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Carbon Monoxide Poisoning - by Eva Ettedgui RN, CLNC |
Carbon Monoxide Poisoning?
from Newsletter - Nov. 2009
Case Study:
I recently analyzed a case for a law firm where the plaintiff, a woman, age 52 claimed that she had been the victim of carbon monoxide exposure over a period of 6 months.
Plaintiff’s Story:
The plaintiff lived in a rental, single standing unit on the property of a main house where her landlord lived. She asked the landlord to turn off the gas on her old wall heater, as even the pilot flame creates heat and she lived in a very hot area of the country. During the 6 months that followed, this woman began experiencing increased severity of the following symptoms.
Symptoms: dizziness, nausea, extreme fatigue, headaches, forgetfulness, loss of coordination. An avid daily swimmer, she could no longer swim.
Medical History:
The plaintiff had a history of fibromyalgia, now considered in remission for 7 years. Her fibromyalgia symptoms in the past were: headaches, nausea, and muscle pains.The plaintiff’s headaches, fatigue, memory loss, and loss of coordination increased over these months until she spent more and more time in her apartment with doors and windows closed. Near the end of the 6 month period, she smelled the faintest hint of gas coming from the wall heater unit. She immediately called the Gas Company and they sent out a technician who discovered that the pilot light was off on this unit and the gas was on. The landlord had failed to turn off the gas.The woman called her doctor who saw her immediately. He did not order a carbon monoxide blood level (called a carboxyhemoglobin level), but sent her right away to a local hospital bariatric chamber for a series of concentrated oxygen exposure/treatments. The plaintiff claims that these bariatric treatments improved her symptoms 75% but that she now lives with neurological problems which have changed her independent life dramatically. She cannot drive a car for longer than 20 minutes with enough coordination and memory to stay safe. She can no longer swim as before or hold down a job because of short term memory deficits and problems focusing. She claims to be the victim of carbon monoxide poisoning. (Have you solved the puzzle yet? If not, read on.)
Legal Nurse Analysis and Discovery:
Plaintiff’s Medical Record:
- The plaintiff’s MRI of the brain did not show the typical white matter fiber tracks which we see with carbon monoxide poisoning.
- The MRI was considered normal/negative for brain damage.
- No blood carboxyhemoglobin level drawn.
- History of anxiety meds and fibromyalgia
My Job:
1. Staying objective in light of fibromyalgia which presents with subjective symptoms.
2. Defining Carbon Monoxide poisoning:
Carbon monoxide is created by the partial combustion of natural gas. Combustion requires a flame, no flame, no carbon monoxide.
This plaintiff was exposed to natural gas, not carbon monoxide. The amount of natural gas that comes through on old wall heater is negligible in terms of health, in addition, these types of heaters are vented so the natural gas escapes out the vent.The plaintiff attorney who retained me to investigate this case was ready to spend $6000.00 of his own money to put the plaintiff through psycho-neurological testing. This computerized testing measures: executive function, processing speed, attention, verbal memory, and multi-tasking of the brain. These faculties will be damaged with serious carbon monoxide exposures and the results serve as objective findings to support a legitimate case.
Components of a Winning Case
Carbon Monoxide Poisoning
Step 1: A story in alignment with true carbon monoxide exposure.
Step 2: A carboxyhemoglobin level greater than 3% in nonsmokers or greater than 10% in smokers to confirm exposure to carbon monoxide.
Step 3: If a gas technician assessed the residence, obtain the gas technician’s report and also request the gas consumption records for the time period in question.
Step 4: Retain a qualified Industrial Specialist to look at the gas reports.
Step 5: Psycho-neurological computerized testing with positive findings for carbon monoxide poisoning sequelae.
Step 6: Obtain a highly sensitive 3-T MRI of the brain. The 3-T MRI is not universally available. Most facilities house the 1.5 –T MRI scanners which generally depict less damage.
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