<< Carbon Monoxide Poisoning In Children: Diagnosis And Management In The Emergency Department

Case Presentations & Case Conclusions

Case Presentations

You receive notification that EMS is bringing in a 14-year-old hockey goalie after a syncopal event. EMS inform you that he is the first of many potential victims en route after multiple players and spectators at a local ice rink began complaining of different symptoms. According to EMS, a noninvasive pulse CO-oximeter reported his COHb level at 21%. His GCS score was 14 at the scene due to confusion and disorientation, his vital signs were stable, and he was given oxygen by nonrebreather face mask. His blood glucose was 115 mg/dL. On arrival, the patient’s vital signs are normal with an oxygen saturation of 100% on 15 L/min of oxygen by nonrebreather face mask. The goalie complains of severe 9/10 frontal headache, nausea, and ringing in his ears. On physical examination, his face is flushed, and he is diaphoretic with an otherwise normal physical examination and mental status. His CBC, electrolytes, and arterial blood gas analysis are in the normal range. His COHb level is 19%. His ECG is normal. As you prepare to manage the patient and other potential victims, you ask yourself: What was the source of this poisoning and are others in danger? What are the most common symptoms of carbon monoxide poisoning in children? What are the treatment goals? What are the indications for consulting with a hyperbaric medicine specialist?

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