Alaska medicine
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Case Reports
The use of exhaled carbon monoxide for the diagnosis of carbon monoxide poisoning. A case report.
Carbon monoxide (CO) poisoning is difficult to confirm in small rural hospitals that lack easy access to a cooximeter. A small hand held device can be used to assess exhaled CO (ECO) in parts per million. This device is often used in smoking cessation clinics to confirm that a person has abstained from smoking. ⋯ The patient's exhaled CO level dropped slower than expected while breathing oxygen delivered by a non-rebreather mask. This could be due to inadequate compliance to oxygen therapy and a fiO2 somewhat less than 1.0. Another limitation of the technique is the calibration gas (50-ppm CO). This concentration may be too low to assess ER patients. Therefore a confirmatory ABG with cooximetry should be obtained if available. Clinicians are cautioned that there is no safe level of HbCO (6). There is a simple formula to convert ECO to HbCO. The use of exhaled CO monitoring may be a promising alternative that is relatively less expensive than cooximetry in the ER setting, but more research is clearly indicated.