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Carbon Monoxide: a poison and a killer

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Summary

This session for medical professionals will dive deep into the topic of carbon monoxide poisoning by expert Laura Fattah from Policy Connect. Carbon monoxide, produced when any carbon-based fuel is burnt, is potentially fatal and is often referred to as the 'silent killer'. As well as causing severe, life-threatening harm, carbon monoxide from domestic appliances and cars can have long-term impacts on health, including cardiovascular, brain and sensory impairments, cognitive and developmental problems or low birth weight. Laura will touch on the number of people at risk and what healthcare professionals should look out for in order to diagnose cases of carbon monoxide poisoning. Attendees will also learn tips on how to prevent carbon monoxide poisoning and promote safety in the home and at work.
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Description

A 40-minute in Conversation style webinar presented by Learn With Nurses Founder and Director Michaela Nuttall with guest speaker Laura Fawzia Fatah discussing Carbon Monoxide:

  • What is carbon monoxide poisoning? What can the effects be?
  • How can carbon monoxide poisoning be detected/diagnosed?
  • Is there any evidence that this is happening on a wide scale?
  • What do nurses need to know?
  • Are some people at higher risk?

Test your knowledge on carbon monoxide poisoning by taking the CO #LWNBiqQuiz and see if you can beat the average score of 82% TAKE THE QUIZ

About Laura:

Laura joined Policy Connect as the Policy Manager for Carbon Monoxide Safety in November 2020, previously working for the whistleblowing charity Protect as an adviser, business consultant and policy officer.

Currently, Laura is leading a parliamentary research inquiry into carbon monoxide awareness, training, and risk management processes in health and social care, which is chaired by Liz Twist MP.

Laura provides the Secretariat for the All-Party Parliamentary Carbon Monoxide Group, which incorporates members from five different political parties. The APPG hosts the annual Carbon Monoxide Awareness Week campaign, which is recognised as the flagship campaign for carbon monoxide safety.

Learning objectives

Learning Objectives 1. Describe the process by which carbon monoxide is produced by burning carbon-based fuels. 2. Identify sources of carbon monoxide and appliances that are associated with the possibility of carbon monoxide poisoning. 3. Recognize the health effects and symptoms of carbon monoxide exposure and poisoning. 4. Discuss the challenges in accurately gauging the prevalence of carbon monoxide poisoning. 5. Develop strategies to prevent carbon monoxide poisoning in households.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

just have to wait for it to go read. I don't know if you get to see that, but good evening, everybody. And welcome to another session with learn with nurses in one of our in conversations. Now, I'm joined tonight by Laura. Laura, I've never said your surname out aloud. But But is it, uh so I wasn't sure if it was how. Anyway, people don't need to know that I can't pronounce names. So, uh, we're going to be joined by Laura is going to be telling us, huh? A whole lot more about carbon monoxide. So remember, we are running this on medal, as you all know, and at the end, I'll pop in the link to be able to do your evaluations and get those certificates. Um, so, yeah, all the usual stuff from us. But for now, I'm going to hand over to Laura to tell us a little bit about herself and the work that she's doing on carbon monoxide. So? So Laura, tell us. Tell us a little bit. In the words of Silla, what's your name and where you're from? Thanks so much, Michaela. I'm absolutely delighted to be here with Leonard. nurses. It's really wonderful to have this opportunity to talk to you, um, and your audience as well. So my name is Laura Fattah. I'm from Policy Connect, and I'm a policy and research manager for carbon monoxide. And part of that role involves providing the secretary Act for the All Party Parliamentary Carbon Monoxide Group, which comprises 16 parliamentary members representing five political parties. So it's a it's a really great job. And, um, I get a lot of exposure to different organizations and individuals who are all, you know, pulling on the bandwagon for improving carbon monoxide safety and awareness and and just in case anyone's not come across policy connect anymore. Can you tell us a little bit more about that organization before we jump into into carbon monoxide and what sort of other stuff you might cover as well, though, in case people want to go and learn a bit more sure, thanks for asking. Um, so Policy Connect is a cross party think tank. We work on various different areas of public policy, one of which is health, which is, um, where carbon monoxide policy sits. We also work on education, assistive technology and sustainability. um so we do cover quite a variety of different areas, which is really excellent, and it means that we can pull on different specialties from colleagues and look at those kind of cross working areas, like energy, like housing, like preventative health care, which affects so much of the work that we do. I'm after a little route around afterwards and see what else is in their particular on the energy side and the health, of course. So I'm going to jump in and our title was around Carbon monoxide, you know, a poisoning and a killer and I when? When when the RCN reached out, cause that's what I want to kill people. So I'm I'm represent the RCN at the all party parliamentary groups that Laura coordinates. And I have to say, if you ever get the opportunity to get involved in one of those organizations or anything like that, if you always say yes because it's really interesting, Um and I It's not that I have a passion for carbon monoxide, but I find with something like that, with, with something like these topics that are always top of the list when we're thinking of things unless you've been unless it touched your world in some way, then you kind of don't think about it. So for me and and and Laura knows this the reason why I said yes, I'll happily happily get involved with carbon monoxide. Well, it's two main reasons. One, my husband is it was is now into renewable energies. But he was, you know, he did Boiler central heating, all of that, and the amount of times that he would talk about carbon monoxide poisoning and incomplete combustion and flues. And, you know, we've been out for dinner and you're saying the state of that flew across the road and all of that sort of stuff, So it was kind of part of my d n a. Without me even trying. But then a friend of my daughter's both him and his mom has carbon monoxide poisoning and and was both very, very unwell, as from as a result of it. So for me, it was a bit of a no brainer getting involved, but for anyone that's listening or joining us, because I remember we had this, people will be joining us in a variety of different ways. Either live now or on demand. It would be really useful if you could just give us a bit of a general outline on Just what is carbon monoxide poisoning? What are the effects? What are the symptoms? Can you give it as a, you know, a short lesson on on carbon monoxide poisoning. Please, Laura. Yes, certainly. I'd love to sew carbon monoxide as you've highlighted, conform when any carbon based fuel is burnt. So that could be, um, your gas, your solid fuel. So Coles would oil any kind of carbon based fuel that you might be using. And, yeah, typical appliances that people associate carbon monoxide with our boilers. Gas cookers can also so pose a risk as well and also even cars and generators. So carbon monoxide can be produced by a really wide variety of different appliances in the home and also can enter the home from outside as well. So it's definitely one to watch and be aware of. And as you say, I think it's it is something that you know will strike people once they've had that carbon monoxide story. If they know somebody that's, you know, had a tragic incident with carbon monoxide that's when it we start to think about it. And actually, it's so important that we're here today because we all need to be thinking about it before harm has occurred so that we can take those preventative steps and actually stop carbon monoxide poisoning from happening. Um, we all are. Well. Many people have heard of carbon monoxide as the silent killer, and that's, you know, part of the reason why I'm so pleased. We've title the session as we have today, because carbon monoxide is a killer and this is obviously one of the most severe effects. But it's also a poison that can have long term impacts for our health as well. So, um, carbon monoxide has been associated with cardiovascular issues with brain damage. It's quite a risky for pregnant women because they have different, um, hemoglobin. So pregnant women, um, and fetal hemoglobin has a higher affinity to carbon monoxide, and it can raise in low birth weight. It's been linked with cognitive and developmental problems in Children. It's also been linked with sensory impairments as well. With low mobility, it's it's essentially, um, a poisonous gas which deprives your body of oxygen. There are also other toxic effects, which are the subject of further research at the moment. But the main sort of known and common issue is the deprivation of oxygen. So that affects your body in terms of the organs which use the most oxygen. It can also obviously cause respiratory problems because you're breathing it in. So it can be really quite dangerous for people with asthma. Um, and other respiratory issues and the symptoms of carbon monoxide poisoning are quite nonspecific. So the typical sorts of symptoms you might get would be headache feeling sick, maybe feeling a little bit dizzy, um, collapsing, Um, and obviously losing consciousness in those more severe cases. But we really need to be okay. Sorry, Makena? Yep. No, I'm here, OK, just a notice on the line. Um, I think what's really important to be aware of is that these kind of symptoms can be caused by so many things. You know, they can be caused by stress. They could be caused by dehydration. Um, so it's really important that we are thinking of carbon monoxide as a possible reason because it could be very easy to misdiagnose or just to put those symptoms down to something, um, that we're a bit more used to seeing. Yeah, and then when you when you first mentioned about the symptoms and we look, you know before and I usually start to imagine that, you know. So if I'm a GP, I'm sitting in my practice and somebody keeps coming back in saying I'm just so tired. I just said this. They they will, you know, they're not very exciting, you know? You call them, not you know you. The symptoms are really not. And and you're right, you say can be so many other things. Do we know at all? Um, how widespread carbon monoxide poisoning is? How how bad is it? How many people it Effexor or, like many things, Do we actually not? No. Because we don't have it diagnosed enough. Yeah, it's quite tricky to kind to try and establish that The estimates. I think the latest information we have from the Office for National Statistics indicates between 20 to 30 individuals from accidental non fire related carbon monoxide poisoning. Because, of course, carbon monoxide can also sadly be used in suicides and can be related to fires as well. Um, which we wouldn't necessarily think of as being within the sort of carbon monoxide poisoning we're trying to target, because if you if you have a fire, then that's quite a clear link there. Um, what we have seen is that a lot of people being admitted to A and E So, uh, the latest estimates were from the, uh I think it's from the NHS. They're around 4000 people coming into accident and emergency, which is obviously a huge number, and we really need to be careful of that. But there are many, many individuals who potentially would have been seeking medical help, as you kind of outlined those mystery patient's, and they would potentially never be diagnosed as having exposure to carbon monoxide. Um, there's also lots of things that can be put down on your death certificate if you have, you know, died of carbon monoxide. If you've died of a heart attack, for example, that would be, um, recorded as the main reason. So the way that carbon monoxide harm data is collected is really quite challenging, and that's a big challenge for us trying to show the prevalence. I think if one of the best indicators we can look at is from engineers and from Fawlty Gas Appliances, where there could be carbon monoxide. So there's some recent work that been done by the gas safe register, where they've essentially mapped out the entire of the UK, and they've shown that one in six homes that they have their engineers have attended have had a dangerous or faulty gas appliance. And that is a huge number thinking about one in six individuals. You know, if you think about that as being a street, that could be tens of people. Um, and I think that's one of the reasons we need to be very vigilant around this and make sure that people are, you know, ensuring that there's appliances are service and that their homes are safe this winter because you might not necessarily think, Oh, you know, my boiler could be making me feel ill. It's quite a difficult connection to be made for an individual. And if that individual you know isn't going and reporting, Oh, I think it's carbon monoxide, Then that healthcare professional again might not immediately make that connection. So the numbers are quite, you know, don't look huge, but when you then look at how many people have a carbon monoxide alarm in their home. It's less than half of the dwellings in England, so there is potentially a, you know, a very large number of individuals suffering without necessarily making those connections and and getting on those kind of official records. Yeah, and actually, if I just so now my little brains ticking away as it does so there's huge potential out there for lots of people to have what I would want to call low grade carbon monoxide poisoning said, Not enough to make you go to hospital. Not so much to make you well, not, you know, you don't die, but but just enough to give you really grumbly symptoms that actually can we really got you to live with. But but not enough to to come to a diagnosis. The potential is quite huge, I think, particularly if it's one in six. Now I'm gonna move us onto some some some Let's let's drill down now into thinking as um what nurses can do now. Of course, we're not nurses who joined Linwood nurses on the call or on the sessions, but But given that when we say nurses were thinking about healthcare professionals. And what are the impact there Now? I've got a call. I've got a question that's coming, and for anyone that's joining us later on on demand you won't be able to see the questions. But I'm But I'm good, so I'm going to read them out. And what so originally, we're going to do? Well, we are going to still talk about. So what does it mean with nurses and what the nurses need to know? But there's a really good question coming in saying, Do healthcare professionals have to report carbon monoxide poisoning to any agency as such? So is there someone we have to tell or ask? Maybe Laura. So one excellent organization I can recommend getting in touch with is the National Poisons Information Service so they actually run a helpline. If you suspect carbon monoxide and you are a healthcare professional working in the clinical setting, you can give them a call. Um, they're really excellent in terms of giving advice and also in terms of recording as well, and they've just published a paper in September this month and sort of updating of all of the calls that they've had in the kind trends in the data that they're seeing. So I definitely recommend getting in touch with them, um, to get some advice and also to, you know, help us to understand that picture of carbon monoxide a little bit more clearly. You can contact them on 03 double 48920 double one. If you're in England, Scotland or Wales and Northern Ireland, it's 0180925, double six. And that's talk space. So So, yeah, I definitely suggest anyone who suspects carbon monoxide exposure in a patient should get in touch because that's exactly what this organization is set up for, and they're very well placed to give you. I might. I might ask you to repeat that at the end for anybody that hasn't scribbled it down right now. If anyone is listening, let you know we'll ask that one again at the end. But so it's not a must do. It's just that you could do so we don't have to. Is that so? Is that right? We don't have to officially inform anybody about carbon monoxide poisoning. Then there's no, uh, there's no statutory obligation. As far as I'm aware on healthcare professionals, I mean, I would advise anybody to check their kind of working code of practice and check what's advised by their particular trust or employing organization, because there may well be some kind of internal processes. Yeah, as far as I am aware of my work, I haven't come across any duty or obligation to report on that, as it were. But it's a very good question whether there should be perhaps a duty or obligation so that we do then have, um, you know better and more accurate data and statistics. And it would almost close the loop, wouldn't it? You know it is in that in that in that coding and informing. So let's stay with the nurses for a bit now. So what? What what the nurses need to know? What are they? Let's think about them. Not not themselves, but when actually sort of themselves. Like where might nurses come across carbon monoxide poisoning? Where might they see patient's? So I think it's particularly important if nurses are visiting individuals in their homes, or perhaps in community settings, that they're aware of the signs and symptoms of carbon monoxide poisoning. They're aware of what to look out for. Um, there are certain signs that you can look for is warning signs. So if you see any city marks on any appliances, so that could be your cooker your boiler. Um, even your PSA stove or wood burning wood burning appliance it would be very important to look for any condensation on Windows that might seem a little strange. But what that can indicate is that the air quality and the ventilation are not great within that home. And therefore it can be an issue that carbon monoxide can shoulder the windows. Just looking at them Just now, I haven't realized condensation on Windows. Oh, my. Yeah, so it's really important that yeah, also, nurses are aware of what kind of practices people are behaving within their homes. So certain cooking practices compose greatest carbon monoxide risk. If you're, for example, using a large pot over several hubs on your cooker, that can cause a risk because it stops the fuel from burning completely anything which is really stopping fuel from burning completely or allowing, um, you know things to go unchecked essentially could be a bit of a warning sign. We're also aware from excellent research from national energy, Axion, that there's a link between fuel poverty and carbon monoxide exposure, which, when you think about it, does make a lot of sense because people in fuel poverty maybe aren't as likely to be able to have their appliances serviced. Maybe they might try to use some kind of alternative heating methods for their home, especially this winter, which can come with greater risk as well. So if the nurse is visiting in homes, I think it's just to be aware of, you know, Is this an individual in fuel poverty? Are they going to help their need? Is there a carbon monoxide alarm? Critically, Um, and is it within date? Has it been checked? You know, are there certain things perhaps that you would think about for evacuating the home if the carbon monoxide alarm were to go off? Is there a protocol for that? Do you have the gas emergency service numb on your phone? Another phone number that I'm gonna give for you guys today. Um, so the gas emergency service are the people to call if you think there's a gas emergency. So if you smell gas or if you suspect carbon monoxide because your alarm's going off, you can call them for free on Oh, 800 Triple one, Triple nine. That's Oh, 800 Triple one, Triple nine. Um, and that should really be I think something that we are communicating because often times people think, Well, I don't know what to do if the alarm goes off and in that moment, you know, you don't want to have to be kind of problem solving. You want to be able to follow a pathway, follow a process? No. So what you're gonna do know that there's help at the end of the line as well? Um, so I think that that's something nurses and particularly employers can really think about. Are they equipping their staff with the information? And the process is they need to be safe themselves and also to keep the patient safe. And I guess it's very different to the to the fire alarm and just wafting a tea towel, because you, you know, that's that was my You know, that's me just opening the doors because I've burning something that way, whereas with carbon monoxide, we don't have those those same indicators that we know it's because we've got smoke and stuff. It's, um it's It's it's the silent killer. As you say now I'm just the list. I'm nodding and I'm hearing and thinking, Yeah, that's brilliant. We can do that. And now that I'm thinking with my nursing hat on, but I've already going in and I've already got a million and one things to think about while I'm visiting a patient while that, you know, with everything else that's going on and I've got and particularly when we think about is you know, it's not just nurses that going to visit patient's, we've got care workers and and low paid workers and actually they limited amount of time and it becomes really challenging to then throw one more thing in. And I'm also thinking, Are they going to be thinking, Oh, let me just check the carbon monoxide alarm. I can see challenges coming back. Um, um, we just don't have the time. Or as Zoey's mentioning here, the training and we'll come onto the training in a moment. But, um, but I wondered if if there's something I mean, I I I don't see, I I think I wonder, can we have? Can we be more proactive? It's just simpler ways. Good nurses do. Do firemen carry their carbon monoxide? Don't. Can we have portable alarms? And why the nurses and healthcare assistance and carers got them in their bags or on their pockets? I don't know. I get in your bag. It wouldn't really work because it be in your bag. But is that an option? Do you think that would help? Rather than having to think, like, let me check the such Let me check for this. Let me check for that. Would you just think it's gonna blip because it's going off with that work? Yeah, I think that's a really good idea. Um, and I just I know that certain fire and rescue services do actually carry with them those kind of personal monitors that you have on your body as well. Um, they I think they come out, they come in around 60 70 lbs or so. Um, so it might be something to think about investing in because those do last a couple of years. Those personal monitors and I can certainly provide some information on where to look at to find out why Information about those If you've got your own carbon monoxide alarm, I mean, you might be You might want to take it with you. The problem with that would be your carbon monoxide alarm might take a longer amount of time to sound if there are lower levels of carbon monoxide. But it's definitely something that would alert you to those acute levels. And that real kind of, you know, you need to evacuate now danger. So I think if you if you, you know the gold standard would really maybe, as you've said, having that kind of personal monitor. But if if that's not available to you and you are able to have a carbon monoxide alarm and kind of take it with you, then that's certainly better than absolutely better than nothing. And I know there are some fire and rescue services which which you use both in either for their safe and well visits. So we've and also, you know, use the fire and rescue service. Um, they offer safe and well visits to people in vulnerable situations. If you're concerned about somebody and you know you don't have time there are other services that you can connect them with. The priority services register is another excellent thing to suggest. Um, it's relatively simple to sign up for as far as I'm aware, it's something you can get through. The patient's can get through their energy suppliers, and that will put them in a better position if there are going to be any kind of emergency works, or if for some reason, um, you know they're going to be cut off. If they're on that register as it is, they should be treated as a as a priority and shouldn't be kind of subjected to any sort of negative consequences that can be avoided. So there are there is help out there. There's help available. I think that you're really you know, you make a very good point, which is that everyone in working in healthcare right now is, you know, working with limited resources. And we've got to prioritize the things that you know are the highest risk and do make the most sense for us. So I totally appreciate it's not, um something we can expect, you know, nurses to suddenly become engineers or gas safety experts. Um But yeah, finding workable solutions is really, really important. And we're actually running an inquiry at the moment into improving practices in health and social care, where we've been doing a bit of research with people on the frontline to find out what's really going to work well for them. So I'll be sure to let you know when that's available. Do you do that? That would be really because because I was about to put a national call out to say, I don't think that well, I definitely don't think people should be buying their own carbon are not miniature, you know, little portable carbon monoxide alarms. But but is there almost a responsibility by some of these trust or organization to ensure the staff safety If they're going into, uh, if that one in six could be faulty, one in six could be faulty, and we're sending in. We're sending in, you know, health, healthcare, workforce into places that potentially are an issue, how now you might not, and I don't know that you matter how quick from being in. So let's imagine I'm going to do a home visit. I've gone in and I'm going to be there for 20 minutes, Let's say, could I feel dizzy at that point, or would it take what would I need to be exposed to it for longer? So I know I'm getting quite clinical now, but is would it? Would I feel it that quickly? Yeah, you can. You can definitely feel it that quickly. I mean, you can You can, um, you know, have a fatality in less than five minutes at very high levels of carbon monoxide, you know, within a couple of minutes. So it really depends on the individual. I think it's one of the things in carbon monoxide that's tricky for us is to classify. You know what's low level, what's high level. What can I expect to see as a clinical outcome in somebody who's been exposed to this level for this long? Because it really does depend a lot on that individual person. I think you know, you could certainly 20 minutes is certainly enough time for harm to happen in a situation. And if you're, you know, visiting a patient who smokes, they might have a higher resistance to you as an individual, so it may well be that you're going into that home, and the patient is kind of not suffering as much as you are. And then suddenly you're actually, um, you know, finding yourself becoming overcome. I think it's absolute, absolutely a workplace safety issue. And all employers do have a legal obligation to provide their employees with a safe and suitable workplace. So I would be, you know, very strongly encouraging unions and other professional bodies to look at this issue quite critically, especially as you know, we are coming up to winter. And, you know, it's a really difficult time for a lot of people in terms of energy and the cost of living. And what about So Let's so now. Now what about if we have to start somewhere? Let's imagine we have to start somewhere. And if we were going to make a push, we're going to start somewhere in that sort of, you know, responsibility from employer. If they say well, we can't afford all that money for all of that home visitors, all of everybody that's going in, what about if we said, Well, let's start with when women are pregnant? Would that be good? Because we know that actually, they're they're more susceptible, more vulnerable. Is that right? When they're pregnant and with and with with with the baby. Would that be Yes. Yeah, absolutely. Yeah, you're You're totally right. Pregnant women, Um, and young Children. And you, Obviously, babies are much more susceptible to carbon monoxide poisoning due to the difference in their hemoglobin. And so that's something I think we definitely should be focusing on because obviously, Children can then have developmental difficulties which can cause them problems for all of their lives. So if we looking at preventative health care as a serious issue, as we should be, you know, in terms of leveling up in the social care white paper and all of these, um, you know, brilliant, integrated kind of systems that we're hoping are gonna are gonna form and develop effectively. I think it's critical that we do prioritize. Pregnant women and pregnant women are generally tested for carbon monoxide during their pregnancy, but after they have their baby, that doesn't tend to continue, You know, consistently. So I think if you have that equipment and you're engaging with that individual already, then just keep, you know, testing for carbon monoxide. Make sure that you're aware of that, um, in their home. And I think if employers don't want to pay for personal monitors, there are free training courses available. Um, so I think that's something which you know should be definitely given. People should be given time to undertake that and be given the tools to be able to protect themselves or just to certainly be aware of when they might need to protect themselves in that situation. Now, interestingly, said training, because there's another comment that's come through well, more of a question. Um, and it says I trained many years ago Exclamation mark, which about myself? I trained over 30 years ago and had no training as a student nurse on carbon monoxide. Do student nurses, health visitors or district nurses, etcetera. We see training. Do we do we get is, does that Do you know? Do we get training as part of our training for being nurses? So my research has led me to believe that it's pretty inconsistent. If I'm honest, I think that might be because, you know, as we've said, there's lots of different things people need to be trained on, and obviously we're keen to kind of you know, not overburden the workforce, but, yeah, I think it's definitely. Conversely, if we did understand carbon monoxide poisoning better we might have a less burden workforce, because people would would not be subjected to this. And we'll be getting well, er so those kind of mystery patient's that keep coming round and round. Um might not necessarily be doing that. So, um, I don't think there is mandatory training. There is, um, an RCN training module available as I know, um, you know Michaela and I'm sure we'll be sharing that as part of the information. And there's also a really great organization called Think CEO who provide training. And, um, you do actually provide in person workshops as well, so I can give you some information to link to some of those resources, too. But it's it is a shame that it's not part of the sort of curriculum as it were, Um, and it's looked at as very much, you know, something which is an extra and a kind of additional thing that you should be bolting on when maybe people don't necessarily have the time to be doing that. So, yeah, I think some really good points coming up here. Um, and also anything you've got for anyone that's attended the sessions or going to listen to the session afterwards. Or if you send me the stuff over, I'll upload it and and it'll be sitting within medal and people say, Yeah, they just go in and download direct from there. And even if you send me something in two weeks time, I can upload it and it send a little email to everyone that's attended or going to attend, um, to say it's here. So if there's a really, really this, this is a great bit of software. That's a great plan, that form medal that allows us to be able to do that. Now, um so has said I was informed that a pregnant woman had a high level of CO2 and, uh, in their blood CEO in their blood and encouraged to contact gas engineers. So is that what? So if somebody's had that they've had a high recording. So you that's what you were saying. Then they were told. Just contact your gas engineer and I guess, and they come out and fix the boiler, replace it. Put your big. Do not use sticker on it. So is that Was that the right advice to give? I'm sure I'm sure it was contact. That means there's no need to evacuate or something at that point. Um, I think it's tricky, you know, when we say a high level of CEO and I should just point out carbon dioxide CO2 is slightly different. Carbon monoxide. I imagine you're probably talking about carbon monoxide because carbon dioxide, we exhale, um, normally as part of our respiratory function. So but it's a very, very common mistake, and I've seen it absolutely loads of times. Um, I think it's, you know, really good advice that she should contact this gas engineers. Maybe having the gas emergency service number would be good for people in all sorts of financial situations. If you're thinking, Oh, I don't want, you know, a big gas bill, you might put that off and you might kind of continue to put yourself at risk. So the levels you know and the individual is really important, and I certainly wouldn't want to critique anyone's advice. I think you know, making that connection between you need to get an engineer around. If you've got High CEO is absolutely correct. I really support that. And it is quite a, you know, quite a jump to make that from kind of treating symptoms and treating a patient in the healthcare setting to actually say, Well, perhaps it's your environment, and you should, you know, maybe take action there. So I'm really pleased to see that that connection is being made. That's fantastic. That's good. That's good. Now we've got one more before we start to think about winding this session up. So But we'll still chat for a few more minutes because I've got another question I want to ask you. But we got a direct question coming, and probably one that's quite useful. Can you test level similar, like on pulls, like would a pulse oximetry show? Yeah. Would you get low oxygen, Saks? Or is it? Does it have to be a blood test to be able to establish it? How how does it work? How do we get that diagnosis? I would strongly encourage you to check with talks based on the National Poisons Information Service. I have seen some reports. Um, that pulse oximetry isn't ideal, but I would definitely not want to give a kind of opinion on that, not being from a medical or clinical background myself. I think it would be really, really good idea to Contact and National Poisons Information service via talk space and see what their advice is. And this is also, you know, a question of what equipment you have available to you. I think it depends, doesn't it? If you're in, you know, if you're in the hospital, then obviously you're much better place. If you're in a domestic setting, you might not have that immediately available, so it's, um yeah, it can be quite tricky, and it's also known accuracy of devices. I think we know that pulse Oximetry is probably not too bad, but it's not always a great indicator, but oxygen SATs. You know it particularly some of the ones that we randomly by off. I don't know why I'm poking at my finger like this, but that we randomly by off the Internet. Um, certainly I'm thinking about devices that people were on the wrists that might talk about pulse oximetry that way. And I know that or they can talk about sacks and I know that. Certainly from a BP perspective, All of the fancy watches that will take your BP probably are not validated. Because what about you put your watch on it? A different strap, tightness and stuff. So most of those we wouldn't say use that way. But also, if you had one that was ridiculously low, then I guess you don't have a double check. And, you know, you got to use your clinical judgment when it gets to that one. Now. So soon. You said about C. O. T. Was popped in the chat? Yes. Sorry. She meant she meant see? Oh, so it happens a lot. And I also stumbled over it when I said it. So So what about nurses themselves? So we're now, as you said you mentioned about we've got a hard winter ahead. Hard for many different reasons. One because it you know, it's been raining a lot. And it's gloomy out there. And the financial pressures that are coming about us and that you know, many women Many nurses are women. They have Children. Um, yeah. What? What about their own homes? What can we do to help ourselves? What can we make sure we do in our own homes, So I definitely advise everybody to ensure they have a carbon monoxide alarm. That's whether you have fuel burning appliances in your home or not. Um, carbon monoxide can pass through walls and can enter from outside. So don't think that you're, you know, completely safe. Just if you're not necessarily on the gas grid or if you're an electric home, you could certainly have carbon monoxide from other places. So get that alarm. Make sure you have your appliances service every year so that you need to be serviced annually. That's your gas appliances. If you have a chimney that needs to be service to ideally, um, you know, by a qualified chimney sweep and or ahead ass approved appliance servicer, make sure that you're really being careful with solid fuel. We need to ensure that every nobody is ventilating homes. Properly sew something that I'm quite concerned about is individuals blocking air bricks or blocking ducks, vents and flues. Ventilation in the home is absolutely essential, and this is one of the ways that we can dissipate. Carbon monoxide from building up. Do always ventilate when you're cooking. That's a critical time. Make sure you've got that carbon monoxide extractor fan on. Make sure you understand the symptoms of carbon monoxide so you can recognize it in family members and particularly Children or pets. You know that there are higher risk. Have that, uh, emergency gas service number saved on your phone. So you know what to do in an emergency and teach anyone you live with never to ignore their carbon side alarm. That's absolutely vital. It's, um sadly, you know that one of the first thing that comes up if you Google, what do I do if my carbon monoxide alarms going off is, take out the batteries or put it outside? Never, ever, ever do that. Please pay attention. Your alarm is there for a reason. Um, so, yeah, that's really critical to, and I should just mention Makayla as well. Before we go off. There's a series of four questions that individuals can ask to try and raise or lower the the suspicion of carbon monoxide poisoning. So the question it's called coma and they stand for cohabit ease outside maintenance and alarms. So just to go through those cohabit eases is anyone you live with feeling sick or feeling. Symptoms of carbon monoxide poisoning outside is Are you feeling better if you go outside when you're away from the source of C. O. M. Is for maintenance. So maintenance of appliances have Your appliance has been well maintained, you know? Are are they a bit older? They a bit dodgy? Um, and A is for alarm. So do you have an alarm? And if so, has it been going off? And if you answer yes to any of those questions, the advice is really to seek information from the National Poisons Information Service and potentially to call that gas emergency service number. Um, and certainly to, you know, take a closer look at that individual. I seem to have lost you, Makayla. I'm not sure if that's the same for others, which is a little bit of a shame as I am. I hear you a little bit. I can hear you, I think. Okay, so that was really odd, but I think it was me that went because I lost the jack for a moment. So you you coped very well there as you obviously been thrown in. Very good. But what I wanted to jump on Was that where you with the sea and cohabit ease? And I think that's, uh, that's something that it's almost a really useful something to know that when we're looking at symptoms, is anybody else in the family having those same sort of symptoms that really should be. I think if I had a big warning bell to anybody that you know, because it's not normal for both of you to get the symptoms or three of you to get symptoms in the same way. And I certainly know a friend of mine and it wasn't carbon monoxide poisoning, but it was something else, and it ended up with both her. She started. And then about six months later, we'll about four months later, the daughter started with symptoms. It just happened to coincide that way. But you know, they're almost going down there. Are we being poisoned in some way? Is there something in the house? Because once you get more than one, you've got to look for that that link. What is the reason that's happening there? And I think that's a really a really good warning bell for people to, um to have in their minds, particularly added themselves or when they're when they're when they're out visiting. So I'm going to apologize for my falling off the Internet briefly for a moment. Uh, there for anyone that might have lost us. But I think we're all back now. Well, Zoe, uh, what am I saying, Zoe? Well, Laura, I think we're almost at the end. Just do you want to in the last moment? Is there anything that you'd like to ask me as a nurse or anything that we have learned with nurses can do to help to help more. So there's anything you want to ask. Well, first of all, I'd like to thank learn with nurses very much for having me today and for helping us to raise awareness around carbon Monoxide Awareness Week, which is running this week. This is the very first day of carbon Monoxide Awareness week, so we're absolutely delighted to be here. Um, and really, you know, if there's any information that would be useful to you, and please get in touch, you know, if there's any, um, content that you find that's good to share, I mean, we obviously have that training module But it's really good to be topical and, you know, to sort of raise individual, um, things that we've seen in news items and so on. And to keep that conversation going. I think so. My my question to you and to others here is just you know what? What would help you to improve carbon monoxide safety and your daily practice? And is there any, you know, greater information that, um, your professional bodies or your unions or anyone could provide That would be helpful. Yeah, well, just funny enough somebody said, Are there any so soon as just written in? Are there any postcards or resources or posters with coma written on it? So is there anything that nurses can go and get or healthcare professionals can go and get that out there? Now, I know the answer is going to be yes, from you, but where where can they go or how can we cascade that information out? So I believe it is covered in a delightful blog from the Royal College of Nursing, which has been done for carbon monoxide awareness week. So you can find, uh, the acronym there. There's also, um, some really helpful one page information from Public Health Wales that I can share with you and perhaps to attach to this and to pass on it is something we'd like to, you know, gain more attention of and promote as a greater sort of awareness raising tool. So I'm really delighted to, you know, be here and to be able to speak about it. And it's great that people find that of interest if you want to follow the campaign the Carbon Monoxide Awareness Week, which features a lot of different resources. Um, some of them will be, you know, more basic than what we've been talking around today. But it's just that sort of eye catching, um, information. And there is a website with a lot further information you can follow hashtag see. Oh A nope. C O A W Sorry, Carbon Monoxide Awareness Week. Or just search for Carbon Monoxide Awareness Week, and you should find the information there. You can also email me. I'll pass on my email address, and I can add you to our mailing list as well, so you'll get all the further information from myself. So, um and you did make reference to the to the RCN bulletin that's coming out. So we will be in the next printed bulletin, which I think is due to be posted out to us all towards the end of November. So very exciting that we're going to be in there and a huge thanks Alora, who has helped us come up with some of the a lot of the content from that because it's very knowledgeable outcome from monoxide. We also have the quiz. So if you haven't taken the quiz yet, have a little go at that. One is only 10 questions, and it is just intended, like all of our quizzes, just to get you a little bit keen and involved. And maybe this is something we could do every awareness week. What's not committing to every awareness week, Laura, But I think definitely come back and just let's do this again. Let's see what it's like this time next year. Discuss any progressions what might have changed? What might not have changed yourself, you know? Well, that way. And, um, yeah, if you've got anybody resources that you would like us to sign, post or share, then let us know we can upload it and people can access it through a variety of different ways and we can sign post there. So it is now 22 8. So at our time, you people might be watching at at a different time. We know in another, um, in another in another country. Also, they're listening on capture. So I did say I'd ask you to repeat those phone numbers again, just in case. So can you repeat them again before I before I say thank you and goodnight. In a moment, I would be delighted to thank you very much. So, uh, the number four talk space is 03448920 Triple one. I'm going to do that again. It's 03 Double 48920 Triple one in Northern Ireland, that's 01809 25 Double 60180925, Double six And the gas emergency service number is oh, 800 Triple one, Triple nine. That's Oh, 800. Triple one, Triple nine. It's free to call. And if you suspect carbon monoxide when you're out and about, um, if you have a carbon monoxide alarm incident, please do give them a ring. Brilliant. Thank you so much for this tonight, Laura. It's been really, in fact, the whole bit you've been very you've been You've been a tweet to tweet, to work with. But I mean that in a really good way. Your energy is always positive. Your knowledge is vast when it comes to carbon monoxide and everything that's going on about it. And often we end up with topics that are, You know, if I think in the health world and it's sometimes, you know, you've got to just keep pushing that stone uphill. You know, it's one of those things you've got to keep pushing that stone uphill so well done for doing it. So Shabaan has popped in. Thank you. It's really informative. Zoe said, to help the same really helpful and informative Thank you. So really that people have enjoyed this one tonight. So a huge thank you to use a very and to the guy. Is it policy connect? I know we'll obviously we'll see each other again because we've got more calls coming up, but what I'm going to do now in the chat Oh, Suze, putting the thank you because We've just put up the link to the RCN magazine that's there. So everyone huge. Thank you for joining us tonight on lower than it is in conversation. I just popped in that feedback chat. Now, also remember that this will be uploaded and may live well, not mine. My bed live made on demand on the landward nurses website, and the amazing, you know, will make that happen in the next couple of days. So please do feel free to share that link to your colleagues because they can watch this anytime they want to. And then over December, I'm turning all of our in conversation sessions into podcasts as well, so you can listen whenever you want to and certainly listen to again if you want to. So, um, the the feedback forms gone up. We are running into quite a quiet time now at learn with. Nurses were having a gentle wind down towards Christmas now because, as you know, many of us well, all of us work as volunteers at lone with nurses, we all have day jobs and say we squeeze these ones in in and around, and it's not just the guys who do this bit, which is quite you know, to me, this is a lovely bit nice and sitting, chatting. But the guys in the back office that do the back office that you know, and we've got lots of nurses and actually non nurses that help all the organizational and the administration all type function, making the quizzes all be perfect. You know, all of that couldn't happen without all of our volunteers. So a huge thank you to those guys. So that's it for us tonight. And thank you very much. I'm going to press the go off from being live button and, um, yeah, thanks.