The EMS call came in over the radio, “Fifty year old man found in the trunk of his car, unresponsive. We’ll be there in five.” The radio hissed and crackled into silence. The hairs on the back of my neck stood on end as I imagined the circumstances. “Did you hear that???” I asked everyone in earshot. How did he get there? Who put him there? Who found him there? Most importantly, WHY was he in the trunk of his car???
The picture became clearer once the medics arrived. He was semi-homeless. He slept in his car. On this occasion, the car was in his mother’s garage, doors shut, engine running. Eventually the car ran out of gas and a friend stopped by. There were a few bottles of medicines on the seat next to him, and emtpy bottle of imipramine and some xanax.
He was completely unresponsive. I pinched the skin on his neck and he barely flinched. He was hyperventilating. The nurse put in a foley and an NG tube and he briefly opened his eyes. I put him on a 100% oxygen mask while I contemplated intubation. For the moment, he was actually breathing well on his own with a patent airway.
His carbon monoxide level was over 30%, displacing oxygen from it’s usual place in the red blood cells. He required a treatment with unproven efficacy, but sound in it’s theory…hyperbaric oxygen. He needed to be sealed in a chamber with oxygen and have the pressure raised to several times that of the outside atmosphere in order for the oxygen to take back it’s place in the red blood cells. He needed the same treatment that the West Virginia trapped miner needed, and for exactly the same reason…Carbon Monoxide poisoning.
In medicine, we call this “diving”, because the body undergoes pressure changes similar to that sustained by a scuba diver while underwater. We transferred him to the closest “dive chamber”, or Hyperbaric Oxygen Treatment Center just across the river from us. Of all the people I’ve see try to commit suicide, he’s come the closest without actually dying. At least he was still alive when we sent him on his way.