Smoke without fire

30 Oct

It’s 2am, you’re just catching up on the waiting room an things are beginning to settle when one of the many bat phones in the department rings to alert you to the imminent arrival of a 75 year old man from a house fire. No details but he’s  sick as.


What runs through your head at this point


Whats the deal with CO poisoning


Want to know more on Carbon Monoxide (CO) Toxicity


How does CO make you sick


So how do I tell if someone as CO poisoning


Do I need an arterial sample


How do I treat it




Case Outcome




13 Replies to “Smoke without fire

  1. Hey Andy,

    Great summary, particularly in the day that’s in it. Hopefully Pun won’t need to quickly read this tonight!

    Just wondering, did this man get transferred to our friendly burns centre?

  2. Nice case Andy! Just about the sats….surely the sats (if the oxyHb and carboxyHb are indistinguishable on the oximeter) should be normal, unless there was hypoxia from something else like a low Fi02 , bronchospasm. or airway obstruction.

    Cheers Vinnie

    • The blood gas machine measures the different hb using co oximetry. It can tell the difference between COHb and oxyHb.

      The sats probe can only tell the difference between oxyHb and deoxyHb.

      So effectively this pt had carboxyhb of 47% and oxyHb of 53%. The sats probe was reading sats in the 80s.

  3. I’d add that you shuold probably give sodium thiosulfate if cyanide poisoning is suspected with hydroxocobalamin. The thiosulfate takes cyanide and makes thiocyanide which is excreted in the urine and plays no role in worsening a patient’s likely concurrent metHb like amyl or sodium nitrite.

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