A 6-year-old boy and a 7-year-old girl were brought to the emergency department in cardiopulmonary arrest after having been removed from a house fire. The children regained normal cardiac function after car diopulmonary resuscitation, but they remained comatose and required mechanical ventilation. Initial laboratory data revealed severe carbon monoxide poisoning and metabolic acidosis.
The patients were treated with hyperbaric oxygen therapy for 45 minutes, and their carboxyhemoglobin levels returned to normal. Each patient remained comatose, with a Glasgow Coma Scale score of 4. Twelve hours after their arrival, cranial computed tomograms were obtained (Figure).
Denouement and Discussion
Carbon Monoxide Poisoning
Carbonmonoxide poisoning accounts for approximately one half of the fatal poisonings in the United States. The gas is odorless, colorless, and nonirritating, and is quickly absorbed into the pulmonary vascular bed. Carbon monoxide produces tissue hypoxia by the following mechanisms1: