Browse the corpus

Pulmonary and Critical Care Medicine Carbon Monoxide Poisoning Diagnosis and Testing Characteristic findings are unexplained flulike symptoms, frontal headache, lightheadedness, difficulty concentrating, confu sion, delirium, coma, dyspnea, nausea, and chest pain that are often associated with use of a grill or burning heat source indoors. Order ABG studies and serum carboxyhemoglobin measurement for all patients with neurologic changes, dyspnea, chest pain, or smoke exposure. A carboxyhemoglobin level >25% in any patient is diagnostic ofsevere acute carbon monoxide poisoning. DOil'T BE TRICKED . Pulse oximetry data are unreliable because the oximeter is unable to differentiate carboxyhemoglobin from oxyhemoglobin. Treatment Normobaric oxygen therapy is the treatment of choice. Hyperbaric oxygen therapy is indicated for patients with severe carbon monoxide poisoning (characterized by loss ofconsciousness and persistent neurologic deficits), patients who are pregnant, or patients with evidence of cardiac ischemia. TESTYOURSELF A 39-year-old man is found unconscious by his family. He had not been seen since late the previous evening. The outside tem- perature was below freezing overnight. He is unresponsive and deeply cyanotic. The patient is intubated and ventilated with 100'/" oxygen. Although the O, saturation is 100'X,, he remains comatose. ANSWER: For diagnosis, choose carbon monoxide poisoning. For management, select carboxyhemoglobin level measurement.

TESTYOURSELF A 39-year-old man is found unconscious by his family. He had not been seen since late the previous evening. The outside tem- perature was below freezing overnight. He is unresponsive and deeply cyanotic. The patient is intubated and ventilated with 100'/" oxygen. Although the O, saturation is 100'X,, he remains comatose. ANSWER: For diagnosis, choose carbon monoxide poisoning. For management, select carboxyhemoglobin level measurement. Toxidromes STUDY YABLET Toxic Syndrome Manifestations and Treatments Syndrome Manifestations Representative Drugs Treatment Sympathomimetic Tachycardia Cocaine Benzodiazepines for agitation Hypertension Amphetamines Avoid p-blockers for hypertension Diaphoresis Ephedrine Haloperidol may worsen hyperthermia Agitation Caffeine Seizures Mydriasis Cholinergic "SLUDGE' Organophosphates Organophosphate poisoning requires (insecticides, sarin) external decontamination Confusion Carbamates Atropine Bronchorrhea Physostigmine May require ventilatory support Bradycardia Edrophonium Add pralidoxime for CNS toxicity Miosis Nicotine Benzodiazepines for convulsions (Continued on the next page) 365