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Using a novel method to review carbon monoxide (CO) exposures in the US, the role of CO detectors in prevention of CO-related deaths was studied. Using a national media clipping service, CO poisonings reported in the US were analyzed. The impact of CO detectors was investigated through nonfatal outcomes attributable to the presence of CO detectors and case fatality rate comparison among cities with and without CO detector ordinances. There were 4,564 CO exposures resulting in 406 (8.9%) fatalities. Of the exposures 2,617 (57.3%) occurred in the home, accounting for 374 (92.1%) deaths. Faulty heating systems constituted 2,540 (55.6%) exposures and 186 (45.8%) deaths, with alternate heating sources responsible for 389 (8.5%) exposures and 104 (25.6%) deaths. Cities with CO detector ordinances showed lower case fatality rates as reported in the media than those cities without ordinances (P <.001). There were 1,008 (24.2%) survivors who attributed their survival to the presence of a CO detector. A media clipping service provided insight into CO poisoning demographics. Despite its limitations, this tool may calibrate the positive impact of CO detectors on the prevention of CO-related deaths.

The objective was to determine the extent of toxicology training in US and Canadian Medical Schools. The authors took a phone survey of the medical schools in the United States and Canada. Questions asked included whether school had a required toxicology course, in what context toxicology was taught, whether basic poison management was taught, and whether a doctoral toxicologist was on staff. Quantitation of hours of toxicology instruction and toxicology-related questions was also sought. Of the 142 medical schools in the United States and Canada, 123 schools were contacted (85.4%); 107 of these schools were US schools while 16 were Canadian medical schools. One hundred two schools (82.8%) stated that toxicology was taught in pharmacology or pathology courses, while only six schools (4.9%) had separate formal toxicology courses. An average of 5.04 hours (+/- 4.6 hours) of toxicology was taught in US courses, while the Canadian average was 6.04 hours (+/- 5.2 hours). Basic poison management was taught in 75 of the schools (61%), while a toxicologist (holding either an MD or PhD degree) was on staff in 56 of the 110 schools responding to this question (51%). While no relationship existed between having a toxicologist on staff and whether poison management was taught in US schools, a significant relationship was noted in Canadian schools (P less than .05). The authors conclude that toxicology as a separate discipline (and poison management in particular) is not routinely taught in medical school.

Five patients presented to the emergency department (ED) following exposure in an enclosed space to methylene chloride (dichloromethane), used for removing paint. Two workers and three rescuers were involved. Two rescuers complained only of dizziness and mild nausea, and were subsequently discharged from the ED. One rescuer was asymptomatic. Worker no. 1 arrived in cardiac arrest and eventually died in the ED despite resuscitation efforts. Worker no. 2 also presented to the ED in cardiac arrest, and was successfully resuscitated to pulse and blood pressure. However, he never regained consciousness or spontaneous respirations, and died on the fourth day. Of interest is that worker no. 2's carboxyhemoglobin level increased from 2% to 8% over the 9 hours following admission, despite administration of 40% to 50% oxygen by endotracheal tube. Among the conclusions that can be drawn are (1) the cause of death in these patients was not carbon monoxide poisoning, but solvent-induced narcosis; (2) carboxyhemoglobin levels may continue to rise following cessation of exposure, despite administration of high flow oxygen; (3) rescuers can easily become victims if proper protective clothing and respirators are not worn.