CPAP and CO Poisoning

[CPAPMedicCO]

At about 0900 this morning I received a call from one of our area clinics here in Crested Butte, Colorado advising me that we had a case of CO Poisoning. BTW I am Critical Care Paramedic that volunteers for our Fire Protection District here as well as a clinical person for Emergent Respiratory Products. The patient was a 48yo male snow plow driver who apparently backed his plow into a snow bank and bent the exhaust system. The exhaust was then blowing into the cab of the plow. The patient advises he became real SOB, nauseous, and weak, “like I was going to pass out.” A co-worker took him to the Clinic for treatment. He initially presented with cherry red skin, unsteady gait, muscle tetany, weakness, headache, and N/V. Initially they got a SPO2 reading of 82% on room air. They placed him on a NRB mask at 15LPM and called me. They have purchased an Emergent CPAPos Porto2Vent and had it set up. I arrived to help initiate CPAP treatment while the patient was on the NRB mask with saturations about 92% on 100% oxygen at 15 LPM. Placing the soft seal mask on the patient and advising him to take a really deep breath and exhale hard, I titrated the unit up to 10cm H2O and the patient was breathing on the system. The initial D-Cylinder lasted 25 minutes and we quickly switched tanks. Monitoring vitals, the patient remained normo-tensive throughout the treatment and his saturations continually climbed to 97-99%. The second D-Cylinder again lasted 25 minutes. The patient was able to communicate with the staff, advising that his headache, muscle tetany, weakness, and N/V had subsided. The patient wanted to discontinue treatment. CPAP was discontinued by the physician at the clinic. After being off the CPAP unit for about 10 minutes, his vitals remained normal, SPO2 remained 99-100% at an elevation of 9375ft above sea level, and the patient had no complaints. His skin color returned to normal, his saturations remained 99-100%, and subsequently the patient was discharged three hours after presenting to the clinic. The only unfortunate thing about this case, if you want to call it unfortunate, is that our RAD57 CO Monitors have not arrived yet and I was unable to get a CO reading on the patient. I do know that blood was drawn before and after the CPAP treatment and sent into town to the lab. We are approximately 288 ground miles from Denver where the closest HBO chamber is. Due to weather conditions, about another 1-2 feet of snow expected today, we were unable to get a flight for life team here. This patient, if transported, would have had to gone by ground ambulance to Gunnison Valley Hospital by Crested Butte Fire Protection District EMS and then by ground to Denver by Gunnison Valley Hospital EMS. (All of which currently have the Emergent CPAPos Porto2Vent System) I know that there is a lot of discussion about the use of CPAP for CO Poisoning but no real hard data supporting it. I thought I would share one of my personal clinical experiences.

[DwayneEMTP]

CPAPMedicCO, welcome to the City!

That is a great scenario, and interesting question. Thanks for posting.

Though to let you know, as I can see you're new, it's considered bad form to post the same content in two different forums (Though I can see the logic behind both choices). Also, if you'll break your long posts up into paragraphs (proper or not) it makes it much easier to read and more folks will take the time to do so, increasing your responses.

Both pieces of advice meant in the Christmas spirit to a new poster! Not trying to disrespect your post, I'm glad you took the time to share it!

I look forward to your posts in the future!

Dwayne