![]() ![]() Initial pulse oximetry was especially low in the 50% range and he had been treated by paramedics with high-flow oxygen via nonrebreather mask. of Narcan prior to arrival without improvement. However, providers suspected drug overdose due to his history of suboxone and hydrocodone use in the past and he received 8 mg. The individual was a smoker without history of medical problems. Case DescriptionĪ Caucasian male in their early to mid 30’s presented to an emergency department (ED) by ambulance with mental status changes. ![]() In this report, we present a severe case of CO poisoning that demonstrates how brain imaging may provide an essential clue during provider diagnosis and prognosis of exposures. 5Įxposures most frequently occur in winter months due to smoke inhalation from fires, motor vehicle exhaust, or the burning of fuel (e.g., oil, wood, coal, gasoline, natural gas) in poorly functioning or improperly ventilated devices (e.g., heating systems, stoves, charcoal grills, portable generators, electrical heaters, etc.). 4 The variability and nonspecific symptomatology is largely due to the colorless, odorless features of CO gas combined with the nature, severity, and duration of exposure. 4 In addition, misdiagnosis can occur due to variable clinical presentations and nonspecific signs and symptoms. However, the estimated reporting of CO-related morbidity and deaths is likely underreported since the United States does not have a comprehensive national system of CO surveillance. 2 In addition, CO poisoning in responsible for approximately 50,000 annual emergency room visits. 1 Although the United States Center for Disease Control and Prevention (CDC) states that there are approximately 500 accidental non-fire related CO poisoning deaths every year, other estimates put this number as high as 1,000-2,000 annual cases. Our observations can be used for further study of the relationship between bilateral GP necrosis and initial presentation and outcome of patients experiencing CO poisoning leading to earlier recognition, treatment, and decreased morbidity/mortality.Ĭarbon monoxide (CO) is the most common cause of death from accidental poisoning in the world. This report investigates the use of bilateral GP lesions, the most frequently affected structure, as well as damage preference to highly metabolic tissues to assist in diagnosis and prognosis for CO poisoning. ![]() In this setting of his delayed presentation as a smoker with carbon monoxide poisoning, carboxyhemoglobin levels alone become less reliable. Subsequent neurology and cardiology workup demonstrated bilateral globus pallidus (GP) lesions on brain imaging, increased non-myocardial infarction troponin levels, carboxyhemoglobin (COHb) level of 3.8%, elevated liver enzymes, and acute kidney failure. The patient had been working on his motor vehicles in the garage during this time, using a portable diesel powered space heater to keep warm. We report a case of a man in his early to mid-30’s presenting to the emergency department with mental status changes, fatigue, headache, and flu-like symptoms for three days. Signs and symptoms are clinically variable secondary to inconsistent targeting of highly metabolic tissues by the gas. Carbon Monoxide (CO) is one of the leading causes of poison deaths in the United States. ![]()
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