Further comments on CO: Ross reminds us of the typical cherry red lips and nail beds (and complexion) which occurs because the C O is in the venous blood, which is normally more of a purple color, rather than the bright red of arterial blood. These findings are relatively rare and a sign of advanced C O poisoning. Look for the nausea, flue like symptoms, head ache, etc., as early symptoms. Yes, the immediate treatment is Oxygen--and if a boat that has oxygen is readily available go there. However in our area it is rare that any of the dive boats will have oxygen (the SCUBA tanks have the normal 20% oxygen and are of no value). As for Hyperbaric chambers Ross cites Divers Alert Network http://www.diversalertnetwork.org/ (1-919-684-8111 Duke Medical Center switch board hot line). This is an excellent organization. The problems is finding a chamber that will accept civilians, the requirement to be screened in an Emergency Room first, transport from a boat to the medical facilities etc.--all of this may take several hours. Prevention is the best path. If early symptoms occur, then get out into fresh air (like sailors do) and head in. Ventilate the boat. The following is excerpts from Post Graduate Medicine: Carbon monoxide causes thousands of needless deaths each year in the United States (1). Patients who survive the initial poisoning still face the prospect of delayed neurologic dysfunction, which occurs in 14% to 40% of serious cases (1). People who work with methylene chloride, a paint stripper, can be poisoned because the fumes are readily absorbed and converted to carbon monoxide in the liver (6). In such cases, peak carboxyhemoglobin (COHb) levels may be delayed and prolonged because of ongoing production. Research suggests that the intracellular uptake of carbon monoxide is a mechanism for neurologic damage. When carbon monoxide binds to cytochrome oxidase, it causes mitochondrial dysfunction that results in oxidative stress (9). The release of nitric oxide from platelets and endothelial cells, which forms the free radical peroxynitrite, can further inactivate mitochondrial enzymes and damage the vascular endothelium of the brain (10). The end result is lipid peroxidation of the brain, which starts during recovery from carbon monoxide poisoning (11). With reperfusion of the brain, leukocyte adhesion and the subsequent release of destructive enzymes and excitatory amino acids all amplify the initial oxidative injury (12). The net result is cognitive defects, particularly in memory and learning, and movement disorders that may not appear for days following the initial poisoning (5). Patients can successfully recover from acute carbon monoxide poisoning, only to return days later with serious neurologic problems. Sequelae range from subtle cognitive deficits, apparent only on neuropsychological testing, to gross incapacitating movement disorders Neurologic sequelae may be immediately evident in the hospital upon initial recovery or may occur after a lucid interval of up to 3 weeks Few clinical studies document the efficacy of hyperbaric oxygen therapy in preventing delayed neurologic sequelae. Some of this relates to the fact that there is usally a long time before the patient gets to a chamber--and most of the C O has already been displaced--even the neurological dammage may already have been done. There are a number of legal cases where C O poisoning was missdiagnosed as the "flue" and subsiquently there was permant neurological dammage. Bob Austin

At 10:30 AM 07/26/2001 EDT, Thataway@aol.com wrote:. > >Yes, the immediate treatment is Oxygen--and if a boat that has oxygen is >readily available go there. However in our area it is rare that any of the >dive boats will have oxygen (the SCUBA tanks have the normal 20% oxygen and >are of no value). > >Bob Austin Most dive boats down here have O2 onboard. The "DAN" ( http://www.diversalertnetwork.org/ ) organization has made getting O2 easy even for private boats. A number of my friends have it onboard. Looking at the above notes, most problems with CO happen during the night. You might not have too many dive boats around to assist, so maybe you need your own. Take a look at the site. (the usual, just a member)...jd Joe DellaFera / Margaret Murray 36' Prairie DC "Prairie Star" Pompano Beach, Fl.

SNIP > Yes, the immediate treatment is Oxygen--and if a boat that has oxygen is > readily available go there. However in our area it is rare that > any of the > dive boats will have oxygen (the SCUBA tanks have the normal 20% > oxygen and > are of no value). > SNIP > Bob Austin That maybe true for the private boat out diving, but, most if not all dive charter boats will be carrying O2 therapy for diving accidents. Also, with the popularity of Nitrox (air mixes with greater than the normal 21% mix of air) in diving today, you will have a better than even chance of any dive boat having something better than fresh air for you to use until you reach proper medical attention. Stan Kurowski M/V Beaver Rock ( http://members.home.net/skurowski/ ) Anacortes, WA