An Evidence-Based Approach To Pediatric Carbon Monoxide Poisoning (Trauma CME) - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category 1 credits, 4 AAP Prescribed credits, and 4 AOA Category 2A or 2B credits.
Published: September 2011 (Volume 8, Number 9)
Abby M. Williams, MD
Clinical Fellow, Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
Tommy Y. Kim, MD, FAAP
Assistant Professor of Emergency Medicine and Pediatrics, Loma Linda Medical Center and Children’s Hospital, Loma Linda, CA
James W. Rhee, MD, FAAEM
Assistant Professor of Medicine and Pediatrics, Director of Medical Toxicology Sections of Emergency Medicine and Pediatric Emergency Medicine, The University of Chicago, Chicago, IL
This article focuses on the evidence-based treatment of carbon monoxide (CO) poisoning, the most common preventable toxic exposure that results in death in children 12 years old and younger. Evidence suggesting that CO poisoning should be considered in the differential diagnosis of pediatric patients with nonspecific complaints is examined, and the use of carboxyhemoglobin levels to determine severity of CO exposure is reviewed.
Excerpt From This Issue
You have just arrived for your 7AM shift on a chilly January morning when an unresponsive 21-month-old girl is brought in by emergency medical services. On arrival to the ED, she is noted to be lethargic and flaccid. She is immediately placed on a cardiorespiratory monitor and the following vital signs are obtained: temperature 37.5°C (99.5°F), heart rate 154 beats per minute, respiratory rate 32 breaths per minute, blood pressure 86/57 mm Hg, and oxygen saturations of 99% on face mask oxygen. On physical examination, you note sluggish opening of her eyes to voice. She moans and localizes to pain, and her skin is pale. She is not apneic or cyanotic. Other than her altered level of consciousness, the rest of her physical examination is normal. She appears to be managing her airway appropriately. Emergency medical services reports that a serum glucose obtained in route was 98 mg/dL. Her mother arrives 20 minutes later and states that the child is previously healthy, and she was in her normal state of health when she placed her in the crib at bedtime. Mother says she went to check on her daughter this morning when she did not wake at her normal time and found her unresponsive with vomitus in the crib. She has not had any fevers, upper respiratory symptoms, diarrhea, or rashes. There is no history of trauma, and the child has been in the care of her mother. When questioned about sick contact exposure, the child’s mother states that she has not been feeling well, with headache and nausea upon waking this morning; however, she is currently feeling better. What other history would you like to obtain from the mother? What diagnostic tests and therapies do you want to start? While you are entering your orders, the nurse calls you to the bedside because the patient has started to seize.