Mark A. Brandenburg, M.D

It’s that time of year again when old man winter is gracing us with his frigid presence. To a paranoid ER doctor that also means it’s time to talk winter safety. One of the biggest hazards we all face is right in our own homes. Carbon monoxide (CO) is responsible for at least half of the 1,200 poisoning deaths in the U.S. each year. Another 5,000 people are injured by CO and require treatment in emergency rooms. Children represent a large percentage of CO victims. Over 300 children under the age of five years are killed each year by CO poisoning. These deaths usually occur in the home, the most common place people are exposed to CO.

Carbon monoxide is an odorless, colorless gas produced by burning fossil fuels such as gasoline, kerosene, propane, natural gas, and wood. The gas is emitted from automobiles, furnaces, gas ranges, fireplaces, charcoal grills, and oil-burning appliances. Often called the “silent killer,” CO cannot be smelled, seen or touched and is deadly when inhaled. It can sneak up on unwary victims and strike without notice.

From the lungs CO enters a person’s bloodstream and prevents hemoglobin in the red blood cells from carrying oxygen to other vital organs. In high concentrations, CO will completely shut down the body’s ability to utilize oxygen. A lack of oxygen for more than a few minutes causes permanent damage to the brain and heart, causing victims of severe CO poisoning to essentially suffocate from within.

Carbon monoxide can enter your home through an attached garage if an automobile is left running, but CO can enter a home by many other routes. Any appliance that uses natural fuel has the potential to release CO into the air. Most cases of CO poisoning occur during the colder months of the year when gas furnaces and fireplaces are used.

Using heaters, lanterns or stoves inside a building or automobile can be a deadly mistake. Camping-related CO poisoning sometimes occurs when a fuel-burning appliance is used inside a tent. Burning charcoal in enclosed spaces is responsible for over 25 deaths each year in the U.S. Never use a fuel-burning appliance in an enclosed space. Automobiles with obstructed exhaust pipes due to snow or other debris can also lead to CO poisoning. Always turn off the engine of an automobile or recreational vehicle when sleeping inside.

While it is true that CO is colorless and odorless, there are some clues that can tell you if you are at risk. Some signs that an appliance could be releasing CO into the air you breathe include:

-a burning smell (while it is true that pure CO is odorless, smoke from a fire can be detected)

-cracking, rusting or sooting of a ventilation device, whether a chimney or vent

-a low efficiency furnace or hot water heater

-missing or loose furnace panel or ventilation connections

-moisture forming on the inside of home windows

– or chimney masonry that is loosening or falling apart

The early signs of CO poisoning are often unrecognized by victims and can be misdiagnosed by physicians because they are so vague. Most people associate the symptoms of mild CO poisoning with common illnesses such as the flu. If these symptoms are experienced on a recurring basis, always consider CO poisoning. Because CO levels can rise quickly and without warning in your home, the night time hours (when your family is sleeping) can be the most dangerous. If you suspect CO poisoning, have the local gas company immediately check your home, workplace, or automobile for a CO leak. This service is usually free and takes only a few minutes to perform. Visit your physician or local ER if you suspect that you or your child is a victim of CO poisoning. A blood test can quickly measure the level of CO in the body. A negative result, however, does not rule out the possibility of intermittent poisoning.

Here are some symptoms of CO poisoning:

-Mild CO poisoning: headaches, nausea, vomiting, dizziness, weakness, chest pains, shortness of breath and rapid heartbeat.

-Moderate CO poisoning: sleepiness and confusion; Severe poisoning: loss of consciousness and death.

Here are some more basic tips to help you prevent CO poisoning in your home:

*An old furnace with holes from rusting or breakage can leak CO into your home, as can a fireplace that leaks or is poorly ventilated. Water heaters, stoves, and space heaters are other appliances that can release CO. Look for cracks in your appliances and be sure there is no missing mortar in the bricks of your fireplace.

*Never let the ventilation duct of your gas oven (or any other appliance) empty into the attic. Be sure your duct travels to the exterior of your home. The same holds true for wood burning stoves and other such appliances. Vent them outside and not into any area of your home.

The absolute best way to protect from CO poisoning is to install CO detectors in your home. These detectors sound an alarm if CO reaches a detectable level. Place several monitors evenly throughout your home. The International Association of Fire Chiefs (IAFC) recommends that at least one CO detector be placed in each level of your home, in each bedroom and on the ceiling above every fuel-burning appliance. Detectors can be found in most local hardware or discount stores. Be sure the one you purchase meets the Underwriters Laboratories (UL) Standard 2034. The price for a CO detector ranges from $35 to $80.

Good luck this winter, have a wonderful new year, and stay “child-safe.”

Mark A. Brandenburg, M.D.

Emergency Physician at St. Francis Hospital in Tulsa, Oklahoma Board Certified by the American Board of Emergency Medicine Fellow of the American Academy of Emergency Medicine (AAEM)