title: Exposure to extremely high concentrations of carbon dioxide: a clinical description of a mass casualty incident.
abstract: Clinical reports on unintentional mass exposure to extreme concentrations of carbon dioxide are rare. We describe an industrial incident caused by a container of liquid carbon dioxide that was unintentionally opened in an enclosed working environment. Twenty-five casualties reached our emergency department. Symptoms included dyspnea, cough, dizziness, chest pain, and headache. ECGs (n=15) revealed ST-segment changes in 2 (13.3%) patients, atrial fibrillation in 2 patients, and non-Q wave myocardial infarction in 1 patient. Chest radiographs (n=22) revealed diffuse or patchy alveolar patterns, consistent with pneumonitis, in 6 (27%) patients and pulmonary edema in 2 (9%) patients. Eleven (44%) patients were admitted to the hospital: 8 were discharged 24 hours later and the others within 8 days. No patient died. Exposure to high concentrations of carbon dioxide resulted in significant but transient cardiopulmonary morbidity with no mortality when victims were promptly evacuated and given supportive therapy. Cardiac complications were frequently observed and should be actively sought.
authors.affiliation: Department of Emergency Medicine and Intensive Care Unit, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. dr_halperin@tasmc.health.gov.il
authors.forename: Pinchas
authors.initials: P
authors.lastname: Halpern
authors.forename: Yosef
authors.initials: Y
authors.lastname: Raskin
authors.forename: Patrick
authors.initials: P
authors.lastname: Sorkine
authors.forename: Arthur
authors.initials: A
authors.lastname: Oganezov
mesh_terms: D000142:Acidosis, Respiratory / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000506:poisoning*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced*; D010102:Oxygen Inhalation Therapy; D011014:Pneumonia / Q000139:chemically induced*; D011041:Poisoning / Q000628:therapy; D011654:Pulmonary Edema / Q000139:chemically induced*
chemical_list: D002245:Carbon Dioxide