CO Poisoning
CC: apartment fire
Multiple patients arrived in resuscitation, with low blood pressure, nausea and vomiting
On exam: gas 15/15 , BP 80/50, SPO2 100% room air
Diagnosis:
CO poisoning
What will you do?
Do blood Lactate level
Do CBC, RFT,…
ABG: ph 7.19 pco2 39 hco3 8
High Lactate 10 then 8 after IVF replacement
Do COHb level
Call ICU for assessment
ENT for bronchoscopy
Give IVF fluid
Losec IV
CXR to look for pulmonary edema
ECG to look for myocardial infarction
Give oxygen by rebreather mask 15 l/minutes
CK to rule rhabdomyolysis
CT brain : bilateral symmetrical hypoattenuation of the globi pallidi as a result of underlying necrosis
Consider hyperbaric oxygen?
For severe CO poisoning:
• Loss of consciousness
• Persistent neurological deficits
• Pregnant
• Cardiac ischemia
Severity ?
Carboxyhemoglobin level > 25%
Complication ?
Movement problems ( Parkinson’s disease- like syndrome )
