Severe carbon monoxide poisoning in the pediatric patient: a case report.

A 10-yr-old female presented at Deaconess Medical Center, Spokane WA, comatose after being rescued from a house fire. Her carboxyhemoglobin was 48%. An 11-yr-old playmate presented with a carboxyhemoglobin level of 51% and later expired. Our patient was treated with hyperbaric oxygen therapy and manual artificial ventilation for 2.5 h. She recovered fully, and 7 mo later has had no neurologic deficits. Carbon monoxide bonds to the hemoglobin more tightly than oxygen, displacing the oxygen hemoglobin dissociation curve to the left and resulting in tissue hypoxia and hypotension. Carbon monoxide also exerts a negative influence on the electron transport chain, may lead to delayed neurologic sequelae because of free radical formation, and produces profound changes in the myocardium. Once seen as a capricious treatment for many symptoms, hyperbaric oxygen therapy is now an accepted treatment for carbon monoxide poisoning. The outcome suggests that in a patient whose prognosis is grave, a good outcome may be achieved with aggressive HBO therapy.