VBG (ABGs are no longer considered necessary as venous and arterial COHg levels will be within ±2%)
CO-oximetry analysis will provide<unk> yhemoglobin level
pH will be low secondary to metabolic acidosis caused by anaerobic metabolism and elevated lactate levels
Pulse CO-oximetry
Special pulse CO-ox can accurately determine CO level
Lactate
Chemistry
Troponin
Total CK (rhabdomyolysis)
Beta-HCG
ECG
May range from normal to STEMI (most common ST/T changes, then prolonged QT)
Few of the patients with AMI from CO have occlusive lesions in their arteries
Head CT
Identified radiographically within 12 hours of exposure
Bilateral hypodense lesions in the basal ganglia: globus pallidus, putamen, and caudate nuclei
CO-oximetry analysis will provide<unk> yhemoglobin level
pH will be low secondary to metabolic acidosis caused by anaerobic metabolism and elevated lactate levels
Special pulse CO-ox can accurately determine CO level
May range from normal to STEMI (most common ST/T changes, then prolonged QT)
Few of the patients with AMI from CO have occlusive lesions in their arteries
Few of the patients with AMI from CO have occlusive lesions in their arteries
Identified radiographically within 12 hours of exposure
Bilateral hypodense lesions in the basal ganglia: globus pallidus, putamen, and caudate nuclei
Must have high clinical suspicion (esp in coma, altered mental status, or anion gap acidosis)
Comatose patients removed from fire should be assumed to have CO poisoning<unk> yhemoglobin Level
Interpretation must take into account time since exposure and O2 treatment
Normal value in non-smokers is ~1%, normal value in smokers may be up to 10%
Symptoms and COhemoglobin levels do not always correlate well
Pulse oximetry is unreliable
COhemoglobin registers the same as O2hemoglobin so will have artificially high SpO2
O2 saturation gap reflects discordance of SpO2 by pulse oximeter vs by VBG
Comatose patients removed from fire should be assumed to have CO poisoning
Interpretation must take into account time since exposure and O2 treatment
Normal value in non-smokers is ~1%, normal value in smokers may be up to 10%
Symptoms and COhemoglobin levels do not always correlate well
COhemoglobin registers the same as O2hemoglobin so will have artificially high SpO2
O2 saturation gap reflects discordance of SpO2 by pulse oximeter vs by VBG
Carbon monoxide toxicity
A "great mimicker" due to the presentation of poisoning being diverse and nonspecific
Oxygen toxicity
Viral syndrome
Chlorate toxicity
Depression
Smoke inhalation injury
Chronic fatigue syndrome