Urgent hyperbaric oxygen therapy (HBO2) for acute carbon monoxide poisoning.

A case with severe acute carbon monoxide poisoning is presented the 17-year-old female was previously healthy and non-smoker. She was found lying unconscious on the floor. Although her father smelled a pungent odor and felt headache, dizziness, agitation, and dyspnea after entering the room, he had realized that she was apneic and than he gave her mouth-to-mouth respiration for 10 minutes before breathing resumed. She was taken to a local hospital and received oxygen via nasal cannula (10 L/minute) within 30 minutes. First cranial tomography (CT) findings were unremarkable other than brain edema. She was admitted to an intensive care unit. No verbal communication was present. Her Glascow score was 6, modified APACHE II score was 24 and MODS score was 6. Arterial blood gas (ABG) sample analysis revealed metabolic acidosis and hypoxemia with pH 7.2. Carboxyhemoglobin (COHb) level was 51.4 % and electrocardiography showed a mild ST-segment depression over anterior leads, suggestive of myocardial ischemia. Routine chest X-ray, serum biochemistry and complete blood counts were unremarkable. HBO2 therapy was immediately initiated within 4 hours after exposure to CO in a multiplace chamber. HBO2 therapy was withheld after completing ten session. Her symptoms improved after first HBO2 therapy and COHb level was 24%. She was discharged on day 4. She had a normal follow-up six weeks after discharge. It has been shown that HBO2 therapy has provided prominent improvement in the early and late effects of carbon monoxide poisoning and this improvement is more quick and more effective in acute phase (Ref. 10). Full Text (Free, PDF) www.bmj.sk.