A 46 year old male was brought in by ambulance to the Emergency Department after being found by friends in an unresponsive state.
On arrival, a nasopharyngeal airway was in situ, SpO2 were 98% on 15L/min oxygen via a non-rebreathe mask, heart rate was 92 beats per minute and blood pressure was 140/95. GCS was 7 (E2V2M3). He has a past medical history of depression and bipolar affective disorder managed in the community.
An arterial blood gas was done which revealed:
pH = 7.19
PaO2 = 50.40 kPa
PaCO2 = 7.4 kPa
COHb = 7.9%
Lactate = 2.50 mmol/L
The decision was made to administer general anaesthesia and intubate the patient for airway protection. During laryngoscopy it was noted that he had an erythematous, swollen airway, covered in soot. He was then transferred to the Critical Care Unit.
Toxin, paracetamol and salicylate screen were negative. He had normal blood results apart from elevated CK of 23,450 U/L.
Written by Dr James Hewitt
First published 1 Dec 2022