Eric Tosh Allison Loynd Marjan Siadat
Julie Nguyen Maria Pak Gloria Kuhn
Brian Kern Richard Gordon Rob Klever
The answer is d.
The most useful diagnostic test obtainable in a suspected CO poisoning is a COHb level. Normal levels range from 0 to 5%, as CO is a natural by-product of the metabolism of porphyrins. COHb levels average 6% in one-pack-per-day smokers. CO poisoning should be suspected when multiple patients, usually in the same family, present with flu-like symptoms, and were exposed to products of combustion (e.g., home heaters/generators). This most commonly occurs in colder, winter months. The mainstay of treatment is the delivery of O2. Hyperbaric O2 is usually used for patients with COHb levels greater than 25%.
(a) Lead toxicity is mainly a disease of children resulting from ingestion of lead-based paints. Adults can be exposed to lead in a variety of occupational circumstances such as welders, glassmakers and scrap metal workers. There is no classic presentation of lead toxicity. Therefore, high suspicion and a thorough history are critical. The diagnosis is made by an elevated whole blood lead level. (b) CO poisoning is often confused for a viral syndrome. Patients with influenza usually present to the ED with high fever. (c) Malingering is the intentional production of false or exaggerated symptoms motivated by external incentives. (e) A lumbar puncture is used to diagnose meningitis, which may present with headache, nausea, and fatigue.
Here is an excellent review article from the New England Journal of Medicine on carbon monoxide poisoning
Thank you for everyone who submitted an answer. Please stay tuned for next week’s quizzER.
quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training.