Carbon monoxide accidental

Public concerns about air quality led to the passage of the Clean Air Act in 1970 to amendments to that act in 1977 and 1990. The 1990 amendments contained seven separate titles covering different regula-toiy programs and include requirements to install more advanced pollution control equipment and make other changes in industrial operations to reduce emissions of air pollutants. The 1990 amendments address sulfur dioxide emissions and acid rain deposition, nitrous oxide emissions, ground-level ozone, carbon monoxide emissions, particulate emissions, tail pipe emissions, evaporative emissions, reformulated gasoline, clean-fueled vehicles and fleets, hazardous air pollutants, solid waste incineration, and accidental chemical releases. 

In ideal combustion 0.45 kgs (1 lb.) of air combines with 1.8 kgs (4 lbs.) of oxygen to produce 1.2 kgs (2.75 lbs.) of carbon dioxide and 1.02 kgs (2.25 lbs.) of water vapor. Carbon monoxide, carbon dioxide, nitrogen and water vapor are the typical exhaust gases of ordinary combustion processes. If other materials are present they will also contribute to the exhaust gases forming other compounds, which in some cases can be highly toxic. Imperfect combustion will occur during accidental fires and explosion incidents. This mainly due to turbulence, lack of adequate oxidizer supplies and other factors that produce free carbon (i.e., smoke) particles, carbon monoxide, etc. 

Carbon monoxide (CO) is a colorless, odorless gas that is ubiquitous because it is created whenever carbon-containing materials are burned. Carbon monoxide poisoning is the leading cause of death due to poisoning in the USA. Most cases occur in victims of fires, but accidental and suicidal exposures are also common. The diagnosis and treatment of carbon monoxide poisoning are described in Chapter 56. Many other toxic gases are produced in fires or released in industrial accidents (Table 58-5). 

The anionic methylruthenium(II) species was autoxidized to a Ru(III) compound, RuMe(OEP). The methyl group of this compound was accidentally transformed into a coordinated carbon monoxide molecule by an excess of 2,2,6,6-tetramethylpiperidine-l-oxyl (TEMPO) [158] on an attempt to use TEMPO as a radical trap for the measurement of the Ru-C bond energy in solution. This was the first transformation of a methyl group to carbon monoxide to be observed in the proximity of a metal. 

Poisoning in the geriatric population is an ongoing public health concern. In the majority of patients older than 64 years of age, accidental poisoning due to dementia and confusion, improper use or storage of a product, and therapeutic errors is the rule. However, approximately one in 10 is intentional with suicidal intent. Interestingly, elderly females are approximately three times more likely to commit suicide with drugs than males (who prefer carbon monoxide). 

SIPs are intended to prevent air pollution emergency episodes. Tlie phuis are directed toward preventing e.xcessive buildup of air pollutants tliat are known to be harmful to the population and the enviroiuiient when concentrations exceed certain limits. The compounds affected under the implementation plans are sulfur dioxide, particulate matter, carbon monoxide, nitrogen dioxide, and ozone. A contingency plan, which will outline the steps to be taken in tlie event tliat a particular pollutant concentration reaches die level at wliich it can be considered to be harmful, must be included in each implementation plan. Tlie implementation plans are solely based on tlie continuous emission of tlie previously stated air pollutants. Tliey do not mandate any actions to be taken in tlie event of an accidental toxic release. 

As the above cases demonstrate, carbon monoxide poisoning can arise from quite unexpected sources and can be serious. Indirect poisoning from this source of the gas is probably relatively uncommon, but direct poisoning with carbon monoxide is probably the most common type of accidental poisoning that affects the general population. There are probably several hundred poisonings from carbon monoxide every year in the UK alone, some of which are fatal. Some mild cases may well go undetected as the main symptom is a headache. 

The most common cause of accidental poisoning with carbon monoxide is a fire, stove, or boiler that is inadequately ventilated. When it is lit, it produces the toxic gas which accumulates in the house, especially in modern homes which are often double-glazed and have little ventilation, and especially in the winter. One reason for poor ventilation may be birds nesting in the chimney, which decreases the availability of air. In a recent case a family lit a fire in a rented holiday cottage, but unbeknown to them the chimney had become blocked with a bird s nest, and all of them died of carbon monoxide poisoning. 

Henz, S., Maeder, M. (2005). Prospective study of accidental carbon monoxide poisoning in 38 Swiss soldiers. Swiss Med. Weekly 135 398-408. 

Gozal D, Ziser A, Shupak A, Melamed Y. Accidental carbon monoxide poisoning. Clin Pediatr 1985 24 132-5. 

Fagin J, Bradley J and WiUiams D (1980). Carbon monoxide poisoning after accidentally inhaling paint remover. British Medical Journal 281, 1461. 

Carbon monoxide, CO, is a common cause of accidental poisoning (Table 3). 

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