A significant medical achievement was recently recorded at Sultan Qaboos University Hospital in the management of acute poisoning. A medical team from the hospital successfully used hyperbaric oxygen therapy (HBOT) in treating the complex case of an 82-year-old woman suffering from severe carbon monoxide poisoning. This case is the first of its kind documented in the sultanate.
The patient arrived at the Emergency Department with severe neurological symptoms with remarkably altered consciousness and dysarthria. This initially suggested a possible stroke. However, further diagnostic tests revealed high levels of carboxyhemoglobin, which is formed by the binding of carbon monoxide to hemoglobin molecules. This prevents them from performing their primary function of transporting oxygen to body tissues such as the brain and heart. This is considered a strong indicator of carbon monoxide poisoning. The poisoning was the result of a charcoal heater in a poorly ventilated space.
The initial treatment consisted of administering high-concentration oxygen via conventional methods. Although this helped in lowering toxic gas levels, it did not produce significant neurological improvement. The team then opted for HBOT as an advanced intervention. The patient underwent a single session, during which she inhaled 100% oxygen under a pressure 2.5 times greater than normal atmospheric levels. This therapeutic environment significantly increased plasma-dissolved oxygen which enabled direct delivery to hypoxic tissues and accelerated the dissociation of carbon monoxide from hemoglobin. The results were remarkable. After a single session of HBOT, the patient demonstrated considerable neurological improvement with full recovery of consciousness and communication abilities. She was discharged in good health after a few days with no neurological or cognitive complications observed during follow-up.
This case clearly demonstrates the critical role of HBOT as an advanced frontline intervention in managing severe carbon monoxide poisoning, especially when patients fail to respond to conventional oxygen therapy. It also highlights the importance of precise diagnostic reasoning when assessing patients presenting with arcane neurological symptoms.
Sultan Qaboos University Medical Journal
Case study
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