Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Am J Emerg Med. 2018 Sep;36(9):1718.e1-1718.e3. doi: 10.1016/j.ajem.2018.05.064. Epub 2018 May 30.
The risk of thromboembolism is higher in those with carbon monoxide (CO) poisoning than in the general population. Pulmonary embolisms (PE) usually develop during admission for acute CO poisoning. We report the first case of a life-threatening PE that occurred immediately after acute CO poisoning and was treated with a thrombolytic agent. A 38-year-old woman presented at the emergency department with a stuporous mental status immediately after acute CO poisoning. She was started on hyperbaric oxygen therapy (HBOT), which maintained her hemodynamic stability. After completing the first HBOT session, profound shock occurred. The results of focused cardiac ultrasound performed by an emergency physician were completely different from those of the ultrasound conducted before HBOT; hyperdynamic left ventricle systolic function and right ventricle enlargement with dysfunction were detected. We administered a thrombolytic agent as she was suspected with acute PE based on ultrasound findings; computed tomography could not be performed because of impending arrest. She recovered after the treatment. We should consider that PE is also an important differential cause in patients with hypotension. In these patients, bedside ultrasound performed by emergency physicians can act as the only diagnostic examination.
一氧化碳（CO）中毒患者的血栓栓塞风险高于一般人群。肺栓塞（PE）通常在急性 CO 中毒住院期间发生。我们报告了首例急性 CO 中毒后立即发生的危及生命的 PE，并采用溶栓剂进行治疗。一名 38 岁女性在急性 CO 中毒后立即出现昏迷状态，到急诊科就诊。她开始接受高压氧治疗（HBOT），HBOT 维持了她的血流动力学稳定。完成第一次 HBOT 治疗后，患者出现严重休克。急诊医生进行的心脏超声检查结果与 HBOT 前的超声检查结果完全不同，发现左心室收缩功能呈高动力状态，右心室扩大且功能障碍。根据超声检查结果，我们怀疑患者患有急性 PE，因此给予溶栓剂治疗；但因即将发生心跳骤停而无法进行 CT 检查。治疗后，患者恢复。我们应考虑到 PE 也是低血压患者的重要鉴别病因。在这些患者中，急诊医生进行的床旁超声检查可作为唯一的诊断检查。
