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100% oxygen
26%
10/38
CT
3%
1/38
Hydroxocobalamin
63%
24/38
Ibuprofen and acetaminophen
5%
2/38
MRI
0%
0/38
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The patient presents with non-specific symptoms of headache, nausea, and dizziness which are only present while the patient is in his garage suggesting a diagnosis of carbon monoxide poisoning warranting immediate administration of 100% oxygen. Carbon monoxide (CO) poisoning can be difficult to diagnose because of its non-specific symptoms. Clinicians should have a high index of suspicion in situations where patients may have had exposure to carbon monoxide including significant smoke inhalation, improperly vented fuel-burning devices, poorly functioning heating systems, and motor vehicles in closed areas. Diagnosis can be supported by arterial gas labs evaluating carboxyhemoglobin since regular pulse oximetry will reveal a falsely normal O2 saturation. Specifically, the blood gas will show metabolic acidosis as a consequence of inadequate oxygen delivery to tissues. Management involves high-flow oxygen for most patients or hyperbaric oxygen for patients who are pregnant, critically ill/symptomatic/frail, or when the patient has a very high carboxyhemoglobin level. Incorrect Answers: Answer 2: CT scan would be indicated if the patient had stroke-like symptoms or symptoms of intracranial bleeding including thunderclap headache or unilateral weakness/changes in sensation. Answer 3: Hydroxocobalamin is the antidote for cyanide poisoning which presents with a lactic acidosis, headache, confusion, nausea, and vomiting and can occur with exposure to fires (thus making it a common intoxication with carbon monoxide poisoning). This patient's most likely exposure is to carbon monoxide; however, after oxygen administration, further laboratory values will be collected to support or refute this diagnosis. Answer 4: Ibuprofen and acetaminophen can be used to treat this patient's headache if the diagnosis was a tension or migraine headache which typically presents with a unilateral or diffuse headache that can be associated with an aura. Answer 5: MRI might be indicated for a neurologic condition such as multiple sclerosis which would present with weakness, numbness, tingling, optic neuritis, or urinary incontinence. Bullet Summary: The best initial step in management in carbon monoxide poisoning is oxygen administration.
4.5
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