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A forty-seven year old male is transported to the Emergency Department by EMS. He is barely responsive. His respiratory frequency is 42 breaths/minute; skin color is “red/flushed”; BP is 142/94; and his pulse is 128. EMS states that the patient was found in his garage workshop in this condition shortly before EMS was called.
No oxygen therapy was initiated due to the lack of signs of hypoxemia. ECG monitoring shows sinus tachycardia at a rate of 128. Screening labs, including an arterial blood gas, are drawn. The ABG comes back: pH = 7.28; paC02 = 28 mmHg; pa02 = 132 mmHg; and the calculated oxyhemoglobin saturation = 99%.
Upon arrival of a family member, it is learned that the patient had been performing repairs to the “heating system” in his workshop all morning. One of the staff suggests the possibility of carbon monoxide poisoning, which is quickly dismissed because of the blood gas result. Another staff member points out that the ABG reported the oxyhemoglobin saturation as “calculated.” Another ABG is drawn and the lab is asked to run the sample though a co-oximeter, directly measuring Sa02 and reduced hemoglobin.
The results come back: Hb02 = 37%, HbCO = 62%, metHb = 1%.
The patient is immediately started on 100% oxygen via facemask and discussion regarding hyperbaric oxygen therapy begins.
1. There is no difference between measured Sa02 and calculated Sa02 reported via blood gas analysis.
a. true
b. false
2. Which of the following are commonly associated with severe HbCO poisoning?
a. headache, vomiting and CNS depression
b. metabolic acidosis
c. cherry red skin color
d. tachycardia
e. all of the above
3. The initial treatment for severe HbCO poisoning is 100% oxygen and evaluation for emergency hyperbaric oxygen therapy.
a. true
b. false
