A patient pulled from an enclosed house fire presents with headache, confusion, cherry-red skin appearance, and normal pulse oximetry. What is the definitive treatment?

Answer and explanation

Correct answer: C. One hundred percent normobaric or hyperbaric oxygen

  1. Step 1: Carbon monoxide binds to hemoglobin with an affinity over 200 times greater than oxygen, forming carboxyhemoglobin and shifting the oxygen dissociation curve to the left.
  2. Step 2: Administration of 100% oxygen significantly shortens the half-life of carboxyhemoglobin from 300 minutes to approximately 60-90 minutes (and to under 30 minutes with hyperbaric oxygen).
Answer
One hundred percent normobaric or hyperbaric oxygen.
Why not the others: Methylene blue is the specific treatment for methemoglobinemia, not carbon monoxide poisoning. Sodium thiosulfate is an antidote for cyanide poisoning. Inhaled nitric oxide is a pulmonary vasodilator that has no role in carbon monoxide displacement.

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