A 26-year-old man has suspected carbon monoxide poisoning after a house fire. His pulse oximeter reads 99 percent. What is the correct interpretation and treatment?
Answer and explanation
Correct answer: C. The reading is falsely reassuring; give high-flow oxygen by non-rebreather mask
- Step 1: Standard pulse oximetry cannot distinguish carboxyhaemoglobin.
- Step 2: High-flow oxygen shortens the half-life of carboxyhaemoglobin and should not be delayed.
Answer
The reading is falsely reassuring; give high-flow oxygen by non-rebreather mask.
Why not the others: The reading is accurate, so supplementary oxygen is not required at this time: Pulse oximeters over-read in carbon monoxide poisoning. The reading is unreliable, so oxygen is held until a venous gas shows a low saturation: Delaying oxygen allows continuing tissue hypoxia. The reading is accurate, so nebulised salbutamol is the best initial treatment: Salbutamol does not treat CO.
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