His CBC, electrolytes, and arterial blood gas analysis are in the normal range. On physical examination, his face is flushed, and he is diaphoretic with an otherwise normal physical examination and mental status. The goalie complains of severe 9/10 frontal headache, nausea, and ringing in his ears. 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. 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. According to EMS, a noninvasive pulse CO-oximeter reported his COHb level at 21%. 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. You receive notification that EMS is bringing in a 14-year-old hockey goalie after a syncopal event. Although the mainstay of treatment is 100% oxygen, the current evidence and controversies in the use of hyperbaric oxygen therapy in pediatric patients is reviewed, along with its possible benefit in preventing delayed neurologic sequelae. This review discusses the limitations of routine pulse oximetry and carboxyhemoglobin measurement in determining carbon monoxide exposure, and notes effects of co-ingestions and comorbidities. While headache, nausea, and vomiting are the most common presenting symptoms in children, the most common symptom in infants is consciousness disturbance. Mild carbon monoxide poisoning may present as viral symptoms in the absence of fever. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to vocalize symptoms or recognize a dangerous exposure, and newborn infants are more vulnerable to carbon monoxide poisoning because of the persistence of fetal hemoglobin. A Multiplace Hyperbaric Oxygen ChamberĪpproximately 5000 children present to the emergency department annually with unintentional carbon monoxide poisoning. The Effect Of Carboxyhemoglobinemia On Oxygen Content And Deliveryįigure 2. Practical Considerations For The Pediatric Hyperbaric Patientįigure 1. Indications For Hyperbaric Oxygen Therapy After Carbon Monoxide Poisoning All Symptoms Reported By Patients With Acute Carbon Monoxide Poisoning Grouped By Organ System
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