[abstract] Hyperbaric oxygen and hypothermic therapy in the severe acute CO patient

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[abstract] Hyperbaric oxygen and hypothermic therapy in the severe acute CO patient

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Title: [abstract] Hyperbaric oxygen and hypothermic therapy in the severe acute CO patient
Author: Chin, WG; Feldman, JF; Sprau, SE; Markovitz, GM
Abstract: Introduction/Background: Carbon monoxide (CO) is one of the leading causes of accidental injury and death by poisoning. Reduction of cerebral blood flow and ischemic reperfusion injury in the CO patient has been linked to permanent brain damage and delayed cognitive sequelae. Hyperbaric oxygen therapy (HBO2T) is an approved indication to treat acute CO. Therapeutic hypothermia (TH) has been used in the treatment of hypoxic brain injury, but is not typically used for acute CO. We present a case where HBO2T and TH were combined with possible synergistic effects. Materials and methods: 18-year-old female was found unresponsive after an eight-hour exposure to CO. Glasgow Coma Scale of 6 with unstable vital signs: blood pressure of 87/49 mmHg, pulse 126 beats/minute, O2 saturation 87% on room air, and blood glucose 41mg. The patient was intubated and placed on 100% O2 at a local emergency department. Initial arterial blood gas: pH7.22, pO2 50mm Hg, pCO2 23mm Hg, carboxyhemoglobin 45.1%, and HCO3 18mmol/L, and troponin 2.45ng/L. She was transferred to UCLA for HBO2T She had no pertinent medical history and was a full-time university student. Results: Using the Weaver protocol, she received three HBO2Ts within 24 hours. During the first treatment the patient was kept cool, with ice bags over the groin and under the head. After the first HBO2T a TH protocol was initiated, with a goal temperature of 33° C utilizing Cool GuardTM for 24 hours. Summary/Conclusion: For the first four weeks the patient showed severe bilateral brain injury with hypothalamic storming but then developed progressive neurological improvement. On hospital day 54, she was sent home with normal naming, repetition, three-step command, and three-object recall at seven minutes, with normal motor strength and gait. She plans to return to school next quarter.
Description: Undersea and Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/9928
Date: 2011

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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