Board Review: Dyspnea after a house fire

While working a shift in your Emergency Department, the local EMS crew brings in a patient who was caught in a house fire. The patient was found by firefights trapped in a room on the third floor. While able to avoid burn injuries, they are shortness of breath and complaining of nausea and a headache. As you are concerned about carbon monoxide poisoning, for which of the following patients would you consider a consultation to a hyperbaric center? (scroll down for the answer)

a) A 14 year old male with a carboxyhemoglobin level of 12%

b) A 27 year old male who remains persistently short of breath after 2 hours of 100% oxygen via a non-rebreather mask. 

c) A 56 year old male smoker with a carboxyhemoglobin of 23%

d) A 24 year old female with an initial lactate of 6.6

e) A 32 year old pregnant female with a carboxyhemoglobin of 16%
























The correct answer is e) a 32 year old pregnant female with a carboxyhemoglobin of 16%

  • While hyperbaric oxygen is not the standard of care for carbon monoxide poisoning, there are certain situations in which a consultation to your nearest hyperbaric center should be made:
    • Pregnant patients with a carboxyhemoglobin level > 15%
    • Carboxyhemoglobin level > 25%
    • Syncope
    • Evidence of acute myocardial ischemia
    • Persistent altered mental status
    • Seizure
    • Coma
    • Focal neurologic deficit
  • The half-life of carboxyhemoglobin is 80-85 minutes while on 100% oxygen. Patient should remain on oxygen and observed for a period of at least four hours and continued until they are asymptomatic and their carboxyhemoglobin level returns to normal (< 3%).
  • For more information, head over to emDocs for an overview of Carbon Monoxide Poisoning.