LAUSR

Study/Objective: To investigate the treatment of CO poisoning using oxygen. Background: Acute carbon monoxide poisoning is a common cause of accidental poisoning. The incident described here occurred in a restaurant in Singapore, where a group of workers were exposed to CO due to a malfunctioning ventilation system. Thirty patients were sent to our ED as our hospital has the only burn unit in Singapore, as well as being the closest in proximity to the incident site. Methods: All patients involved in the incident were charted upon arrival and seen by a team of Emergency Department doctors, including three medical officers and two toxicologists. Once the diagnosis of the index case was confirmed with an elevated carboxyhemoglobin, he was initiated on 100% oxygen using a Non-breather Mask (NRM). Subsequent cases were also initiated on NRM once there is confirmed history of being in the affected area of the restaurant, and patients complained of symptoms of headache, giddiness, breathlessness, or chest tightness. All cases were screened with the following investigations Chest X Ray, full blood count, renal panel, troponin T, carboxyhemoglobin, venous/arterial blood gas, and lactate levels. Results: Two patients were admitted to inpatient and 17 to our observation unit. All cases displayed down trending of carboxyhemoglobin levels with oxygen. Three cases with raised Troponin had initial complaints of chest tightness that resolved with oxygen therapy. All patients were discharged and none required HBOT. Conclusion: Carbon monoxide poisoning is readily treatable once the diagnosis is clinched through a thorough history taking, physical examination, and appropriate investigations. Importantly, a concomitant cyanide poisoning should be excluded, as the treatment is different. A mass-casualty situation can also happen in such instances, so a protocol should either be activated or drawn up immediately upon identification of the first few cases. Hyperbaric oxygen treatment is a consideration in severe cases.