Carbon Monoxide Poisoning Research Articles

Carbon monoxide poisoning: assessment and actions for nurses working in service users' homes.

Carbon monoxide is a colourless, tasteless and odourless gas that is a by-product of incomplete combustion of hydrocarbons such as gas or coal. Carbon monoxide poisoning is associated with high levels of mortality and morbidity, although the symptoms of exposure are non-specific and difficult to diagnose. Historically, healthcare professionals who work directly in service users' homes have faced a higher risk of exposure to environments contaminated with carbon monoxide. Despite improved heating engineering and greater protective legislation, there still remains a tangible risk for community nurses and service users, particularly in homes still using open fires, old heating systems and poorly maintained heating appliances. This article provides a scientific summary of carbon monoxide poisoning for nurses working in the community setting. It outlines evidence-based guidance on prevention and initial treatment actions, along with safety instructions to follow in the event of exposure to carbon monoxide.

Carbon Monoxide Intoxication Leading to Crush Syndrome and Acute Renal Failure: A Case Report

Carbon Monoxide Intoxication Leading to Crush Syndrome and Acute Renal Failure: A Case Report

Post Mortem Molecular Biomarkers of Asphyxia: A Literature Review

Asphyxia is a critical condition characterized by inadequate oxygen supply to the body. Post mortem diagnostics of asphyxia present significant challenges in forensic pathology, particularly when there are equivocal signs during autopsy or uncertain circumstantial data. The identification of biochemical biomarkers that indicate asphyxia has emerged as a promising area of research, as these markers can provide vital insights into the physiological changes occurring at the cellular level during asphyxiation. We performed a review of the scientific literature on the search engines Pubmed and Scopus in order to assess the state of the art on this topic. The aim of this study is to analyze which are the most promising markers and methods in the post mortem diagnosis of asphyxia. The literature review highlighted the great potential that molecular investigations can have in the analysis of this type of death, especially considering that hypoxia determines strong biochemical alterations in response to cellular stress. These changes are marked by specific biochemical alterations, which can be detected through various advanced technologies and methodologies, including mass spectrometry, immunohistochemistry, and metabolomic profiling. The review evidenced a combination of markers that can be used for diagnostic purposes in various cases, including mechanical asphyxia, carbon monoxide (CO) poisoning, perinatal asphyxia, and drowning analysis. However, we highlight that, to date, there are still no standard protocols for forensic biochemistry in asphyxia. By scrutinizing the reliability of identified biomarkers and their potential to reshape forensic investigative practices, this research aims to elucidate the critical role that post mortem biochemical analysis can play in diagnosing asphyxia, ultimately contributing to a more nuanced understanding of death-related scenarios and the development of standardized protocols in forensic examinations.

Beyond Injuries: February 6th Kahramanmaras Earthquakes and Other Patients Transported by Ambulance.

This study evaluates the Emergency Medical Service system and overall emergency preparedness by analyzing ambulance-transported patients during the February 6, 2023 earthquakes, focusing on those without earthquake-related injuries (medical emergencies and traumas not caused by earthquakes). A retrospective, observational case series was conducted, involving patients aged 18 and above transported by ambulance between February 6 and March 6, 2023. Patient demographic characteristics, vital signs, diagnoses, treatments, and outcomes were recorded. Predisposing factors for ambulance transportation including post-earthquake health facility issues, housing problems, hygiene, heating, and smoke exposure were meticulously analyzed. The study included 1872 patients, with a 55.4% hospitalization rate and a 13.7% mortality rate. Cardiovascular emergencies were the primary reason for admission (28.9%). Patients from the hospital in the study's location form Group 1, whereas those from other earthquake-affected provinces constitute Group 2. Significant predisposing factors for ambulance transportation included post-earthquake health facilities (P < 0.001), housing problems (P < 0.001), hygiene (P < 0.001), heating (P = 0.001), and smoke exposure (P < 0.001). In Group 2, pneumonia (P = 0.001), soft tissue infection (P = 0.002), sepsis (P = 0.004), carbon monoxide poisoning (P < 0.001), and diabetic emergencies (P = 0.013) were statistically significantly more frequent. Analyzing post-earthquake ambulance-transported patients is vital to comprehend the demand for emergency health care and address post-disaster health care challenges.

Carbon monoxide poisoning is associated with an increased risk of epilepsy and status epilepticus: a nationwide population-based cohort study conducted in the Republic of Korea between 2002–2021

Introduction Carbon monoxide poisoning may result in various neurological injuries, including acute symptomatic seizures. We aimed to investigate the long-term risk of epilepsy and status epilepticus in patients with previous carbon monoxide poisoning. Methods The study population was derived from the National Health Insurance Service database of the Republic of Korea between 1 January 2002 and 31 December 2021. We included adults with at least one documented visit to medical facilities because of carbon monoxide poisoning (International Classification of Diseases, Tenth Revision, code T58). Patients were matched, on the same index date, with controls, without a T58 code, for age, sex, insurance type, income level, and residence location in a 1:1 ratio. Follow-up continued until death, migration, or the end of the observation period (31 December 2021). The primary outcome was the incidence of epilepsy (codes G40 or R56) and status epilepticus (code G41). Results This study included 53,380 patients with carbon monoxide poisoning and 53,380 controls, with 44.2% women and a mean age of 45.7 years. The mean (±SD) follow-up period was 5.7 ± 4.3 years in the carbon monoxide poisoned group and 6.4 ± 4.4 years in controls. The overall risk of epilepsy (adjusted hazard ratio 2.60; 95% CI: 2.43–2.78; P < 0.001) and status epilepticus (adjusted hazard ratio 4.10; 95% CI: 2.84–5.92; P < 0.001) was significantly increased in the carbon monoxide poisoned group compared to controls. The risk of epilepsy and status epilepticus was increased in patients with previous carbon monoxide poisoning, regardless of sex, age or a history of stroke, neurodegenerative diseases, or central nervous system tumour or infection. However, in the subgroup analysis according to age, the highest risk of epilepsy and status epilepticus was observed in patients less than 40 years of age. Discussion In this population-based cohort study, previous carbon monoxide poisoning was associated with an increased risk of epilepsy and status epilepticus. The risk was more noticeable in patients aged less than 40 years. Further studies are needed to confirm such an association in other populations. Conclusions Previous carbon monoxide poisoning was associated with an increased risk of epilepsy and status epilepticus, particularly in the younger population. The long-term management of survivors of carbon monoxide poisoning should include monitoring for epilepsy and status epilepticus.

Spectrum of delayed post-hypoxic leukoencephalopathy syndrome: A systematic review

BACKGROUND Delayed post hypoxic leukoencephalopathy syndrome (DPHLS), also known as Grinker’s myelinopathy, is a rare but significant neurological condition that manifests days to weeks after a hypoxic event. Characterized by delayed onset of neurological and cognitive deficits, DPHLS presents substantial diagnostic and therapeutic challenges. AIM To consolidate current knowledge on pathophysiology, clinical features, diagnostic approaches, and management strategies for DPHLS, providing a comprehensive overview and highlighting gaps for future research. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines, we systematically searched PubMed, ScienceDirect and Hinari databases using terms related to delayed post-hypoxic leukoencephalopathy. Inclusion criteria were original research articles, case reports, and case series involving human subjects with detailed clinical, neuroimaging, or pathological data on DPHLS. Data were extracted on study characteristics, participant demographics, clinical features, neuroimaging findings, pathological findings, treatment, and outcomes. The quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist. RESULTS A total of 73 cases were reviewed. Common comorbidities included schizoaffective disorder, bipolar disorder, hypertension, and substance use disorder. The primary causes of hypoxia were benzodiazepine overdose, opioid overdose, polysubstance overdose, and carbon monoxide (CO) poisoning. Symptoms frequently include decreased level of consciousness, psychomotor agitation, cognitive decline, parkinsonism, and encephalopathy. Neuroimaging commonly revealed diffuse T2 hyperintensities in cerebral white matter, sometimes involving the basal ganglia and the globus pallidus. Magnetic resonance spectroscopy often showed decreased N-acetylaspartate, elevated choline, choline-to-creatinine ratio, and normal or elevated lactate. Treatment is often supportive, including amantadine, an antioxidant cocktail, and steroids. Hyperbaric oxygen therapy may be beneficial in those with CO poisoning. Parkinsonism was often treated with levodopa. Most of the patients had substantial recovery over the course of months and many cases had some residual neurocognitive deficits. CONCLUSION DPHLS remains a complex and multifaceted condition with various etiologies and clinical manifestations. Early recognition and appropriate management are crucial to improving patient outcomes. Future research should focus on standardizing diagnostic criteria, using advanced imaging techniques, and exploring therapeutic interventions to improve understanding and treatment of DPHLS. Conducting prospective cohort studies and developing biomarkers for early diagnosis and monitoring will be essential to advance patient care.

Critical values for carbon monoxide in cases admitted to the emergency department in a local hospital

Abstract Carbon monoxide (CO) poisoning has been an important concern in winter particularly due to malfunctioning coal stoves, in many developing countries, including Turkey. Winter months, especially February, were the most dangerous periods for CO exposure. Carbon monoxide has no color or smell so has known as the silent killer. Brain, heart, and other organs are under risk in CO poisoning. Because patients usually present with non-specific symptoms, CO poisoning should be considered in the differential diagnosis of unexplained nausea and vomiting, neurological or cardiac signs and symptoms. Carboxyhemoglobin (COHb) is a reliable marker to monitor the patient. Lactate is also important as a measure of impaired systemic oxygen delivery. Fifteen patients with a diagnosis of CO poisoning were included in the study. This is the number of all cases admitted to the emergency in the last one and a half months in our local hospital located in a town with almost 48.918 residents. Blood gas analysis was performed by ABL90 FLEX, Radiometer. Reference for COHb was 0.6-1.5 % and for lactate was 0.5-1.6 mmol/L. Troponin I levels were also analyzed in some patients to assess possible myocardial ischemia. Troponin levels were analyzed by ARCHITECT i2000, Abbott and reference range was &amp;lt;16 ng/mL in woman, &amp;lt;34 ng/mL in men. Graph Pad Prism program was used for statistical analysis of the data. We had 15 cases aged between 4-56 years with COHb values with panic values (&amp;gt; 20%) except two of the cases with values 16.5% and 19%. The female-male ratio was 6/9. On admission to the Emergency Department, 46.6% of patients (n=7) had headache and vomiting, 40% of patients (n=6) had headache, 6.6% (n=1) fatigue and 6.6% of patients (n=1) had syncope. Median value of COHb % was 23.7(16.5-40.8), lactate was 1.9 (0.8-4.8), pH was 7.39 (7.30-7.47). Excluding three patients as outliers, lactate levels had a good correlation with carboxyhemoglobin values (R2=0.9413). It was notable that 1 patient had a higher-than-normal Troponin I level (24.9 ng/mL) who has highest lactate level (4.8 mmol/L). Four of the patients, from the same family was admitted for suspected food poisoning for the symptoms of nausea, vomiting, diarrhea. A diagnosis of CO poisoning was made after a COHb value between 16.5-25.7% for these patients. This was very critical for the accurate treatment given to those patients being hyperbaric oxygen treatment in CO poisoning cases. CO poisoning should be considered in patients admitting to the emergency department with complaints of headache, dizziness, weakness, nausea, and vomiting. Reporting panic values is a means of alerting the clinician for the right diagnosis.

Electronic interactions between neighboring functionalized guest Sb single atoms and Pt clusters enhance CO tolerance

Platinum-based (Pt) catalysts are notoriously susceptible to deactivation in industrial chemical processes due to carbon monoxide (CO) poisoning. Overcoming this poisoning deactivation of Pt-based catalysts while enhancing their catalytic activity, selectivity, and durability remains a major challenge. Herein, we propose a strategy to enhance the CO tolerance of Pt clusters (Ptn) by introducing neighboring functionalized guest single atoms (such as Fe, Co, Ni, Cu, Sb, and Bi). Among them, antimony (Sb) single atoms (SAs) exhibit significant performance enhancement, achieving 99% CO selectivity and 33.6% CO2 conversion at 450 °C. Experimental results and density functional theory (DFT) calculations indicate the optimization arises from the electronic interaction between neighboring functionalized Sb SAs and Pt clusters, leading to optimal 5d electron redistribution in Pt clusters compared to other functionalized guest single atoms. The redistribution of 5d electrons weaken both the σ donation and π backdonation interactions, resulting in a weakened bond strength with CO and enhancing catalyst activity and selectivity. The redistribution of 5d electrons weaken both the σ donation and π backdonation interactions, resulting in a weakened bond strength with CO. In situ environmental transmission electron microscopy (ETEM) further demonstrates the exception thermal stability of catalyst, even under H2 at 700 ℃. Notably, the functionalized Sb SAs also improve CO tolerance in various heterogenous catalysts, including Co/CeO2, Ni/CeO2, Pt/Al2O3, and Pt/CeO2-C. This finding provides an effective approach to overcome the primary challenge of CO poisoning in Pt-based catalysts, making their broader applications in various industrial catalysts.

Hyperbaric Oxygen Therapy: An Evidence-Based Primer for Emergency Physicians

BackgroundHyperbaric medicine is a subspecialty that many emergency physicians may not encounter frequently in their daily practice. As such, we hope to provide a review, where we present an overview of hyperbaric oxygen therapy, complications from the therapy, and a description of how the treatments are administered. We also discuss seven emergency indications that may benefit from transfer to a hyperbaric facility for treatment. Objective of the ReviewOur aim is to provide an overview of hyperbaric oxygen therapy as it pertains to an emergency physician. We hope that this review will help emergency physicians identify conditions that may benefit from transfer to a hyperbaric facility. DiscussionWe discuss seven emergency conditions that may benefit from transfer to a hyperbaric facility for management – decompression sickness, arterial gas embolism, central retinal artery occlusion, carbon monoxide poisoning, crush injury, necrotizing soft tissue infection, and symptomatic anemia. We also describe special considerations for how to transfer patients needing evaluation by a hyperbaric physician. ConclusionsThis review aims to describe hyperbaric oxygen therapy, identify conditions that may benefit from treatment with hyperbaric oxygen, and discuss management of patients with those conditions as it pertains to an emergency physician.

Mechanism of Butylphthalide in Treating Delayed Encephalopathy After Carbon Monoxide Poisoning Based on Activation of Microglia

Objective To explore the mechanism of butylphthalide (NBP) in regulating microglia activation and inflammatory cytokine expression in the hippocampus of the mouse model of delayed encephalopathy after carbon monoxide poisoning (DEACMP). Methods Wild-type C57 adult mice with normal cognitive function were selected,and DEACMP was modeled by static inhalation of carbon monoxide.The mice were randomized into three groups:DEACMP,control,and NBP.The NBP group was administrated with NBP suspension at 6 mg/kg by gavage for 21 days,and the DEACMP and control groups were administrated with the same amount of vegetable oil by gavage.The hippocampal injury was observed by HE staining.The protein level of ionized calcium-binding adapter molecule 1 (IBA1) was determined by Western blotting,and the levels of downstream inflammatory cytokines were measured by ELISA. Results Compared with the control group,the DEACMP and NBP groups showed prolonged escape latency (P=0.001,P=0.029),reduced nerve cells (P=0.001,P=0.035),up-regulated expression of IBA1 (P=0.001,P=0.042),increased mean fluorescence intensity of IBA1 (P=0.001,P=0.021),and elevated levels of tumor necrosis factor-α (TNF-α) (P=0.002,P=0.024),interleukin (IL)-6 (P=0.001,P=0.015),and IL-1β (P=0.001,P=0.023).Compared with the DEACMP group,the NBP group showed shortened escape latency (P=0.025),increased nerve cells (P=0.039),down-regulated expression of IBA1 (P=0.035),decreased average fluorescence intensity of IBA1 (P=0.031),and lowered levels of TNF-α (P=0.028),IL-6 (P=0.037),and IL-1β (P=0.034). Conclusion NBP can inhibit the activation of microglia and reduce the expression of inflammatory factors,thereby alleviating cognitive dysfunction and brain tissue damage caused by DEACMP.

Mortality Risks and Causes in Previous Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study

Objectives: Carbon monoxide (CO) poisoning can cause brain, heart, and kidney injuries. We aimed to determine the association of risks of all-cause and cause-specific mortality in patients with previous CO poisoning. Design, Setting, and Patients: This population-based cohort study used data from the National Health Insurance Service database and the National Death Registry of Korea. Adult patients diagnosed with CO poisoning and controls between 2002 and 2020 were included. Patients were matched with controls on a 1:1 ratio, considering age, sex, insurance type, income level, residential location, smoking status, alcohol consumption, obesity status, medical and psychiatric illness history, and Charlson Comorbidity Index at the index date. The cohort was monitored from 2002 to 2022 or until death or emigration in terms of all-cause and cause-specific mortality. Interventions: None. Measurements and Main Results: A total of 48,600 patients with CO poisoning and matched controls were included. The cohort included 41.30% females, and the mean age was 48.05 years. Patients with CO poisoning exhibited a substantially elevated risk of all-cause mortality compared with those in the control group, with an adjusted hazard ratio (aHR) of 15.67 (95% CI, 12.58–19.51). The mortality associated with infectious (aHR, 6.71; 95% CI, 1.51–29.72), neoplasm/oncologic (aHR, 5.20; 95% CI, 3.39–7.99), endocrine (aHR, 13.44; 95% CI, 1.76–102.70), neurologic (aHR, 7.42; 95% CI, 2.91–18.90), cardiovascular (aHR, 8.97; 95% CI, 5.05–15.93), respiratory (aHR, 17.54; 95% CI, 5.48–56.17), and gastrointestinal (aHR, 24.72; 95% CI, 3.34–182.69) disorders was significantly greater in the former. Deaths due to external causes, including suicide, were significantly higher in the CO poisoning group (aHR, 50.07; 95% CI, 30.98–80.90). Conclusions: Patients with CO poisoning exhibited a heightened risk of all-cause mortality compared with the matched controls. Additionally, the cause-specific mortality risk differed between the groups.

Mass Carbon Monoxide Poisoning on a Train in Italy, March 1944. History Reconstructed

World War II was approaching its end in Italy in 1944 when one of the worst train disasters in world history occurred near the small town of Balvano in the Apennine Mountains. The train did not derail or crash into something as in most major train disasters. Instead, it entered a mountainous railway tunnel, and when it emerged, over 500 passengers were dead from carbon monoxide poisoning. The event was not allowed to be publicized for almost two decades. This manuscript reconstructs the story of possibly the most significant incident of carbon monoxide mortality ever recorded.

Use of Digital Technologies for the Conduct of Work in the Government System Based on the Demans of the Current Times

This article deals with the issues of ensuring the safety of the population in the residences of citizens. It is planned to implement an electronic platform that allows for quick collection and analysis of information on the technical and social condition of residential areas. These strategies focus on digital transformation in the national economy, industry, and society. In Uzbekistan, significant steps have been taken to implement modern information and communication technologies (ICT) in public administration, education, healthcare, and agriculture. One notable challenge addressed in this study is the management of carbon monoxide poisoning, fire hazards, and explosions during the heating season. The research highlights the limitations of manual data collection, including the risk of data loss, difficulty in locating information, and inefficiencies in processing critical safety data. The program processes data in less than a minute, facilitating more efficient emergency management and preventive measures. This system exemplifies the role of digital technology in enhancing public safety and optimizing government operations.

Carbon Monoxide: A Pleiotropic Redox Regulator of Life and Death.

Despite recent technological progress, carbon monoxide poisoning is still one of the leading causes of domestic and industrial morbidity and mortality. The brain is particularly vulnerable to CO toxicity, and thus the majority of survivors develop delayed movement and cognitive complications. CO binds to haemoglobin in erythrocytes, preventing oxygen delivery to tissues, and additionally inhibits mitochondrial respiration. This renders the effect of CO to be closely related to hypoxia reperfusion injury. Oxygen deprivation, as well as CO poisoning and re-oxygenation, are shown to be able to activate the production of reactive oxygen species and to induce oxidative stress. Here, we review the role of reactive oxygen species production and oxidative stress in the mechanism of neuronal cell death induced by carbon monoxide and re-oxygenation. We discuss possible protective mechanisms used by brain cells with a specific focus on the inhibition of CO-induced ROS production and oxidative stress.

Constructing CO-immune water dissociation sites around Pt to achieve stable operation in high CO concentration environment

The serious problem of carbon monoxide (CO) poisoning on the surface of Pt-based catalysts has long constrained the commercialization of proton exchange membrane fuel cells (PEMFCs). Regeneration of Pt sites by maintaining CO scavenging ability through precise construction of the surface and interface structure of the catalyst is the key to obtaining high-performance CO-resistant catalysts. Here, we used molybdenum carbide (MoCx) as the support for Pt and introduced Ru single atoms (SA-Ru) at the Pt-MoCx interface to jointly decrease the CO adsorption strength on Pt. More importantly, the MoCx and SA-Ru are immune to CO poisoning, which continuously assists in the oxidation of adsorbed CO by generating oxygen species from water dissociation. These two effects combine to confer this anode catalyst (SA-Ru@Pt/MoCx) remarkable CO tolerance and the ability to operate stably in fuel cell with high CO concentration (power output 85.5 mW cm−2@20,000 ppm CO + H2 – O2), making it possible to directly use the cheap reformed hydrogen as the fuel for PEMFCs.

A Rare Case of a Patient with 6.3 pH due to Carbon Monoxide Poisoning Returned to Life with a Cardiopulmonary Resuscitation

A Rare Case of a Patient with 6.3 pH due to Carbon Monoxide Poisoning Returned to Life with a Cardiopulmonary Resuscitation

Serum glucose/potassium ratio as an indicator of early and delayed outcomes of acute carbon monoxide poisoning.

Carbon monoxide (CO) poisoning is a major health problem associated with a high rate of severe morbidity and mortality. This study aimed to evaluate the validity of the serum glucose/potassium (Glu/K) ratio as a quick predictor of both early and delayed unfavorable outcomes following acute CO poisoning. This prospective cohort study included 136 patients with acute CO poisoning admitted at Tanta Poison Control Center, Egypt, between January 2023 and June 2024. The serum Glu/K ratio was calculated for all patients. The primary outcome was a prediction of mortality. Secondary outcomes were the prediction of delayed neurological sequelae (DNS) within six months after CO exposure, the need for mechanical ventilation, and the need for hyperbaric oxygen. A receiver operating curve analysis was applied to test the performance of the Glu/K ratio in predicting acute CO poisoning outcomes. The mortality rate was 12.5% of patients with acute CO poisoning. Meanwhile, 14.7% of patients developed DNS. Furthermore, mechanical ventilation was required in 16.9% of patients. An elevated Glu/K ratio was significantly associated with the severity of acute CO poisoning. At a cut-off value of >31.62, the Glu/K ratio demonstrated an AUC of 0.649 for predicting mortality. The Glu/K ratio was employed to predict DNS at a cut-off value of 33.10, with a sensitivity of 60.0%, a specificity of 82.76%, and an AUC of 0.692. Early Glu/K ratio may be an effective, reliable, and convenient laboratory predictor of mortality, DNS, and the need for mechanical ventilation in patients with acute CO poisoning.

“To BAL or not to BAL, that is the question”: Variations in smoke inhalation injury guidelines from burn units and centres in England, Scotland and Wales

AimTo evaluate variations in diagnostic criteria and management recommendations for smoke inhalation injury (SII) amongst the burn networks of England, Scotland, and Wales. MethodsA descriptive cross-sectional study examining SII guidelines provided by adult burn units and centres in England, Scotland and Wales. ResultsAll 16 adult burn units and centres responded. Fourteen (87.5 %) had guidelines. Due to sharing of guidelines, ten unique guidelines were assessed. Diagnostic criteria showed variability with no universal criterion shared amongst guidelines. Bronchoscopy was recommended by 90 % of guidelines, but the timing varied. The use of bronchoscopic scoring systems was recommended by four guidelines. Bronchoalveolar lavage (BAL) was recommended by four, with considerable variation in frequency and choice of lavage fluid. All guidelines advised at least one nebulised agent: heparin (n = 8); N-acetyl cysteine (NAC) (n = 8); or salbutamol (n = 8). All guidelines included advice on carbon monoxide poisoning; however, carboxyhaemoglobin (COHb) cut-off levels for treatment varied (5 % [n-4], 10 % [n = 3], 15 % [n = 1]). All recommended high-flow oxygen. Seven (70 %) guidelines offered guidance on cyanide poisoning. Reduced/altered consciousness was the only consistent diagnostic criterion. Five (50 %) guidelines provided intubation guidance, emphasising the role of a ‘senior clinician’ as the intubator. Ventilatory guidance appeared in eight guidelines, focusing on lung protective ventilation (n = 8); oxygenation goals (n = 3); and permissive hypercapnia (n = 3). Within lung-protective ventilation, advice on tidal volume (6, or 6–8 ml/kg) and plateau pressures (>30 cmH2O) were presented most commonly (n = 7). ConclusionThis study has outlined the substantial variations in guidance for the management of SII. The results underscore the need for a national guideline outlining a standardised approach to the diagnosis and management of SII, within the limitations of the current evidence.

Mass Carbon Monoxide Poisoning at a Daycare: A Public Health Lesson.

Carbon monoxide (CO) poisoning is a leading cause of preventable toxicity-related deaths in the United States. We describe a case series of 16 individuals who were exposed to CO due to a malfunctioning furnace at a Pennsylvania daycare, a state which did not mandate CO detectors in daycares. An institutional review board-approved retrospective analysis was performed, and de-identified patient records were examined. Collected data included age, sex, race, ethnicity, CO concentrations, arrival time, time to hyperbaric oxygen center contact, and time to transfer and discharge. Emergency medical services transported 16 patients to a tertiary care emergency department (ED) with both adult and pediatric departments. Fourteen patients were 10 years of age or younger. Fifteen patients arrived within one hour. Sixty-two percent (N=10) were male, and 94% (N=15) identified as Hispanic. Emergency physicians, medical toxicologists, clinicians, interpreters, and volunteers from across the hospital system were mobilized to the ED to assist with management. This large-scale daycare CO poisoning represents a potentially avoidable mass casualty incident among children and daycare staff and necessitated significant coordination of care. CO detectors in Pennsylvania daycares would provide early warning for staff, prevent or minimize toxicity, inform first responders, and better prepare EDs to handle similar situations.

Delayed Post-hypoxic Leukoencephalopathy after Carbon Monoxide Intoxication Improved by High-dose Steroid Treatment

Delayed post-hypoxic leukoencephalopathy (DHPL) is a demyelinating syndrome characterized by acute onset of neuropsychiatric symptoms within days to weeks following apparent recovery from coma after a period of prolonged cerebral hypo-oxygenation. The majority of DPHL cases are associated with carbon monoxide intoxication. There is no specific treatment, and the prognosis is usually poor. However, we present a case of DHPL patient with akinetic mutism, parkinsonism, stool and urine incontinence, and severe cognitive impairment improved after treatment with high-dose steroid therapy.