42.3 🩺 內科專科考前版

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42.3.0.1 📌 一頁重點

• 22E focus on co-oximetry interpretation
• HBO for CO + cyanide
• Taiwan: 機車排氣 CO中毒、火災煙霧

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42.3.0.2 💊 進階治療

42.3.0.2.1 CO Poisoning

• 100% O2 via non-rebreather
• HBO for: LOC, neurological deficit, MI, pregnancy, severe COHb > 25%
• Counsel for delayed neurologic sequelae

42.3.0.2.2 Methemoglobinemia

• Methylene blue 1-2 mg/kg IV
• G6PD def → ascorbic acid instead
• Hyperbaric O2 if severe

42.3.0.2.3 Cyanide

• Hydroxocobalamin 5 g IV (preferred — turns 紅 urine)
• Or sodium thiosulfate 12.5 g IV
• 不 routine nitrites（可能 worse hypoxia in fire victim）

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42.3.0.3 🌟 Pearls (8)

1. CO + cyanide co-occur in smoke inhalation
2. Pulse ox 假高 in CO, MetHb
3. Hyperbaric O2 indications strict
4. A-a gradient = quick diagnostic tool
5. Methemoglobinemia in G6PD avoid methylene blue
6. Cyanosis 在 anemia less visible (low Hb)
7. Cyanosis 在 polycythemia more visible
8. Pulse ox 6 月嬰兒以上 reliable

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42.3.0.4 📍 台灣 Context

• 機車排氣 CO 中毒（夏天）
• 火災 + 煙霧
• HBO chambers limited（北部、南部少數醫學中心）

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42.3.0.5 🎓 內專重點

1. 4 類 hypoxia
2. A-a gradient
3. CO / MetHb / cyanide 解毒
4. Pulse ox 限制
5. HBO indications

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