An Invisible Killer

A severe winter storm has caused widespread power outages in the area. Temperatures are in the 20s Fahrenheit. To power their multifamily home, a group of families has set up a gasoline-powered generator in the basement, which has been running overnight. This has caused elevated carbon monoxide (CO) levels in the home as the CO has permeated the drywall and reached every part of the home. Multiple members of the families have begun feeling ill. One of them, a 75-year-old grandfather with multiple medical problems, is confused, lethargic, and cannot walk. He has a carboxyhemoglobin level of 30%, ischemic changes on his ECG, and an elevated troponin. If high-flow oxygen is not applied, the patient will have unstable ventricular tachycardia requiring synchronized cardioversion. He will stabilize with appropriate therapy. Family members will complain of symptoms, and this should prompt their evaluation or referral to be evaluated. If this does not happen, one of them will collapse on the floor.