Pathophysiology: relative anemia and hypoxia
A. Binding affinity of Hb: 200 times of O2 (fetal hemoglobin has an even higher binding affinity)
B. Half-life: room air (5-6 hr); 100 % O2 (1 hr);
Clinical feature
A. Heache, visual disturbance, vomiting, confusion, ataxia, dyspnea/tachypnea, seizure, ECG change/dysrhythmias, syncope, retinal hemorrhage, chest pain, bullous skin lesions, focal neurologic deficit
B. “flu-like”
C. Hx: concurrent symptoms in other members of the household or pets
D. CO poisoning should always be in the D/D for coma pt, pt with mental status changes, as well as for pt who are noted to have an elevated anion gap metabolic acidosis or otherwise unexplained lactic acidosis
E. Cherry red oral mucosa is rarely seen in living pt
F. A coma pt removed from a fired scene should be assumed to have CO poisoning until proven otherwise, even in the absece of cutaneous or airway burn
Diagnosis
Elevated carboxyhemoglobin level (need to take consideration time and duration of exposure time from exposure to presentation, treatment), artificial elevated oxyhemoglobin saturation using pulse oximetry, elevated lactate, elevated anion gap metabolic acidosis, elevated CPK, elevated troponin, variable ECG finding (normal to injury pattern), bilateral globus pallidus lesion on MRI
Treatment
Indication for HBO: syncope, confusion/altered mental statusm seizure, coma, focal neurologic deficit, pregnancy with CO level > 15 %, blood level > 25 %, evidence of AMI
Disposition
A.Minimal or no symptoms: home
B.Headache, vomiting, elevated CO level: home after symptom resolution (O2 100% + obs 4 hr)
C. Ataxia, seizure, syncope, chest pain, focal neurologic deficit, dyspnea, ECG finding: hospitalize + consult HBO
ps:因標題無法容納太多字 正確文題是:Carbon monoxide (CO) intoxication |
住戶編號:2028043
檢舉原因
心情: 
