ABSTRACT
Hydrogen sulfide inhalation injury can be life threatening. The toxic gas is produced, sometimes unexpectedly, from a wide variety of sources. Because its mechanism of toxicity is similar to that of cyanide, hydrogen sulfide poisoning is commonly treated with the nitrite component of the cyanide antidote kit. In this case report, hyperbaric oxygen was successfully used to treat hydrogen sulfide intoxication. Further evaluation of hyperbaric oxygen therapy as adjunctive treatment of hydrogen sulfide poisoning is recommended.
Subject(s)
Hydrogen Sulfide/poisoning , Hyperbaric Oxygenation , Adult , Emergencies , Humans , MaleABSTRACT
Five patients with smoke inhalation from house fires presented to the hospital in a comatose state. Carboxyhemoglobin levels were elevated in all five patients, mean=32% +/- 6. Arterial blood gases revealed the following means: pH 7.16 +/- 0.06; PCO2 35 mm HG +/- 10.5; HCO3 12.6 mEq/L +/- 0.07; base excess -16 mEq/L +/- 1.58; PO2 353 mm Hg +/- 149; O2 saturation 66% +/- 5.5. The patients were presumed to have both cyanide and carbon monoxide intoxication and were treated with the cyanide antidote kit and hyperbaric oxygen (HBO). Four of five patients awoke within 15 minutes of reaching maximum pressure and remained neurologically intact thereafter. The fifth patient died one week later. Cyanide blood levels drawn prior to treatment revealed a mean of 1.62 microgram/mL +/- 1.44. The highest cyanide level was 3.9 microgram/mL (the death) and the lowest 0.35 microgram/mL. We conclude that smoke inhalation can result in acute cyanide poisoning and that hyperbaric oxygen is a useful adjunct in the treatment of smoke inhalation.
Subject(s)
Burns, Inhalation/therapy , Hyperbaric Oxygenation , Adult , Aged , Ampicillin/therapeutic use , Burns, Inhalation/blood , Burns, Inhalation/drug therapy , Cephalosporins/therapeutic use , Child, Preschool , Cyanides/poisoning , Electrocardiography , Female , Humans , Infant , Male , Monitoring, Physiologic , Pneumonia/prevention & control , Prospective Studies , Steroids/therapeutic useABSTRACT
The recognition and prompt treatment of air embolism and decompression sickness by the emergency physician can do much to reverse the unfavorable outcome of these two medical emergencies. Recognition depends on the physician maintaining a high index of suspicion. While the primary treatment for these disorders is recompression, other forms of therapy are outlined which must be instituted promptly.
