The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

CARBON MONOXIDE POISONING DETECTED AND MONITORED CONTINUOUSLY AND NONINVASIVELY: A CASE REPORT.

Troilus Plante MD, Darcy Harris DO, James Monti MD, Robert Tubbs MD, Gregory D. Jay MD PhD; Rhode Island Hospital & Brown Medical School, Department of Emergency Medicine


Introduction: Carbon monoxide (CO) poisoning is the most common toxidrome encountered in emergency departments (ED's).Detection and diagnosis of CO poisoning is currently based upon clinical suspicion and confirmed by blood sampling for carboxyhemoglobin (COHb) analyzed by CO-oximetry. This may lead to under detection and delayed treatment initiation, potentially resulting in long-term neurologic complications. We report the first case of CO poisoning detected and monitored with the use of a continuous, noninvasive, multiple wavelength pulse CO-oximeter, the Masimo Rad-57. This device is the first commercially available noninvasive unit to measure SpO2, pulse rate and noninvasive carboxyhemoglobin (SpCO) concentration. This case illustrates several firsts including 1) detection and management CO poisoning with continuous SpCO monitoring, 2) correlation with blood draw CO-oximetry, and 3) zero order elimination of CO suggesting that physiologic compartments in CO poisoning are being purged more slowly, using non-hyperbaric oxygen therapy.

Case Summary:
Victim of a house fire was treated in the ED for smoke inhalation. The Rad-57 pulse CO-oximeter was attached to the patient's digit and blood was drawn for CO-oximetry assessment. The patient was endotracheally intubated and placed on 100% oxygen. The CO poisoning was confirmed as the SpCO was 39% and the COHb was 35%. After 150 minutes of 100% oxygen therapy the SpCO was 6% and the COHb was 5%. Figure 1 shows the time course of elimination of COHb breathing 100% oxygen.

Conclusions:
The case demonstrates the clinical utility of bedside pulse CO-oximetry in a patient suffering from CO poisoning. While larger patient populations need to be evaluated to determine the clinical accuracy of this new device, the ability to continuously and noninvasively monitor SpCO was demonstrated in this case.

Figure 1 - Time course of elimination of COHb in a patient breathing 100% oxygen via an endotracheal tube, measured noninvasively with a Masimo Rad-57 pulse CO-oximeter.

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