CLINICAL ASSESSMENT OF CARBON MONOXIDE INHALATION IN FIRE BURN PATIENTS: A STUDY USING PULSE CO-OXIMETRY: A FORENSIC AND HISTOPATHOLOGICAL EVALUATION
Main Article Content
Keywords
Arterial blood gas, carboxyhemoglobin, carbon monoxide poisoning, histopathology, pulse CO-oximetry, total body surface area
Abstract
Background: Carbon monoxide (CO) poisoning is a common complication in fire burn patients, with
potential for severe morbidity and mortality. Accurate detection of carboxyhemoglobin (COHb) levels is essential for clinical management. Pulse CO-oximetry, a non-invasive method, offers an alternative to arterial blood gas (ABG) analysis, but its diagnostic accuracy needs further investigation.
Objective: To assess the diagnostic accuracy of pulse CO-oximetry in measuring COHb levels in fire
burn patients and to evaluate the histopathological and forensic findings associated with CO
poisoning.
Study Design & Setting: This was a cross-sectional study conducted over six months at Forensic
Medicine Department Liaquat University of Medical And Health Sciences Jamshoro from June 2023 to November 2023. Methodology: We enrolled 90 fire burn patients suspected of CO inhalation. Demographic and clinical data were collected, including age, gender, total body surface area (TBSA) burned, and symptoms like altered mental status, headache, and nausea. Pulse COoximetry was used to measure COHb levels, and blood samples were taken for ABG analysis for validation. Histopathological evaluations of deceased patients' organs (brain, heart, and lungs) were performed to assess hypoxic injury and ischemic necrosis. Data were analyzed using descriptive statistics, Bland-Altman analysis, chi-square tests, and logistic regression.
Results: The study showed a high agreement between pulse CO-oximetry and ABG COHb levels
(p<0.001). Histopathological findings revealed significant hypoxic injury and ischemic necrosis in
vital organs. Clinical symptoms, such as headache and nausea, were more prevalent in moderate and severe CO poisoning cases.
Conclusion: Pulse CO-oximetry is a reliable, non-invasive tool for COHb level measurement in fire
burn patients, with strong agreement with ABG results. Histopathological findings reinforce the
severity of CO-induced damage.
References
2. Skolnik A, Sloan EP, Wolf SJ. Diagnosis and management of carbon monoxide poisoning in the emergency department. Emergency medicine practice. 2011:2.
3. Al Khaldi T, Gulreez R, Abdelhamid MM, Louri N. Acute carbon monoxide poisoning as a cause of rhabdomyolysis in a case of flame burn. BMJ Case Reports CP. 2023 May 1;16(5):e236012.
4. İşler Y. Carbon Monoxide Poisoning. Eurasian Journal of Toxicology. 2022 Aug 1;4(2):44-50.
5. Loke J, Matthay RA, Smith GW. The toxic environment and its medical implications with special emphasis on smoke inhalation. InPathophysiology and treatment of inhalation injuries 2020 Nov 25 (pp. 453-504). CRC Press.
6. Stevens J, El-Shammaa E, LoVecchio F. Carbon Monoxide and Cyanide Poisoning in Smoke Inhalation Victims: A Review. Trauma Reports. 2015 Jan 1;16(1).
7. Kleinman MT. Carbon monoxide. Environmental Toxicants: Human Exposures and Their Health Effects. 2020 Mar 17:455-86.
8. McAllister JL, Carpenter DJ, Roby RJ, Purser D. The importance of autopsy and injury data in the investigation of fires. Fire Technology. 2014 Nov;50:1357-77.
9. Liu Z, Meng H, Huang J, Kwangwari P, Ma K, Xiao B, Li L. Acute carbon monoxide poisoning with low saturation of carboxyhaemoglobin: a forensic retrospective study in Shanghai, China. Scientific reports. 2021 Sep 17;11(1):18554.
10. Nugent K, Orellana-Barrios MA, Buscemi D. Comprehensive histological and immunochemical forensic studies in deaths occurring in custody. International scholarly research notices. 2017;2017(1):9793528.
11. Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning—a public health perspective. Toxicology. 2000 Apr 7;145(1):1-4.
12. Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. American journal of respiratory and critical care medicine. 2012 Dec 1;186(11):1095-101.
13. Dinis-Oliveira RJ, Carvalho F, Duarte JA, Remiao F, Marques A, Santos A, Magalhaes T. Collection of biological samples in forensic toxicology. Toxicology Mechanisms and Methods. 2010 Sep 1;20(7):363-414.
14. Mazzotti MC, Teti G, Giorgetti A, Carano F, Pelletti G, Pascali JP, Falconi M, Pelotti S, Fais P. Insights in opiates toxicity: impairment of human vascular mesenchymal stromal cells. International journal of legal medicine. 2023 Jul;137(4):1039-49.
15. Abdel Hasan Shallall Muhammed, Abd Al-Hassan Shalal Alhan, A. Mubarak Hayfaa, Abbas Hasan Ahmed,Assessment of carbon monoxide poisoning for patients who have unexplained pathophysiology. Journal of Medicinal and Pharmaceutical Chemistry Research, 2024,7(5), 824-835.
16. Aydoğdu HI, Ketenci HÇ, Askay M, Boz H, Kırcı GS, Özer E. Evaluation of the fire-related deaths: Autopsy study. Turkish Journal of Trauma and Emergency Surgery. 2021 Sep 1;27(5):539.
17. Ramponi G, Gianni F, Karlafti E, Piazza I, Albertoni F, Colombo G, Casazza G, Garegnani A, Casella R, Costantino G. The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis. Frontiers in medicine. 2023 Dec 28;10:1250845.
18. Ferrés-Padró V, Sequera VG, Vilajeliu A, Vidal M, Trilla A. Experience with pulse carbon monoxide oximetry for prehospital assessment of patients exposed to smoke from fires in closed spaces in Catalonia. Emergencias. 2015 Feb 1;27:23-6.
19. Shazia S, Khan O, Bukhari S, Abbasi S, Khan MA. Carbon Monoxide, The Silent Killer, A Preventable Unintentional Poisoning. Journal of Saidu Medical College, Swat. 2024 Jul 24;14(3):148-54.
20. Roth D, Hubmann N, Havel C, Herkner H, Schreiber W, Laggner A. Victim of carbon monoxide poisoning identified by carbon monoxide oximetry. The Journal of emergency medicine. 2011 Jun 1;40(6):640-2.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Adil Umer Khan
Associate Professor Community Medicine, PHD Scholar HSA Islamabad
Nasim Irshad
Assistant professor Army Medical College Forensic Medicine Department, Rawalpindi
Aisha Rasheed
MBBS, MD Forensic Medicine, Assistant Professor Forensic Medicine And Toxicology, Liaquat University Of Medical And Health Sciences Jamshoro Sind
Shumaila Najeeb
Associate Professor Department of Histopathology, Mohiuddin Islamic Medical College, AJK
Hafiza Kubra
MBBS, Women Medical Officer DHQ Hospital, Narowal
Nadia Aslam
MBBS, DMJ, CHPE, Lecturer Department of Forensic Medicine and Toxicology, Liaquat University of Medical and Health Sciences, Jamshoro