In the recent wind cooling severe acute carbon monoxide poisoning patient Mr. Bu after a few days of hyperbaric oxygen comprehensive treatment, poisoning symptoms improved, but combined with carbon monoxide poisoning complications of cerebral infarction. He is currently under treatment. This is the first case of severe acute carbon monoxide poisoning admitted to the hyperbaric oxygen department of Beijing Chaoyang Hospital since the beginning of autumn this year. According to statistics, the hospital has seen two patients with acute carbon monoxide poisoning since the temperature dropped. Mr. Bu said after he sobered up: He was on duty alone in the unit on the night of October 18, when the temperature plummeted, and he found a basin with a few pieces of lit coal in the house in order to keep warm, but ignored that the room had neither windows nor a chimney. He went to bed at 9:00 p.m., not expecting to wake up in the hospital the next day, but fortunately he was found by his colleagues on the next morning. If found later the consequences are difficult to imagine. At about 10 a.m. on the 19th, Mr. Bu, 66, was taken by ambulance to the emergency department of Beijing Chaoyang Hospital. He was found to be unable to wake up at around 6:00 a.m. that morning by his colleagues on duty, and was sent to a local hospital for examination, where the possibility of acute carbon monoxide poisoning was considered high, and was transferred to Beijing Chaoyang Hospital because there was no local hyperbaric chamber. During the treatment, the patient was found to be confused, unconscious, unable to answer questions, unable to move his limbs, vomiting, and in a comatose state. The patient’s blood carboxyhemoglobin was significantly elevated and the partial pressure of blood oxygen was reduced by laboratory tests. The patient was admitted to the hyperbaric chamber for hyperbaric oxygen therapy. The patient received medication while receiving oxygen in the chamber, and the medical staff in the chamber closely observed the changes in the patient’s condition and adjusted the treatment in a timely manner. After about 2 hours of hyperbaric oxygen treatment, the patient’s symptoms improved significantly when he left the chamber, not only was he clear, he could move his limbs and answer simple questions. In order to further treat and prevent the emergence of carbon monoxide poisoning late onset encephalopathy, the patient was hospitalized to continue treatment. After treatment, although the patient’s symptoms of poisoning improved significantly, the complication of cerebral infarction due to carbon monoxide poisoning required further treatment, and the possibility of late onset encephalopathy due to carbon monoxide poisoning could not be ruled out. Second, paralysis is the main cause Every year, after entering the alternate autumn and winter seasons and the emergence of windy and cooling weather, carbon monoxide poisoning patients will appear one after another, mainly in cottages that use coal stoves. In particular, there are some workers who just came from the south will not use the coal stove for heating, which is more likely to cause poisoning. Among them, paralysis is also the main reason. For example, the room is not equipped with wind buckets to save time, resulting in poor ventilation; the fire pit placed indoors for temporary heating is forgotten to put outside; when dining in a restaurant room using charcoal fire shabu-shabu, the doors and windows are tightly closed; when using non-forced gas water heaters for bathing, the room is poorly ventilated, resulting in incomplete combustion to produce carbon monoxide, etc. If you have light symptoms such as dizziness, headache, vomiting, etc., open the windows as soon as possible and leave the toxic environment, pay attention to keeping warm when you are outdoors, and if the symptoms are reduced after ventilation, you can be treated in the hospital. Some people take folk methods such as giving vinegar to patients and using orange peels to detoxify them is not scientific. Reminder: the use of coal stove families, often open doors and windows, so that indoor air circulation, fresh, to avoid the accumulation of carbon monoxide; heating coal stove to install a good chimney, the stove should be purchased from the regular channels, the chimney connection is best to use tape closed, and keep the chimney structure tight and well ventilated, to prevent leakage of smoke, back smoke, and keep it open; it is best to sweep the chimney every two months, when the chimney in the accumulation of coal ash It is best to sweep the chimney every two months, when the ash accumulated in the chimney is particularly large and most likely to block the flue; the chimney interface should be checked frequently and sealed with adhesive tape to prevent air leakage; it is best to install an outlet with an elbow at the chimney outlet so that the opening is downward to avoid carbon monoxide pouring into the room when the wind is blowing. Do not put the coal fireplace without a chimney into the room. When using a charcoal fire for hot pot in a restaurant room, you should also pay attention to opening the windows to avoid carbon monoxide poisoning caused by incomplete combustion of the charcoal fire. When using a non-forced gas water heater for bathing, pay attention to indoor ventilation. The first thing that you should do is to make sure that you have a good idea of what you are getting into. In the case of “acute carbon monoxide poisoning”, the patient should be moved out of the environment in time to breathe fresh air or oxygen, and in the case of moderate to severe “carbon monoxide poisoning”, the patient should be sent to the hospital in time for rescue treatment, and the condition should be treated with hyperbaric oxygen in time. The reason is that patients with severe carbon monoxide poisoning will suffer from generalized multi-organ hypoxia, brain edema, pulmonary edema and other comorbidities, and in serious cases, fatal respiratory distress syndrome; patients over 40 years old with diabetes, hyperlipidemia, hypertension and other underlying diseases should go to the hospital for normobaric oxygenation, anticoagulation and other treatments if they are in a brief coma after carbon monoxide poisoning, even if they have awakened after taking measures such as ventilation. Anticoagulation and other treatments to avoid the development of hypoxic brain disease – delayed onset encephalopathy. The treatment of hyperbaric oxygen is to force oxygen to combine with hemoglobin and force out carbon monoxide under high pressure and high concentration of oxygen. Oxygen in a hyperbaric chamber expels carbon monoxide 15 times faster than in air. The timely treatment of hyperbaric oxygen can rapidly improve the hypoxia caused by “carbon monoxide poisoning”. Reducing hypoxic injury. Because of the low oxygen reserve and high oxygen demand of human brain, hypoxia is most likely to cause brain damage. This leads to prolonged impairment of consciousness and a series of secondary injuries. After a period of time (pseudo-healing period) after the resuscitation of consciousness after carbon monoxide poisoning, the subsequent symptoms of dementia, mental abnormality, difficulty in walking, incontinence and even difficulty in swallowing and bed-rest are the main manifestations of “carbon monoxide poisoning” late onset encephalopathy. The pseudo-healing period is mostly 10 to 20 days. The cause of delayed onset encephalopathy is not well understood, but the underlying diseases such as great trauma, advanced age, hypertension, hyperlipidemia and cardiovascular disease are important risk factors. The incidence of “carbon monoxide poisoning delayed onset encephalopathy” without systematic treatment is reported to be 10-60% at home and abroad. In China, the incidence of late onset encephalopathy has been greatly reduced by hyperbaric oxygen and comprehensive treatment. Beijing Chaoyang Hospital has developed diagnostic criteria and treatment protocols for carbon monoxide poisoning delayed-onset encephalopathy and hyperbaric oxygen treatment courses based on research on the pathogenesis and treatment mechanism of the disease, so that the incidence of “carbon monoxide poisoning delayed-onset encephalopathy” is <10%.