Acute carbon monoxide toxicity
Craig Laing MSN, RN, ANP-BC, CEN

$7.95 		Nursing2013 Critical Care
January 2013 
Volume 8  Number 1
Pages 30 - 34
 
  PDF Version Available!

ABSTRACT
Mr. C, a 29-year-old office manager, lives alone in a 90-year-old house that he's renovating in the evenings. One chilly fall morning, he fails to report to work and doesn't answer repeated phone calls to his home. A coworker goes to Mr. C's house and discovers him in bed, confused, lethargic, and covered in vomit.The coworker drives Mr. C to the ED four blocks away. Upon arrival, Mr. C has a Glasgow Coma Scale score of 10. He opens his eyes only to painful stimuli, is unable to obey simple commands but localizes to painful stimuli and attempts to remove the source, and is able to speak but only in words and phrases that don't make sense. His cough and gag reflexes are intact. The nurse administers 100% supplemental oxygen by non-rebreather face mask. The coworker informs the nurse that Mr. C was out the night before celebrating a friend's birthday and was last seen at about 2 a.m. acting normally. Mr. C is placed on a cardiac monitor, peripheral venous access is obtained and blood specimens are sent to the lab, and a stat 12-lead ECG is obtained. The ED nurse educates the coworker about the importance of calling 911 instead of transporting Mr. C to the hospital himself.The ECG shows sinus tachycardia with a heart rate of 117 and no ectopy or ST-T wave changes. Mr. C's BP is 98/61 and his SpO2 on supplemental oxygen by pulse oximetry is within normal limits. He's afebrile with a respiratory rate of 24. His complete blood cell (CBC) count and basic metabolic panel are normal, and he has a negative blood ethanol and toxicology screen. A computed tomography scan of the head doesn't reveal any acute abnormalities.After 2 hours in the ED, Mr. C is awake and alert, with no recollection of why he was brought to the hospital. He states that he remembers going out last evening and coming home, taking a shower, and going to bed. The next thing he remembers is waking up in the ED. Mr. C is discharged home with a diagnosis of altered mental status. Follow-up appointments with his

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