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Tue Oct 24 13:36:46 BST 2006

I absolutely love the way the author of the article crafted the last
sentence. Quite an understatement if not tongue in cheek. 

Feelings about HBO for other than acute decompression sickness or acute CO
poisoning are so intense as to "good vs. evil" religious fervor.

The problem with CO poisoning is not that it is measurable in the blood
because it is binding to Hgb better than O2, because as you point out, that
is rapidly reversible with high concentration O2. The problem and the reason
to use HBO therapy is that CO is also binding to other cytochrome systems,
like in the brain and on the myocardial cells a couple of orders of
magnitude more avidly thus depriving those cells of the ability to use O2.

R. Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Gustavo E. Flores
Sent: Tuesday, October 24, 2006 7:29 AM
To: 'Trauma &amp; Critical Care mailing list'
Cc: CCM-L List
Subject: RE: Carboxyhemoglobin Levels

Certainly HBO is available for COHb patients but not all of them require it.
T½ of CO is 4-6 hours at 21% O2, and 40-60 mins at 100%. 

COHb between 3-12% could be due to a lot of things.
12-25% - look for symptoms, but still give 100% O2.
25-30% - consider HBO even with mild symptoms.

"Although 92% would use HBO for a patient presenting with headache, nausea,
and COHb 40%, only 62% of facilities utilize a specified minimum COHb level
as the sole criterion for HBO therapy of an asymptomatic patient. When COHb
is used as an independent criterion to determine HBO treatment, the level
utilized varies widely between institutions. Half of responding facilities
place limits on the delay to treatment for patients with only transient LOC.
Time limits are applied less often in cases with persistent neurologic
deficits. While variability exists, majority opinions can be derived for
many patient selection criteria regarding the use of HBO in acute CO
poisoning."
--J Emerg Med. 1995 Mar-Apr;13(2):227-31.

I am forwarding this to CCM-L too. 

Gustavo E. Flores Bauer, MSIII EMT-P :.
EmergencyTeam.Net
San Juan, Puerto Rico
Iberoamerican University School of Medicine Santo Domingo, Dominican
Republic

Cel: 829-770-0707
Fax: 809-686-6988
MSN Messenger: gustavoflores911
Skype: gflores911
E-Mail: gustavo at emergencyteam.net
Web: www.emergencyteam.net

The Serenity Prayer:

"God, grant me the serenity to accept the things I cannot change, courage to
change the ones I can, and wisdom to know the difference."

S:.F:.U:.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Anthony Caruso
Sent: Monday, October 23, 2006 5:42 PM
To: trauma-list at trauma.org
Subject: FW: Carboxyhemoglobin Levels

To all on this group.  Some advice is needed regarding carboxyhemoglobin
levels on certain patients.  What levels are permissible to treat only with
1.0 Fio2?  What levels are treated with a hyperbaric therapy?  Let's start
from neonates all the way up to the elderly.  If anyone has some advice or a
website that might point me in the right direction.  That would be helpful
as well.  I'm trying to find hard numbers, but I cant seem to Google it for
the life of me.  
  Thanks'
  Anthony M. Caruso
  NREMT-P

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