Details

Autor(en) / Beteiligte

• Sloan, Edward P
• Murphy, Daniel G
• Hart, Raymond
• Cooper, Mary Ann
• Turnbull, Timothy
• Barreca, Ronald S
• Ellerson, Barry

Titel

Complications and protocol considerations in carbon monoxide-poisoned patients who require hyperbaric oxygen therapy: Report from a ten-year experience

Ist Teil von

• Annals of emergency medicine, 1989-06, Vol.18 (6), p.629-634

Ort / Verlag

New York, NY: Mosby, Inc

Erscheinungsjahr

1989

Quelle

Elsevier Journal Backfiles on ScienceDirect (DFG Nationallizenzen)

Beschreibungen/Notizen

• We conducted a study to determine the type, incidence, and timing of complications that occur in patients who have a carbon monoxide (CO) exposure serious enough to require hyperbaric oxygen therapy (HBOT). Complication data were retrospectively collected from a ten-year period for 297 consecutive CO-poisoned emergency department patients who received HBOT HBOT was indicated for 41% of the patients because of an elevated carboxyhemoglobin (COHb) level alone. Central nervous system dysfunction, including loss of consciousness, and/or cardiovascular dysfunction, was the criteria for HBOT in 59% of patients, regardless of their COHb level. The mean peak COHb level was 38 mg%, with 88% of patients having a peak COHb level greater than 25 mg%. The mortality rate was 6% in this case series. Cardiac arrest occurred in 8% of patients; all experienced their first arrest prior to HBOT The 3% of patients who sustained an isolated respiratory arrest and those who had a myocardial infarction did so prior to HBOT Several complications, however, occurred for the first time or as a recurrent event during HBOT These included emesis (6%), seizures (5%), agitation requiring restraints or sedation (2%), cardiac dysrhythmias or arrests (2%), and arterial hypotension (2%). No patient's level of consciousness deteriorated subsequent to the initial resuscitation except for those who later had a generalized seizure. The most significant complication attributable to HBOT was tension pneumothorax, noted in three patients (1%). Epistaxis or tympanic membrane rupture occurred in 1%. In 3%, HBOT was terminated prematurely, in half the cases because of complications that required management outside of the chamber, and in half because of persistent otalgia after complete clinical recovery. We conclude that the transfer of CO-poisoned patients to an HBOT facility need not be deferred for fear of impending cardiac arrest, respiratory arrest, myocardial infarction, or worsening mental status if these complications have not occurred prior to or during the initial emergency department resuscitation. In contrast, dysrhythmias, hypotension, seizures, agitation, and emesis must be anticipated both during the initial resuscitation and later during transfer and HBOT.