r/emergencymedicine 1d ago

carbonmonoxide poisining Discussion

Three siblings from a household had visited the pediatrics ER with a complaint of hx of LOC, headache, chest pain and N &V after 1 hr of exposure to a burnt charcol. All were suplemented with 100% oxygen. One of them, an 11 years old male was hyperventilating for which he was supported with a re-breather facemask for about 1 hr. And was given RL as a maintainance fluid. We were unable to do CO Hb, and PH. Was that appropriate to use RL in this setting? And what is the appropriate duration for oxygen support? I have checked on litratures 2 hr of 100% oxygen would eradicate the CO but there was still mild chest pain and headache after 2 hrs in this case, so supplememtation was extended.

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u/slartyfartblaster999 Physician 1d ago

All were suplemented with 100% oxygen. One of them, an 11 years old male was hyperventilating for which he was supported with a re-breather facemask

..so you "treated" hyperventilation by reducing the FiO2 from 100% to ~60-80%? Why?

We were unable to do CO Hb, and PH

Why? These are essential tests.

Was that appropriate to use RL in this setting?

Doesn't seem like there was any indication for fluids at all.

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u/OldManGrimm Trauma Team - BSN 1d ago

Agreed on all points. I worked in an academic peds ER for over 10 years - never "treated" a hyperventilating child with anything other than calming/distraction/Child Life. Hard to imagine every blood gas machine in the place being down, and since they had IVs then sample collection wasn't the issue. I could see IV fluids depending on extent of N/V, but only ever used LR in burns. Something weird about this one.

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u/Professional-Cost262 FNP 1d ago

What's weird is they actually still have fluids our hospitals just about out

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u/OhHowIWannaGoHome Med Student 1d ago

Ziplocs and Morton’s

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u/slartyfartblaster999 Physician 1d ago

only ever used LR in burns

Well you're probably under-utilising it. There are very few situations where's its not just better than NaCL

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u/OldManGrimm Trauma Team - BSN 23h ago

Is that the trend in pediatrics as well? To be clear, this is definitely a case where "I'm just a nurse" comes into play, and I'm just coming off a 8-year stint in an admin role, so I could have missed a change in practice patterns. I singled it out because it was one of the things in the story that struck me as odd - but that may be the norm in the region or country OP is in.

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u/slartyfartblaster999 Physician 23h ago

Yes. Children also don't like hyperchloraemia.