Carbon Monoxide Poisoning for Practical Nurses

Carbon monoxide (CO) is a colorless, odorless, tasteless gas produced by the incomplete combustion of carbon-containing fuels (natural gas, gasoline, wood, charcoal, propane). CO exerts its toxic effects through multiple cellular mechanisms that impair oxygen delivery and utilization at the tissue level. The primary mechanism involves CO binding to hemoglobin with an affinity approximately 200-250 times greater than oxygen, forming carboxyhemoglobin (COHb). This binding occurs at the same site on the hemoglobin molecule where oxygen normally attaches (the iron center of the heme group). When CO occupies one or more of the four heme binding sites, it causes a conformational change in the hemoglobin molecule that increases the affinity of the remaining heme groups for oxygen. This is known as the left shift of the oxyhemoglobin dissociation curve, meaning that hemoglobin holds onto oxygen more tightly and releases it less readily to the tissues. The result is a dual insult: reduced oxygen-carrying capacity (because CO-occupied sites cannot carry oxygen) and impaired oxygen release at the cellular level (because the remaining oxygen is bound too tightly). CO also binds to myoglobin...