Retrograde amnesia following carbon monoxide poisoning: a case report

Retrograde amnesia is a recognised neurological complication of carbon monoxide poisoning. This article describes the case of a female found dead in her bath where initial post-mortem findings and the surrounding circumstances raised strong suspicions of homicide, especially when there was contradictory evidence from her husband who was the only other person present. He was later diagnosed as having retrograde amnesia between his two visits to the bathroom to attend to his wife which caused him to merge them into one event, thus arousing suspicions of foul play. The discussion explores the current clinical views on non-fatal carbon monoxide poisoning as well as problems of interpretation of information derived from case work.     

Hyperbaric treatment of patients with carbon monoxide poisoning in the United States.

INTRODUCTION: Hyperbaric oxygen (HBO2) is effective therapy for carbon monoxide (CO) poisoning. In recent years, many hyperbaric physicians in the US have felt that numbers of patients referred for treatment of CO poisoning have decreased. Further, since the 2002 Weaver et al study (5), there has been discussion regarding the best treatment protocol. This study was conducted to determine numbers of patients treated with HBO2 annually over the past decade in the US and whether there is a consensus about the number of treatments per patient. MATERIALS AND METHODS: A survey was mailed to all US facilities listed in the 2001 UHMS Chamber Directory. Two subsequent mailings were sent to survey nonresponders, followed by telephone contacts. RESULTS: Of the 320 facilities listed in the directory, 10 were nonresponders, 26 had closed since publication and 80 do not treat CO poisoning, leaving 204 facilities. From 1992-2002, a total of 16,367 patients were treated with HBO2 for CO poisoning, an average of 1,488 +/- 121 patients/year (mean < or = SD). While the total number of patients treated annually did not decrease during the period studied, the number treated per facility did decline as a result of an increase in number of treating facilities. Only 46 facilities (23%) automatically give more than 1 hyperbaric treatment per CO-poisoned patient. Among those that do, 20 facilities (10%) give 3 treatments per patient. Conversely, 136 (67%) sometimes give more than one treatment and 12 facilities (8%) never retreat. CONCLUSIONS: Approximately 1,500 CO-poisoned patients are treated with HBO2 in the US annually, a number that has remained relatively constant since 1992. The majority of facilities does not routinely give more than one hyperbaric treatment, but will give repetitive treatment in certain situations.     

An unusual case of suicidal carbon monoxide poisoning

The authors present a case of suicide by carbon monoxide poisoning in a confined space with interesting elements related to the method and the circumstances in which it took place. Carbon monoxide poisoning is a very common cause of death in accidental and suicidal cases, but the method used in this case, consisting of burning charcoal in a small office bathroom, presents some particularly interesting aspects. The circumstances, moreover, appear very interesting because the person who committed suicide was an employee of the Public Administration and he had received notification regarding his involvement in a legal prosecution.     

高压氧综合治疗海绵窦综合征一例

海绵窦综合征是由各种蝶鞍旁损害累及海绵窦所致,肿瘤、颈动脉瘤、颈动脉-海绵窦瘘和炎症是海绵窦综合征的主要病因.2007年9月我中心收治1例由外院误诊并给予手术治疗的海绵窦综合征患者.现报告如下.     

Hyperbaric oxygen treatment for skin flap necrosis after a mastectomy: a case study

The rate of complications in immediate breast reconstruction is in 15% to 20% due to partial loss of the mastectomy skin flaps. In the case of skin necrosis or ischemia, a therapy that reduces skin loss could be of additional benefit. Hyperbaric oxygen has been used to treat compromised flaps and grafts, an indication recognized and reimbursed according to the Undersea and Hyperbaric Medical Society (UHMS). So far, hyperbaric oxygen has not been previously reported as therapy for full-thickness breast skin flap necrosis on patients with a direct reconstruction with silicone implants after a skin-sparing mastectomy. This report presents such a case, in which a 52-year-old woman carrier of the BRCA2 mutation gene was successfully treated with hyperbaric oxygen therapy.     

Questionnaire results of hyperbaric oxygen therapy for acute carbon monoxide poisoning in Japan

Carbon monoxide (CO) poisoning results in not only severe psychoneurological disorders, but can also cause secondary delayed psychoneurological disorders. Therefore, timely and appropriate treatment in the acute stage is crucial to prevent such direct neurological damage and secondary disorders. However, various conflicting results have been reported in studies of CO poisoning treatment, and the efficacy of hyperbaric oxygen therapy (HBO2T) for CO poisoning has not been established. This retrospective multi-institutional study was performed by the questionnaire in 1667 cases of acute CO poisoning in Japan. The effectiveness of HBO2T for CO poisoning was evaluated based on prognoses in cases and various classes of hospital based on the grade of their positive stance regarding HBO2T. The results showed that the prognosis in the group treated with HBOT was significantly better than that in the group treated with normobaric oxygen therapy (NBO2T) (P < 0.01), thus confirming the effectiveness of HBO2T for CO poisoning. Furthermore, while hospitals were separated into three groups according to their indication criteria for HBO2T, the ineffective ratio of NBO2T was dependent on the indication criteria, even though the effective ratio of HBO2T was the same in all three groups. In conclusion, a retrospective multi-institutional study showed that HBO2T is an effective form of therapy for CO poisoning.     

急性一氧化碳中毒的胸部X线表现(附7例报告)

目的 探讨燃气热水器致急性一氧化碳中毒柿部X线表现。方法对7例急性一氧化碳中毒病人于中毒后30min-4h内进行胸部X线检查分析总结。结果7例病人中表现为急性肺泡性肺水肿改变3例；表现为肺纹理增粗、紊乱．模糊3例；心肺膈未见病变1例。结论 急性一氧化碳中霉致肺部改变，以肺泡性肺水肿改变为主，胸部X线检查可为临床治疗提供有价值的诊治依据。     

A curious autopsy case of accidental carbon monoxide poisoning in a motor vehicle

A 26-year-old man was found dead in his car. All doors and windows were locked inside. The ignition key was in the "on" position; but the engine was not running and the fuel tank was empty. His post-mortem lividity was cherry-pink, and marked congestion was observed in the lungs and brain macroscopically. Massive intracardiac blood containing a small amount of cruor was found in the heart. In histological examination of the heart, partial disarrangement or necrosis was found in the myocardium. The liver cells showed derangement and degenerative changes, with focal lymphocyte infiltration in the portal regions, although they were not severe. The chemical tests showed that the blood concentration of carboxyhemoglobin was 46.6%. Stimulants were also detected from his blood and urine; the concentrations of methamphetamine and amphetamine were 3.25 and 0.84 microg/ml, respectively, for his cardiac blood. Therefore, it seemed reasonable to judge that the cause of his death was carbon monoxide poisoning; the cardiomyopathy and the presence of stimulants in blood might facilitate his death. Upon careful investigation of his car, it was disclosed that exhaust gas, leaked from small holes of the exhaust pipe due to rust-through, invaded the interior through four holes on the floor of the car during parking with the engine being on for the purpose of air-conditioning of the interior. It is very common to commit suicide by introducing exhaust gas into an interior of a closed motor car, but the present accidental case of carbon monoxide poisoning in a car seems rare and worthwhile reporting.     

Postmortem magnetic resonance imaging revealed bilateral globi pallidi lesions in a death associated with prolonged carbon monoxide poisoning: a case report

International Journal of Legal Medicine - A man and a woman were found dead in the same car with a burned coal briquette. The cause of death of the woman was assigned to acute carbon monoxide (CO)...     

不同高压氧治疗方案对急性一氧化碳中毒受损心肌的疗效分析

目的 探讨不同高压氧(hyperbaric oxygen,HBO)治疗方案对急性一氧化碳(carbon monoxide,CO)中毒受损心肌的影响.方法 对2006年10月至2010年3月收治的155例重症CO中毒患者进行HBO常规治疗(常规组,75例)和HBO改进治疗(改进组,80例).(1)常规组治疗方案:治疗压力0.25 MPa,加压20 min,稳压后吸氧2次,每次30 min,中间间歇10 min,减压20 min出舱.每日1次,12次为1个疗程,治疗9-68次.(2)改进组方案:前5 d采用HBO常规治疗,以后采用减小治疗压力、缩短吸氧时间、增加吸氧间隔、间歇给氧的治疗方案,治疗压力0.20 MPa,稳压吸氧4次,每次10min,中间间歇5 min,减压20 min出舱.连续治疗3 d后间隔1 d,10 d为1个疗程.2组患者使用相同的药物治疗方案.统计分析常规组和改进组ST-T变化及血清心肌酶变化.结果 改进组与常规组相比ST-T恢复率(56%,28%)明显升高(P＜0.05),HBO治疗第3天和第6天ST-T加重率(第3天21%、25%.第6天16%、27%)明显降低(P＜0.01);2组血清心肌酶恢复率和加重率比较差异有统计学意义(P＜0.05.P＜0.01).结论 HBO改进方案对CO中毒患者受损心肌疗效较好.

Abstract：

Objective To investigate the effects of different hyperbaric oxygen ( HBO) treatment profiles on damaged myocardium induced by acute carbon monoxide poisoning. Methods One hundred and fifty-five serious cases of acute carbon monoxide ( CO) poisoning admitted into the hospital for treatment from October 2006 to March 2010 were randomly divided into the routine HBO treatment group (the routine group,75 cases) and the improved HBO treatment group (the improved group,80 cases). The treatment profile of the routine HBO treatment group: the patients were compressed for 20 min to the treatment pressure of 0.25 Mpa. Following stabilization at the said pressure, the patients breathed oxygen twice for 30 min plus 10 min, once a day. The whole treatment course consisted of 12 sessions, with the patients receiving HBO treatments from 9 to 68 times. The treatment profile of the improved HBO treatment group: the patients were given routine HBO treatment in the first 5 days, then, received improved HBO treatment, with a treatment profile of lower pressure (0.20 Mpa) , shorter oxygen-breathing time, lengthening of oxygen-breathing intervals and intermittent oxygen breathing. Total oxygen-breathing time was 4 times, each for 10 min plus 3 times each for 5 min. Then, the patients were decompressed to the surface following 20-min oxygen-breathing decompression. The patients received treatment for a succession of 3 days, then, had 1-day interval, and the whole treatment course consisted of 10 sessions. Changes in ST-T and myocardial enzymes of both the routine HBO treatment group and the improved HBO treatment group were measured and analyzed. Results ST-T recovery rate of the improved HBO treatment group increased (56% ,28% ) obviously, when compared with that of the routine HBO treatment group(P ＜ 0. 05). ST-T worse rate decreased significantly following HBO treatment on the 3rd and 6th days (21% and 25% on the 3rd day, 16% and 27% on the 6th day) respectively (P＜0.01). Statistical differences could be seen in the myocardial recovery rate and worse rate, when a comparison was made between them (P＜0. 05, P＜0. 01). Conclusions The improved HBO treatment profile showed better therapeutic effect on damaged myocardium induced by CO poisoning. This treatment profile should be used instead of other treatment profiles.     

不同高压氧治疗方案对急性一氧化碳中毒受损心肌的疗效分析

Objective To investigate the effects of different hyperbaric oxygen ( HBO) treatment profiles on damaged myocardium induced by acute carbon monoxide poisoning. Methods One hundred and fifty-five serious cases of acute carbon monoxide ( CO) poisoning admitted into the hospital for treatment from October 2006 to March 2010 were randomly divided into the routine HBO treatment group (the routine group,75 cases) and the improved HBO treatment group (the improved group,80 cases). The treatment profile of the routine HBO treatment group: the patients were compressed for 20 min to the treatment pressure of 0.25 Mpa. Following stabilization at the said pressure, the patients breathed oxygen twice for 30 min plus 10 min, once a day. The whole treatment course consisted of 12 sessions, with the patients receiving HBO treatments from 9 to 68 times. The treatment profile of the improved HBO treatment group: the patients were given routine HBO treatment in the first 5 days, then, received improved HBO treatment, with a treatment profile of lower pressure (0.20 Mpa) , shorter oxygen-breathing time, lengthening of oxygen-breathing intervals and intermittent oxygen breathing. Total oxygen-breathing time was 4 times, each for 10 min plus 3 times each for 5 min. Then, the patients were decompressed to the surface following 20-min oxygen-breathing decompression. The patients received treatment for a succession of 3 days, then, had 1-day interval, and the whole treatment course consisted of 10 sessions. Changes in ST-T and myocardial enzymes of both the routine HBO treatment group and the improved HBO treatment group were measured and analyzed. Results ST-T recovery rate of the improved HBO treatment group increased (56% ,28% ) obviously, when compared with that of the routine HBO treatment group(P ＜ 0. 05). ST-T worse rate decreased significantly following HBO treatment on the 3rd and 6th days (21% and 25% on the 3rd day, 16% and 27% on the 6th day) respectively (P＜0.01). Statistical differences could be seen in the myocardial recovery rate and worse rate, when a comparison was made between them (P＜0. 05, P＜0. 01). Conclusions The improved HBO treatment profile showed better therapeutic effect on damaged myocardium induced by CO poisoning. This treatment profile should be used instead of other treatment profiles.     

Hyperbaric oxygen therapy and optic neuritis: case report and literature review

A history of optic neuritis has long been considered a relative contraindication to hyperbaric oxygen therapy. However, the published medical literature regarding the use of hyperbaric oxygen therapy in patients with previous optic neuritis is very limited, and patients who might benefit from hyperbaric oxygen therapy may be denied its benefit without adequate consideration of the risk-benefit ratio. We present a case report of a patient with a history of optic neuritis who underwent comprehensive ophthalmologic evaluation before and after 40 treatments with hyperbaric oxygen therapy, with no detectable ophthalmologic deficit.     

A case of carbon monoxide poisoning before a vehicle fire: Availability of volatile hydrocarbons analysis

Benzene is one of volatile hydrocarbons contained in fire smoke, and the concentrations in the blood are known to be positively correlated with that of carbon monoxide-hemoglobin (CO-Hb) in fire-related deaths. In this report, we present a vehicle fire case in which CO and benzene concentration is atypically un-correlated. The car driven by the vehicle dweller ran into an oncoming lane at high speed, hitting a traffic signal pole. A vehicle fire started when the rescuer opened the car door. A burned body and briquette stove were found when the fire was extinguished. An autopsy revealed a small amount of soot deposit in the airways. The CO-Hb concentration in the heart blood was 63%. Volatile hydrocarbon analysis of the blood was performed; compared with the CO-Hb concentration, the benzene concentration was significantly lower than expected. High CO-Hb concentration without a hydrocarbon component indicated that the deceased inhaled CO that was not related to fire smoke. Thus, we concluded that the cause of death was CO poisoning caused by the briquette stove before the vehicle fire started. Comparing volatile hydrocarbon concentrations with CO-Hb concentrations could provide more information about the circumstances surrounding a vehicle fire-related death.     

Hyperbaric treatment of arterial CO2 embolism occuring after laparoscopic surgery: a case report.

Arterial carbon dioxide (CO2) embolism is a serious and sometimes fatal iatrogenic medical condition encountered in surgery. A thirty-five year old Caucasian female developed a CO2 embolism during a laparoscopic appendectomy. After initial resuscitation and completion of the surgery, she was treated with hyperbaric oxygen (HBO2) to help reduce the size of large CO2 bubbles that had migrated into her left ventricle during surgery. The HBO2 protocol was 2.8 atmospheres for 90 minutes, which resolved the problem with no adverse effects.