Page 130 - Critical Care Notes

4223_Tab03_107-130 29/08/14 8:28 AM Page 124

RESP
Later signs:
■ Chest pain, palpitations
■ Dysrhythmias
■ MI
■ Pulmonary edema
■ Throbbing headache, weakness, fatigue, dizziness, memory loss, ataxia,
gait disturbances, confusion, inability to concentrate
■ Skin pale to reddish purple (not a reliable sign; “When you’re red, you’re
dead.”)
■ Blurred vision, retinal hemorrhages
■ Tachypnea, dyspnea, respiratory alkalosis
■ Nausea, vomiting, lactic acidosis, rhabdomyolysis
■ Fecal and urinary incontinence
■ Upper airway obstruction: hoarseness, dry cough, DOE or labored breathing,
stridor, difficulty swallowing
■ Brassy cough with carbonaceous (soot or carbon) sputum
■ Wheezing, bronchospasm
■ Hallucinations, seizures, syncope, coma when COHgb ≥40%
■ Death possible if COHgb ≥60%
Diagnostic Tests
Diagnostic testing is done not only to confirm the diagnosis of CO toxicity but
also to determine complications.
■ COHgb and myoglobin concentration, methemoglobin
■ ABG (pulse oximetry SpO 2 inaccurate)
■ CO oximetry of an ABG sample or bedside pulse CO oximetry
■ ECG, CXR
■ CT to rule out cerebral edema and focal lesions
■ Troponin, CK, CK-MB, myoglobin
■ CBC and serum chemistry tests including electrolytes, glucose, BUN,
creatinine, and liver function tests
■ Urinalysis
■ Toxicology screen, ethanol level, and cyanide levels possibly ordered
· ·
■ Fiberoptic bronchoscopy and V/Q scan
Management
■ Assess respiratory and neurological status.
■ Monitor COHgb levels until <10%.
■ Administer 100% O 2 via rebreather mask or ETT (mechanical ventilation) to
increase PaO 2 levels and decrease PaCO 2 levels. Pulse oximetry not valid.
■ Assess LOC using Glasgow Coma Scale.
■ Monitor pH level if lactic acidosis present.
■ Monitor cardiac status. Myocardial injury is a common consequence of
moderate to severe CO poisoning → higher risk of death. Monitor for
arrhythmias.
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