHgb level for smokers strongly supports a diagnosis of CO poisoning. The COHgb level must be interpreted in light of the patient’s exposure history and length of time away from CO exposure, as levels gradually fall once the patient is removed from the exposure. In addition, carbon monoxide can be produced endogenously as a by-product of heme metabolism. Patients with sickle cell disease can have an elevated COHgb level as a result of hemolytic anemia or hemolysis. For additional information about interpretation of COHgb levels, visit https://www.cdc.gov/disasters/co_guidance.html or call Poison Control at (800) 222-1222.
  5. Hyperbaric oxygen therapy (HBO) should be considered in consultation with a toxicologist, hyperbaric oxygen facility, or Poison Control Center (800) 222-1222. For additional management considerations, consult a toxicologist, Poison Control at (800) 222-1222, or a hyperbaric oxygen facility.
  6. Be aware that CO exposure may be ongoing for others spending time in or near the same environment as the patient. These individuals should be evaluated and tested as described in this advisory.
  7. Clinicians treating people for CO poisoning should notify emergency medical services (EMS), the fire department, or law enforcement to investigate and mitigate the source and advise people when it is safe to return.
  8. Advise patients about safe practices related to generators, grills, camp stoves, or other gasoline, propane, natural gas, or charcoal-burning devices. Stress that that these devices should never be used inside an enclosed space, home, basement, garage, or camper — or even outside near an open window or window air conditioner. Please see https://www.cdc.gov/co/pdfs/generators.pdf.

For More Information
Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster
https://www.cdc.gov/disasters/co_guidance.html

 


Global Drowning: 3.72 million drown annually in the world

WHO on Drowning

“…..WHO in its latest report on drowning reported that 3,72,000 people die every year worldwide due to drowning. 90 per cent of these deaths takes place in LMIC’s (Low and middle income countries). It is a major contributor towards mortality rates in south east Asia……”

 


Walking in a polluted environment in London: New research on the perils of pollution on bad hearts and lungs;

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study

Sinharay, Rudy et al.
The Lancet , Volume 391 , Issue 10118 , 339 – 349
“….a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park).….”
“…Interpretation:  Short-term exposure to traffic pollution prevents the beneficial cardiopulmonary effects of walking in people with COPD, ischaemic heart disease, and those free from chronic cardiopulmonary diseases….”

An oil spill from an Iranian tanker that sank in the East China Sea is rapidly spreading (two huge slicks covering 52 square miles)

NY Times


UN Environment and WHO agree to major collaboration on environmental health risks

UN/WHO

10 Jan 2018
UN Environment and World Health Organization agree to major collaboration on environmental health risks

10 January 2018 / Nairobi–UN Environment and the World Health Organization have agreed a new, wide-ranging collaboration to accelerate action to curb environmental health risks that cause an estimated 12.6 million deaths a year.

Today in Nairobi, Mr. Erik Solheim, head of UN Environment, and Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO, signed an agreement to step up joint actions to combat air pollution, climate change and antimicrobial resistance, as well as improve coordination on waste and chemicals management, water quality, and food and nutrition issues. The collaboration also includes joint management of the BreatheLife advocacy campaign to reduce air pollution for multiple climate, environment and health benefits.

Although the two agencies cooperate in a range of areas, this represents the most significant formal agreement on joint action across the spectrum of environment and health issues in over 15 years.

“There is an urgent need for our two agencies to work more closely together to address the critical threats to environmental sustainability and climate – which are the foundations for life on this planet.  This new agreement recognizes that sober reality,” said UN Environment’s Solheim.

“Our health is directly related to the health of the environment we live in. Together, air, water and chemical hazards kill some 12.6 million people a year. This cannot and must not continue,” said WHO’s Tedros.

He added: “Most of these deaths occur in developing countries in Asia, Africa and Latin America where environmental pollution takes its biggest health toll.”

The new collaboration creates a more systematic framework for joint research, development of tools and guidance, capacity building, monitoring of Sustainable Development Goals, global and regional partnerships, and support to regional health and environment fora.

The two agencies will develop a joint work programme and hold an annual high-level meeting to evaluate progress and make recommendations for continued collaboration.

The WHO-UN Environment collaboration follows a Ministerial Declaration on Health, Environment and Climate Change calling for the creation of a global “Health, Environment and Climate Change” Coalition, at the United Nations Framework Convention on Climate Change (UNFCCC) COP 22 in Marrakesh, Morocco in 2016.

Just last month, under the overarching topic “Towards a Pollution-Free Planet”, the United Nations Environment Assembly (UNEA), which convenes environment ministers worldwide, adopted a resolution on Environment and Health, called for expanded partnerships with relevant UN agencies and partners, and for an implementation plan to tackle pollution.

Note to Editors 

Priority areas of cooperation between WHO and UN Environment include:

  • Air Quality – More effective air quality monitoring including guidance to countries on standard operating procedures; more accurate environment and health assessments, including economic assessment; and advocacy, including the BreatheLife campaign promoting air pollution reductions for climate and health benefits.
  • Climate – Tackling vector-borne disease and other climate-related health risks, including through improved assessment of health benefits from climate mitigation and adaptation strategies.
  • Water – Ensuring effective monitoring of data on water quality, including through data sharing and collaborative analysis of pollution risks to health.
  • Waste and chemicals – Promotion of more sustainable waste and chemicals management, particularly in the area of pesticides, fertilizers, use of antimicrobials. The collaboration aims to advance the goal of sound lifecycle chemicals management by 2020, a target set out at the 2012 United Nations Conference on Sustainable Development.

Ongoing WHO/UN Environment collaboration includes:

  • Ministerial Declaration on Health, Environment and Climate Change –WHO/UN Environment announcement at COP22  – http://www.who.int/globalchange/mediacentre/events/Ministerial-declaration-EN.pdf
  • BreatheLife campaign has engaged countries, regions and cities in commitments to reduce air pollution for climate and health benefits, covering more than 120 million people across the planet, including Santiago, Chile; London, England; Washington DC, USA, and Oslo, Norway, with major cities in Asia and Africa set to join. www.breathelife2030.org
  • Strategic Approach to International Chemicals Management (SAICM) – which has included effective past actions to phase out lead paint, mercury emissions and persistent organic pollutants. http://www.saicm.org/

Media contacts

UN Environment News & Media, unepnewsdesk@unep.org, +254 715 618 081

Sarah Cumberland, Communications officer, WHO, cumberlands@who.int, +41 79 206 1403

Related Sustainable Development Goals

Goal 3

Good Health and Well-Being
+

Goal 7

Affordable and Clean Energy
+

Goal 11

Sustainable Cities and Communities
+

Goal 12

Sustainable Consumption and Production
+

Goal 13

Climate Action
+

After the hurricanes: Inside a Senior Complex in Puerto Rico

NY Times

“…..With large areas of Puerto Rico still in the dark three months after the first of the storms — according to government reports, only 60.4 percent of the pre-storm power grid load has been restored — older residents and those with chronic medical conditions are suffering in even more ways than their neighbors. Many nursing homes have no power. The failure to re-establish functioning telephone networks and transportation systems in many areas makes it difficult to get regular medical care. Fire safety systems are inoperable, posing special dangers for those who cannot easily escape.….”


About 5,000 barrels of oil, or about 210,000 gallons, gushed out of the Keystone Pipeline on Thursday in South Dakota

NY Times

 


Triage at a sweltering nursing home……

NY Times

“…..After a third rescue call, around 5 a.m., the hospital’s staff was concerned enough to walk down the street to check the building themselves.

What they found was an oven.

The Rehabilitation Center at Hollywood Hills needed to be evacuated immediately. Rescue units were hurrying its more than 100 residents out. Dozens of hospital workers established a command center outside, giving red wristbands to patients with critical, life-threatening conditions and yellow and green ones to those in better shape.

Checking the nursing home room by room, the hospital staff found three people who were already dead and nearly 40 others who needed red wristbands, many of whom had trouble breathing. The workers rushed them to Memorial’s emergency room, where they were given oxygen. The rest went to other hospitals nearby….”


Irma turned the Rehabilitation Center at Hollywood Hills into a living hell. Was it a tragic error or was it criminal?

Miami Herald

Bobby Owens, 84;

Manuel Mario Mendieta, 96;

Miguel Antonio Franco, 92;

Estella Hendricks, 71;

Gail Nova, 71;

Carolyn Eatherly, 78;

Betty Hibbard, 84;

Albertina Vega, 99.

“…..yet to be determined is how long these vulnerable people — either residents or recovering from surgery — were left in such stifling heat and, most important, why…..

The eight nursing-home residents who died were not the only seniors trapped by sketchy planning. In Miami Dade, WLRN reporter Nadege Green found elderly residents in a series of Coconut Grove senior-living apartments who remained trapped, no elevator, no electricity; on Tuesday, about 50 residents of a senior-citizens tower in Miami’s Civic Center neighborhood damaged by Irma were being taken to a shelter…..”

 


8/21/1986: An eruption of lethal gas from Lake Nyos in Cameroon kills nearly 2,000 people and wipes out four villages.

History Channel

 


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