They showed a closed-circuit video of the explosion, and informed the medical staff about what had happened in more detail. Later, police officers visited the emergency room to check the patient’s condition. Carbon dioxide concentration decreased rapidly, and it returned to normal within half an hour ( Table 1).ĪBGA, arterial blood gas analysis CPR, cardiopulmonary resuscitation ROSC, return of spontaneous circulation pCO2, partial pressure of carbon dioxide pO2, partial pressure of oxygen HCO3, bicarbonate sO2, oxygen saturation O2Hb, oxyhemoglobin COHb, carboxyhemoglobin MetHb, methemoglobin. After starting a mechanical ventilation, serial arterial blood gas analysis findings improved rapidly. His non-enhanced brain computed tomography showed no evidence of acute intracranial hemorrhage. Portable chest radiograph showed no active lung lesions. The results of bedside Focused Abdominal Sonography for Trauma, and transthoracic echocardiography, were normal. Electrocardiography directly after the return of spontaneous circulation showed atrial fibrillation, but no remarkable ST segment changes. After receiving six minutes of CPR at the emergency department, the patient had a return of spontaneous circulation. The patient’s initial arterial blood gas analysis showed the following results: pH 6.63, partial pressure of carbon dioxide 201.6 mmHg, partial pressure of oxygen 8.9 mmHg, capillary oxygen saturation 3.0%, and bicarbonate 20.6 mmol/L. It took about 20 minutes to get to the hospital. With the patient not having received any bystander CPR, the emergency medical service providers promptly initiated CPR, and inserted a laryngeal mask airway before transporting him to our emergency medical center. When they arrived at the site, they discovered two unconscious people lying on the floor. The emergency medical service providers accompanying the patient reported that they had been dispatched to the scene after receiving a call about an explosion in a building. Thus, cardiopulmonary resuscitation (CPR) was continued. On arrival, he was comatose and electrocardiography confirmed that his heart had stopped. This cardiac arrest could have been avoided if the patient had been fully aware of the hazardous effects and serious consequences of exposure to high concentrations of carbon dioxide.Ī 66-year-old male with a history of hypertension arrived at the emergency department with cardiac arrest. Here we describe a case of carbon dioxide poisoning following an explosion of a carbon dioxide tank, which led to cardiac arrest. However, only a limited number of cases of carbon dioxide poisoning have been reported in Korea, and all these reports have been of mild intoxication. In Western societies, there have been case reports of carbon dioxide intoxication that has led to cardiac arrest. At higher concentrations, carbon dioxide can cause an instantaneous loss of consciousness and respiratory arrest because it acts both as an asphyxiant, and a toxicant. These symptoms can range from mild, such as headache, dizziness, and drowsiness, to severe, such as loss of consciousness, visual disturbances, and hearing difficulties. Victims of carbon dioxide exposure may experience a wide range of symptoms. Air containing 40,000 ppm of carbon dioxide poses an immediate threat to human life and health. The National Institute for Occupational Safety and Health recommends that short-term occupational exposure should not exceed 30,000 ppm over a period of fifteen minutes. However, exposure to high concentrations of carbon dioxide can have serious consequences. At low concentrations, carbon dioxide exposure does not cause any symptoms. A possible result of carbon dioxide accumulation is what is known as confined space hypoxic syndrome, in which the atmospheric deficit of oxygen can cause life-threatening conditions. Carbon dioxide has a molecular weight that is heavier than that of oxygen, and so it may accumulate if it is released in enclosed environments. Carbon dioxide, the fourth most common gas in the atmosphere, is widely produced and utilized by many industries for purposes such as refrigeration, fire suppression, and as a solvent.
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