Carbon Monoxide Poisoning In Children .pdf


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VISIT US AT ACEP
SCIENTIFIC ASSEMBLY,
OCT. 16-18,
BOOTH S1913

Carbon Monoxide Poisoning In
Children: Diagnosis And Management
In The Emergency Department
Abstract
Approximately 5000 children present annually to emergency departments in the United States with unintentional carbon monoxide poisoning. Children may be more vulnerable to carbon monoxide poisoning because of their increased metabolic demand and their inability to
vocalize symptoms or recognize a dangerous exposure. Developing
fetuses and newborn infants are more vulnerable to carbon monoxide
poisoning because of the persistence of fetal hemoglobin. Mild carbon
monoxide poisoning may present as viral symptoms in the absence
of fever. While headache, nausea, and vomiting are the most common presenting symptoms in children, the most common symptom in
infants is consciousness disturbance. This review discusses the limitations of routine pulse oximetry and carboxyhemoglobin measurement in determining carbon monoxide exposure, and notes effects of
co-ingestions and comorbidities. Although the mainstay of treatment
is 100% oxygen, the current evidence and controversies in the use of
hyperbaric oxygen therapy in pediatric patients are reviewed, along
with its possible benefit in preventing delayed neurologic sequelae.
Editor-in-Chief
Adam E. Vella, MD, FAAP
Associate Professor of Emergency
Medicine, Pediatrics, and Medical
Education, Director Of Pediatric
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, New
York, NY

Associate Editor-in-Chief
Vincent J. Wang, MD, MHA
Professor of Pediatrics, Keck
School of Medicine of USC;
Associate Division Head, Division
of Emergency Medicine, Children's
Hospital Los Angeles, Los Angeles,
CA

Editorial Board
Jeffrey R. Avner, MD, FAAP
Professor of Pediatrics and Chief
of Pediatric Emergency Medicine,
Albert Einstein College of Medicine,
Children’s Hospital at Montefiore,
Bronx, NY
Steven Bin, MD
Associate Clinical Professor
of Emergency Medicine and
Pediatrics, UCSF School of
Medicine; Medical Director, UCSF
Benioff Children's Hospital, San
Francisco, CA
Richard M. Cantor, MD, FAAP,
FACEP
Professor of Emergency Medicine
and Pediatrics, Director, Pediatric
Emergency Department, Medical
Director, Central New York Poison
Control Center, Golisano Children's
Hospital, Syracuse, NY

September 2016
Volume 13, Number 9

Authors
Theodore E. Macnow, MD
Assistant Professor of Pediatrics, University of Massachusetts
Medical School; Pediatric Emergency Medicine Division, UMass
Memorial Medical Center, Worcester, MA
Mark L. Waltzman, MD, FAAP
Chief of Pediatrics, South Shore Hospital; Assistant Professor
of Pediatrics, Harvard Medical School; Division of Emergency
Medicine, Boston Children’s Hospital, Boston, MA
Peer Reviewers
Michael Levine, MD
Assistant Professor, Department of Emergency Medicine,
Division of Medical Toxicology, University of Southern California,
Los Angeles, CA
Nima Majlesi, DO, FAAEM
Director of Toxicology, Staten Island University Hospital;
Assistant Professor of Emergency Medicine, SUNY Downstate,
New York, NY
Prior to beginning this activity, see “Physician CME Information”
on the back page.

Ilene Claudius, MD
Associate Professor of Emergency
Medicine, Keck School of Medicine
of USC, Los Angeles, CA

Alson S. Inaba, MD, FAAP
Garth Meckler, MD, MSHS
Pediatric Emergency Medicine
Associate Professor of Pediatrics,
Specialist, Kapiolani Medical Center
University of British Columbia;
for Women & Children; Associate
Division Head, Pediatric Emergency
Professor of Pediatrics, University
Medicine, BC Children's Hospital,
Ari Cohen, MD
of Hawaii John A. Burns School of
Vancouver, BC, Canada
Chief of Pediatric Emergency Medicine
Medicine,
Honolulu,
HI
Services, Massachusetts General
Joshua Nagler, MD, MHPEd
Hospital; Instructor in Pediatrics,
Madeline Matar Joseph, MD, FACEP, Assistant Professor of Pediatrics,
Harvard Medical School, Boston, MA
FAAP

Harvard Medical School; Fellowship
Director, Division of Emergency
Marianne Gausche-Hill, MD, FACEP, Professor of Emergency Medicine
and
Pediatrics,
Chief
and
Medical
Medicine, Boston Children’s
FAAP
Director, Pediatric Emergency
Hospital, Boston, MA
Medical Director, Los Angeles
Medicine Division, University
County EMS Agency; Professor of
James Naprawa, MD
of
Florida
College
of
MedicineClinical Medicine and Pediatrics,
Attending Physician, Emergency
Jacksonville, Jacksonville, FL
David Geffen School of Medicine at
Department USCF Benioff
UCLA, Los Angeles, CA
Michael J. Gerardi, MD, FAAP,
FACEP, President
Associate Professor of Emergency
Medicine, Icahn School of Medicine
at Mount Sinai; Director, Pediatric
Emergency Medicine, Goryeb
Children's Hospital, Morristown
Medical Center, Morristown, NJ

Stephanie Kennebeck, MD
Associate Professor, University of
Cincinnati Department of Pediatrics,
Cincinnati, OH
Anupam Kharbanda, MD, MS
Chief, Critical Care Services
Children's Hospitals and Clinics of
Minnesota, Minneapolis, MN

Tommy Y. Kim, MD, FAAP, FACEP
Sandip Godambe, MD, PhD
Associate Professor, Loma Linda
Vice President, Quality & Patient
University Medical Center and
Safety, Professor of Pediatrics and
Children's Hospital, Department of
Emergency Medicine, Attending
Emergency Medicine, Division of
Physician, Children's Hospital of the
Pediatric Emergency Medicine, Loma
King's Daughters Health System,
Linda, CA
Norfolk, VA
Melissa Langhan, MD, MHS
Ran D. Goldman, MD
Associate Professor of Pediatrics and
Professor, Department of Pediatrics,
Emergency Medicine; Fellowship
University of British Columbia;
Director, Director of Education,
Co-Lead, Division of Translational
Pediatric Emergency Medicine, Yale
Therapeutics; Research Director,
University School of Medicine, New
Pediatric Emergency Medicine, BC
Haven, CT
Children's Hospital, Vancouver, BC, Robert Luten, MD
Canada
Professor, Pediatrics and
Emergency Medicine, University of
Florida, Jacksonville, FL

Children's Hospital, Oakland, CA
Joshua Rocker, MD
Assistant Chief of Emergency
Medicine and Pediatric, Hofstra
School of Medicine; Associate
Director, Division of Pediatric
Emergency Medicine, Cohen
Children's Medical Center, New
Hyde Park, NY
Steven Rogers, MD
Associate Professor, University of
Connecticut School of Medicine,
Attending Emergency Medicine
Physician, Connecticut Children's
Medical Center, Hartford, CT

David M. Walker, MD, FACEP, FAAP
Director, Pediatric Emergency
Medicine; Associate Director,
Department of Emergency Medicine,
New York-Presbyterian/Queens,
Flushing, NY

International Editor
Lara Zibners, MD, FAAP, FACEP
Honorary Consultant, Paediatric
Emergency Medicine St. Mary's
Hospital Imperial College Trust,
London, UK; Nonclinical Instructor
Emergency Medicine Icahn school
of medicine at Mount Sinai, New
York, NY

Pharmacology Editor
James Damilini, PharmD, MS, BCPS
Clinical Pharmacy Specialist,
Emergency Medicine, St. Joseph's
Hospital and Medical Center,
Phoenix, AZ

Quality Editor
Steven Choi, MD
Assistant Vice President, Montefiore
Network Performance Improvement;
Director, Montefiore Institute for
Performance Improvement; Assistant
Professor of Pediatrics, Albert
Einstein College of Medicine, Bronx,
NY

Christopher Strother, MD
Assistant Professor, Emergency
Medicine, Pediatrics, and Medical
CME Editor
Education; Director, Undergraduate
Deborah R. Liu, MD
and Emergency Department
Assistant Professor of Pediatrics,
Simulation; Icahn School of Medicine
Keck School of Medicine of USC;
at Mount Sinai, New York, NY
Division of Emergency Medicine,
Children's Hospital Los Angeles,
Los Angeles, CA