Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient
| Autor: | Derek M. Culnan, William C. Lineaweaver, Maggie J. Kuhlmann-Capek, Yiji Tu, Genevieve H. Bitz, Karel D. Capek, Beretta Craft-Coffman |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Emergency Medical Services
Smoke inhalation Cyanide Burn Units Article Carbon Monoxide Poisoning 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Pregnancy Fetal hemoglobin medicine Humans 030212 general & internal medicine Hyperbaric Oxygenation Cyanides business.industry 030208 emergency & critical care medicine Smoke Inhalation Injury Hydroxocobalamin medicine.disease Pregnancy Complications chemistry Anesthesia Toxicity Carboxyhemoglobin Cyanide poisoning Female Surgery Hemoglobin business medicine.drug |
| Zdroj: | Annals of Plastic Surgery. 80:S106-S112 |
| ISSN: | 0148-7043 |
| DOI: | 10.1097/sap.0000000000001351 |
| Popis: | Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy. |
| Databáze: | OpenAIRE |
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