Board Review: Dyspnea after a house fire
While working a shift in your Emergency Department, the local EMS crew brings in a patient who was caught in a house fire. The patient was found by firefights trapped in a room on the third floor. While able to avoid burn injuries, they are shortness of breath and complaining of nausea and a headache. As you are concerned about carbon monoxide poisoning, for which of the following patients would you consider a consultation to a hyperbaric center? (scroll down for the answer)
a) A 14 year old male with a carboxyhemoglobin level of 12%
b) A 27 year old male who remains persistently short of breath after 2 hours of 100% oxygen via a non-rebreather mask.
c) A 56 year old male smoker with a carboxyhemoglobin of 23%
d) A 24 year old female with an initial lactate of 6.6
e) A 32 year old pregnant female with a carboxyhemoglobin of 16%
The correct answer is e) a 32 year old pregnant female with a carboxyhemoglobin of 16%
- While hyperbaric oxygen is not the standard of care for carbon monoxide poisoning, there are certain situations in which a consultation to your nearest hyperbaric center should be made:
- Pregnant patients with a carboxyhemoglobin level > 15%
- Carboxyhemoglobin level > 25%
- Evidence of acute myocardial ischemia
- Persistent altered mental status
- Focal neurologic deficit
- The half-life of carboxyhemoglobin is 80-85 minutes while on 100% oxygen. Patient should remain on oxygen and observed for a period of at least four hours and continued until they are asymptomatic and their carboxyhemoglobin level returns to normal (< 3%).
- For more information, head over to emDocs for an overview of Carbon Monoxide Poisoning. http://www.emdocs.net/carbon-monoxide-poisoning/