SEVERE CARBON-MONOXIDE POISONING IN THE PEDIATRIC-PATIENT - A CASE-REPORT

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.