The 10-year-old girl in the Linden, NJ carbon monoxide poisoning tragedy, Emike Asekomhe, is still in “extremely critical condition” at Newark Beth Israel Hospital. Her 9-year-old brother died after both were found unconscious by their mother at 7:30 a.m. on Tuesday, May 3rd.

The mother has stayed by the girl’s side in the hospital. The town is hosting a candlelight vigil Saturday, May 7th in Dorothy Ford Park. It is not known whether or not the girl received hyperbaric-oxygen treatment.

The hyperbaric-oxygen treatment reduces the degree of problems in secondary conditions resulting from the poisoning. The normal oxygen treatment will see more secondary problems. These delayed symptoms are sometimes called Delayed Neurological Sequelae and can range from memory problems to seizures to visual problems.

The important aspect to remember about treating carbon monoxide poisoning is the follow-up. Scheduling follow-up visits with specialists and neurologists is essential to take care of the delayed symptoms from the poisoning. Otherwise these symptoms will go untreated.

Giuseppe Pepe and colleagues at Careggi University General Hospital in Florence, Italy published a 2011 study called “Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study.” The study stated that DNS usually occurs after recovery from acute carbon monoxide poisoning. Early recognition of patients at risk for DNS in the emergency department may help with the quality of care provided. The researchers looked at past emergency department visits to research predictive risk factors for DNS development.

The researchers studied all patients admitted to the emergency department for CO poisoning at Careggi University General Hospital from 1992 to 2007. Patients were asked to come to three follow-up appointments at one, six, and twelve months. They then analyzed the data to study the risk factors for DNS.

Of the 347 patients admitted to the emergency department for CO poisoning from 1992 to 2007, 141 took part in a follow-up visit after one month. Twenty-four percent of those were diagnosed with DNS.

No significant correlation was found with sex, headache, transient loss of consciousness (blackouts), Glasgow Coma Scale between 14 and 9, and arterial lactate. The study developed risk factors for DNS and also emphasized that adequate patient follow-up is necessary and more research should be done in this area.

DNS can occur in the weeks or months following the actual carbon monoxide poisoning. Initial symptoms of acute carbon monoxide poisoning may include headaches, nausea, malaise, and fatigue. The symptoms following the poisoning must also be tended to. These delayed neurological symptoms may include difficulty with higher intellectual functions, short-term memory loss, dementia, amnesia, psychosis, irritability, a strange gait, speech disturbances, Parkinson’s disease-like syndromes, cortical blindness, and a depressed mood.

It is important to schedule follow-up visits to check up on the possible delayed neurological sequelae. Early identification of risk factors may also improve care. This is going to be true in the Linden, NJ carbon monoxide poisoning tragedy. For those with DNS, the symptoms can be treated, and a full recovery is possible.

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