Treatment of carbon monoxide poisoning with hyperbaric oxygen and therapeutic hypothermia.

We present a preliminary case report series of severe, acute carbon monoxide poisoning in which both hyperbaric oxygen (HBO2) and therapeutic hypothermia (TH) were used to ameliorate neurological sequelae. Carbon monoxide poisoning is a standard indication for HBO2. While typically used postcardiac arrest, TH has been used for other types of hypoxic-ischemic brain injury. Four patients were found comatose from carbon monoxide exposure. They were intubated and treated with high-flow oxygen before transfer to our hospital for HBO2. All received three HBO2 treatments and 24 hours of TH with a goal temperature of 33 degrees C utilizing the CoolGard 3000 Intravascular Temperature Management System. While in the HBO2 chamber, cooling was maintained with ice bags in the groin, axillae and under the head. Three of the four cases were discharged home with normal neurological exams. One patient sustained severe, diffuse brain injury yet made a dramatic neurological recovery with only minor limitations in higher order memory and attention. No patient left the hospital with other end organ damage including cardiac dysfunction. To our knowledge, these are the first reported cases of the use of both HBO2 and TH to treat severe, acute carbon monoxide poisoning.

D-dimer is not elevated in asymptomatic high altitude climbers after descent to 5340 m: the Mount Everest Deep Venous Thrombosis Study (Ev-DVT).

We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340 m (17,500 ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.

Syncope, massive aspiration, and sudden death following rattlesnake bite.

Fatalities following rattlesnake bite are rare in the United States, usually occur some hours following the bite, and are generally secondary to direct venom effects. We report a patient with acute syncope and subsequent massive aspiration resulting in airway obstruction and rapid death following a probable Northern Pacific rattlesnake (Crotalus oreganus oreganus) bite.