NREMT Paramedic Cognitive ExamTraumaEasy
A 55-year-old male is found unconscious in his garage with a running engine. He has cherry-red skin, a pulse oximetry reading of 99%, and a GCS of 3. What is the most appropriate initial treatment for this patient?
- AAdminister 100% oxygen via non-rebreather mask
- BTransport immediately with ventilatory support
- CBegin CPR and prepare for defibrillation
- DAdminister activated charcoal orally
Show answer & explanationAnswer & explanation
Correct answer: A. Administer 100% oxygen via non-rebreather mask
The patient's presentation (unconscious in a running garage, cherry-red skin, normal SpO2 but low GCS) is highly indicative of carbon monoxide poisoning. The most critical initial treatment is to administer 100% oxygen to displace carbon monoxide from hemoglobin.
Why the other options are wrong
- B. While immediate transport is important, ventilatory support without 100% oxygen is insufficient. The critical first step is high-flow oxygen.
- C. CPR and defibrillation are indicated for cardiac arrest, which is not directly presented here, although CO poisoning can lead to it. Oxygenation is more immediate.
- D. Activated charcoal is used for ingested toxins and is ineffective for inhaled gases like carbon monoxide.
Carbon Monoxide Poisoning
A condition resulting from inhalation of carbon monoxide (CO), which binds to hemoglobin with much greater affinity than oxygen, leading to tissue hypoxia despite normal pulse oximetry readings.
- Cherry-red skin is a classic but unreliable sign.
- Pulse oximetry is misleadingly normal because it cannot differentiate between O2Hb and COHb.
- Treatment is high-flow 100% oxygen to displace CO from hemoglobin.
Memory trick: CO=O2: Carbon Out, Oxygen In