Undersea & Hyperbaric Medicine Journal Volume 45, Issue #2

Course overview

Learner Objectives: As a result of having attended the meeting, the participants should have had the opportunity to: 1. To provide the practitioner managing patients with carbon monoxide poisoning a basic clinical understanding of carboxyhemoglobin; 2. To provide a summary of measurement techniques for carboxyhemoglobin and a suggested role for the carboxyhemoglonin level in patient management; 3. Understand the study’s design, outcome measures, and intervention effects; 4. Understand the study’s limitations and possible future directions for research; 5. To understand the importance of appropriate first aid, medical treatment, early cardiorespiratory investigations and recommendations for SDPE patients; 6. To explain how age and other predisposing factors contributed to immersion pulmonary edema - incorporating both swimming-induced pulmonary edema (SIPE) and scuba divers pulmonary edema (SDPE). Subject Matter: Adjunctive hyperbaric oxygen treatment for idiopathic sudden sensorineural hearing loss; Review Article Carboxyhemoglobin: a primer for clinicians; Research Article Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial; Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature. Teaching Methods: Journal Reading, Examination of material, Evaluation of activity. Evaluation Methods: Evaluation is offered through the online educational portal with 3 graded questions each UHM Journal paper and an overall evaluation at completion of the Journal-based activity. References: 1. Piantadosi CA. Carbon monoxide poisoning. Undersea Hyperb Med 2004; 31(1):167-177. 2. Piantadosi CA. Carbon monoxide poisoning. N Engl J Med 2002; 347(14):1054-1055. 3. Rodkey FL, O’Neal JD, Collison HA, Uddin DE. Relative affinity of hemoglobin S and hemoglobin A for carbon monoxide and oxygen. Clin Chem 1974; 20:83-84. 4. Hope F. Uber die Einwirking des Kohlenoxydgases auf das Hematoglobulin. Virchows Arch Pathol Anat Physiol Klin Med 1857; 11:288. 5. Simini B. Cherry-red discolouration in carbon monoxide poisoning. The Lancet 1988; 352(9134):1154. 6. Findlay GH. Carbon monoxide poisoning: Optics and histology of skin and blood. Br J Derm 1988; 119(1):45-51. 7. Uhl W, Nolting A, Golor G, Rost KL, Kovar A. Safety of hydroxocobalamin in healthy volunteers in a randomized, placebocontrolled study. Clin Toxicol 2006; 44(Suppl 1):17-28. 8. Sayers RR, Yant WP. The pyrotannic acid method for the quantitative determination of carbon monoxide in blood and air: Its use in the diagnosis and investigation of cases of carbon monoxide poisoning. Bureau of Mines Technical Paper 373, United States Department of Commerce, 1925. 9. Barker SJ, Tremper KK. The effect of carbon monoxide inhalation on pulse oximetry and transcutaneous PO2. Anesthesiology 1987; 66:677-679. 10. Alexander CM, Teller LE, Gross JB. Principles of pulse oximetry: Theoretical and practical considerations. Anesth Analg 1989; 68:368-376. 11. Hampson NB. Pulse oximetry in severe carbon monoxide poisoning. Chest 1998; 114:1036-1041. 12. Barker SJ, Curry J, Redford D, Morgan S. Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: A human volunteer study. Anesthesiology 2006; 105(5):892-897. 13. Piatkowski A, Ulrich D, Grieb G, Pallua N. A new tool for the early diagnosis of carbon monoxide intoxication. Inhal Toxicol 2009; 21(13):1144-1147. 14. Touger M, Birnbaum A, Wang J, Chou K, Pearson D, Bijur P. Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement. Ann Emerg Med 2010; 56:382-388. 15. Roth D, Herkner H, Schreiber W, N, Gamper G, Laggner AN, Havel C. Accuracy of noninvasive multiwave pulse oximetry compared with carboxyhemoglobin from blood gas analysis in unselected emergency department patients. Ann Emerg Med. 2011; 58:74-79. 16. Weaver LK, Churchill S, Deru K, Cooney D. False positive rate of carbon