Db. Brown et al., SEVERE CARBON-MONOXIDE POISONING IN THE PEDIATRIC-PATIENT - A CASE-REPORT, Aviation, space, and environmental medicine, 67(3), 1996, pp. 262-265
A 10-yr-old female presented at Deaconess Medical Center, Spokane WA,
comatose after being rescued from a house fire. Her carboxyhemoglobin
was 48%. An 11-yr-old playmate presented with a carboxyhemoglobin leve
l of 51% and later expired. Our patient was treated with hyperbaric ox
ygen therapy and manual artificial ventilation for 2.5 h. She recovere
d fully, and 7 mo later has had no neurologic deficits. Carbon monoxid
e bonds to the hemoglobin more tightly than oxygen, displacing the oxy
gen hemoglobin dissociation curve to the left and resulting in tissue
hypoxia and hypotension. Carbon monoxide also exerts a negative influe
nce on the electron transport chain, may lead to delayed neurologic se
quelae because of free radical formation, and produces profound change
s in the myocardium. Once seen as a capricious treatment for many symp
toms, hyperbaric oxygen therapy is now an accepted treatment for carbo
n monoxide poisoning. The outcome suggests that in a patient whose pro
gnosis is grave, a good outcome may be achieved with aggressive HBO th
erapy.