CO Poisoning

Case Summary: A daughter, mother and grandaughter present to Jeff ED c/o nausea, lightheadedness, vomiting, and headache for several hours. The CO Monitor at home went off this afternoon s/p the furnace was turned on for the first time this morning.

DX: CO Poisoning

Plan:

1) Start pt on 100% High Flow Oxygen Mask.
2) Draw carboxy hemoglobin levels

Results/TX/What I learned:

The patients carboxy levels were elevated-- 10%, 22%, and 36% for D, Mom, and Grand Mom, respectively. CO levels can be elevated in smokers (10% is nml). CO has a half life of 4-8 hours. With high flow o2 mask, this half life is reduced to 60 mins. (with hyperbaric 02 chamber, halflife is reduced to 23 mins) Pts were left on mask for 2 hours, and then D/C'd. Common symptoms with CO exposure include lightheadedness, headaches, N/V. Blood venous PO2 measurements tend to be normal, because PO2 reflects O2 dissolved in blood and this process not affected by CO. In contrast, hemoglobin-bound O2 (which normally comprises 98 percent of arterial O2 content) is profoundly reduced in the presence of COHb. In this case, venous blood was sent.