Case studies on carbon monoxide intoxication

1. By
Kerolus Ekram Gad Shehata
• PGY-III IM Resident, Ain Shams University
• ECFMG certified
Case studies on Carbon Monoxide
Intoxication

2. A husband and his wife presented via the EMS C/O vomiting 2
times, abdominal pain and headache after eating a fish meal at
home. Abdominal PE was WNL. Chest was clear without fever. Both
are A/O TPP
B.P: 120/75, Pulse: 75, RR: 19
ABG: PH: 7.32, PCO2: 36, HCO3: 18, PO2: 91, SaO2: 95
 What is your differential?
 What is the first thing to do?
 What medication would you give?
 What if the husband had a HX of IHD?
 What if the husband was dizzy and confused?
 What if the B.P of the husband was 140/90?
 What if the B.P of the wife was 80/50?
 What if the PH: 7.29, HCO3: 16, Pco2: 34?
 Will you recommend HBO afterwards?
 Will you recommend follow up?

3. M and F were found in a coma at home while husband’s older
brother was bathing (later found dead at the scene). The father
have vomited twice before passing out. GCS: 7, chest: Bilateral
crepitations, pulse is faint, Pupils: mid-dilated and non-reactive
B.P: 80/50, Pulse: 74, RR: 14
ABG: PH: 7.19, PCO2: 54, HCO3: 14, SaO2: 92, PO2: 89
 What is the first thing to do for both of them?
 What is the main reason for ICU admission?
 How would you correct this metabolic acidosis?
 What if you find depressed T- wave on the ECG?
 Will you administer nitroglycerine?
 What is the complication that may have already occurred in the lungs?
 What if you find the PO2/Fio2 < 200/300?
 What if the GCS didn’t improve for 6 days in the ICU? You suspect………
 If both are improved, will you recommend HBO?

4. Questions & Comments