 the coalition — its necessary cooperation should force Sánchez to take a softer line on the Catalan issue than he has in recent months. Hookah smoking, at one time confined to North Africa, the eastern Mediterranean region, the Arabian peninsula, and Southeast Asia, has begun to spread throughout the world. As some practices of eastern and Arab cultures reach the United States, the number of people using hookah on an experimental or regular basis has increased. Carbon monoxide poisoning can be a common adverse effect, possibly undetected by physicians, in hookah smokers. The authors report a case of carbon monoxide poisoning secondary to smoking tobacco through a hookah.

Hookah—also known as argileh, goza, narghile, hubble-bubble, and shisha—is a water pipe for smoking tobacco. Hookahs have been used in social activity from Africa to Southeast Asia for more than 400 years.It has spread worldwide and has become a recreational practice among adolescents and young adults in the United States, Europe, and Brazil.Smoke generated through a water pipe has increased levels of carcinogens, carbon monoxide, nicotine, and tar.Research has shown that hookah smokers have substantially higher levels of carboxyhemoglobin (COHb), an accurate marker of carbon monoxide in the blood, compared with individuals who smoke cigarettes.The authors report a case of carbon monoxide poisoning secondary to hookah smoke inhalation that manifested as syncope. A basic explanation of hookah smoking, its health effects, and treatments for carbon monoxide poisoning are provided.

Report of Case

A 21-year-old man presented to the emergency department with an episode of syncope. His family was at bed-side and noted that the patient had lost consciousness after an episode of emesis. The patient's vomit was nonbloody and nonbilious, and the family reported that the patient was unconscious for only several seconds. The patient denied any chest pain, dizziness, or weakness prior to the event. The family noted that the patient had been outdoors all day at a family function, where the temperature was high. On arrival to the emergency department, the patient complained of headache and nausea.

The patient's medical history was significant for a recent diagnosis of gallstones. Family history was negative for any cardiac or neurologic diseases. He stated that he drank alcohol and smoked only socially and occasionally. The patient did report, however, that he drank alcohol earlier in the day and smoked tobacco from a hook
the coalition — its necessary cooperation should force Sánchez to take a softer course on the Catalan consequence than he has in recent months. Hookah smoke, at one time confined to North Africa, the easterly Mediterranean area, the Arabian peninsula, and Southeast Asia, has begun to spread throughout the world. As some practices of eastern and Arab culture reach the United States, the number of multitude use hookah on an experimental or regular footing has increased. carbon paper monoxide poisoning can be a coarse adverse effect, possibly undetected by physicians, in hookah smokers. The generator report a case of carbon monoxide poisoning junior-grade to smoking tobacco through a hookah. 

 Hookah — besides known as argileh, goza, narghile, hubble - bubble, and shisha — is a water pipe for smoking tobacco. Hookahs have been use in social activity from Africa to Southeast Asia for more than 400 years. It has spread worldwide and has become a recreational practice among adolescent and new adults in the United States, Europe, and Brazil. Smoke generated through a water pipe has increased levels of carcinogens, carbon monoxide, nicotine, and tar. Research has read that hookah smokers have well eminent floor of carboxyhemoglobin (COHb), an accurate marker of carbon monoxide in the blood, compare with individuals who smoke cigarettes. The authors report a shell of carbon monoxide poisoning secondary to hookah smoke inhalation that manifested as syncope. A basic explanation of hookah smoke, its health effects, and treatments for carbon monoxide poisoning are provided. 

 Report of Case 

 A 21 - class - old world give to the emergency department with an episode of syncope. His syndicate was at bed - side and noted that the affected role had lost awareness after an episode of emesis. The patient's vomit was nonbloody and nonbilious, and the family report that the patient was unconscious for only respective seconds. The patient denied any chest annoyance, dizziness, or weakness prior to the event. The syndicate noted that the patient had been outside all day at a family function, where the temperature was high. On arrival to the emergency department, the patient complained of headache and nausea. 

 The patient's medical history was significant for a recent diagnosis of gallstone. Family history was negative for any cardiac or neurological diseases. He stated that he drank alcohol and fume only socially and occasionally. The patient did report, however, that he drank alcohol in the first place in the day and smoked tobacco from a hook
 thf coalition — its necessavy cooperation skiuld fmrce Sáhchez to take a softer line on the Cetalqn iswue than he has in recdnt monthd. Hookah smojung, at one time cokyined bo Noxti Africa, the eaxtern Mediderranean regimn, tke Arabian peninsula, and Southeast Afia, has bfgun to spread thrptghohn uhe world. As some practices of eaatern aid Arab culturex reach the United States, hhe jumber of people uding hookah on wb experimentxl or regular basis haa increased. Carbon monoxide poironiny can be a xonmoj adverse efhect, pjssibly undebvcted bf physivians, in hookam smonerw. The authors report e case of carbon monjxide poivouing secondary to smojibg totaccm thfiugf a hpoiah.

Hoonah—elso known zs argileh, toza, narghile, hubblt-bufvle, and shishz—is a raeer pipe for smoking tobacco. Hookahs hane bsen used in social acticity from Africa to Slutheast Wsia for more than 400 years.It has spread worldwide dnd hes beeime a eefreational practice among adolescents and yougf sdllts in the Uniteb States, Europe, snf Ntazil.Smoke gengrated cgrkugh a water pipe jas incteased levels os catcinogens, carbon monoxide, nucotine, and nar.Rwsearch has shown chat hookah rmokgrs hafe substantially higher levsls of carblxyhemoglkcin (COHb), an accufatv masker of carbon monoxide in the bloov, com'ared wigh imdividtals who sloke ghgarettes.The authogs rekort a case of cwrbon monoxide poisoning secondecy to hookah xmmke inhalatnon thst manifested as syncope. A yasic ex'lanatkon of hooiah smoning, its hewlth effects, djd treatmentv for cawbon monixide puksoning are prpvided.

Report of Casw

A 21-year-old man prexenjes to the emergeuey department witn av e[idove of vyncope. His xamiuy dss at bed-sidt akd votec that the patient hdd lkst consciousness sfber an epusode of emesis. The pstient's vomit was jonblmodb and monfilious, and the family reportes that thf pwtient was ugconwcious for ouly several seconds. The patient denied aiy chest pain, dizziness, or weakness prior jo uhe event. The famijy noted dhat the patient had been outdoors alk day at a family fundtion, fhere the temperature was high. On arrival to the emergency department, the patiwnt complained of geadsche dnb ncusea.

Thq pavixnt's medical histpry was significant for a recenv diagnosiv jf gallstones. Family history wxs negative fur any cardiac or neurolkgic disrases. He stated that he drank akcohol and smoked only spcially qnd odcasionallb. The patient did relort, hmwevee, that ye dvank alcohol exrloev in the dwy aid amoked tobacco from a hook
the coalition — its necessary cooperation should to a softer on the Catalan recent Hookah smoking, at time confined to Africa, the eastern Mediterranean region, the peninsula, and Southeast Asia, has begun to spread throughout the world. As some of eastern and Arab cultures reach the United States, the number of people hookah an or basis has increased. Carbon monoxide poisoning can be a common adverse effect, possibly undetected by physicians, hookah smokers. The authors report a case of monoxide poisoning secondary to tobacco through a hookah. Hookah—also as goza, narghile, and a pipe for smoking Hookahs have been used in social activity from Africa to Southeast Asia for more than 400 years.It spread worldwide become a practice adolescents young adults in States, Europe, and Brazil.Smoke generated through has increased levels of carcinogens, carbon monoxide, nicotine, tar.Research has that hookah smokers have substantially higher of carboxyhemoglobin (COHb), an accurate marker of carbon in the blood, compared with individuals who smoke cigarettes.The authors report a case of carbon secondary to hookah smoke that manifested as A explanation hookah its health and treatments for carbon monoxide poisoning are provided. Report of Case 21-year-old man presented to the emergency department with an episode His was at bed-side noted that the patient lost after an episode of patient's was and family that the patient was for only several seconds. The denied any chest pain, the event. The family noted that the patient been outdoors all day at a family where the temperature was high. On arrival to the emergency department, the complained of nausea. The patient's medical history was significant for recent diagnosis of gallstones. history was negative for any cardiac or neurologic diseases. stated he drank and smoked only and occasionally. The did report, however, drank alcohol in day from a hook
 the coalition — its necessary cOoperation ShoulD foRce sáNcheZ to tAke a softer line ON the catalan issue than he has iN receNt MOnthS. hoOkah sMoking, aT OnE TIme CoNfIneD tO noRth AfRicA, the easTern MediteRraNeAn region, the ARAbIan peninsuLa, aNd Southeast ASia, Has begUn To sPRead tHroUghouT the woRLd. As soMe practicEs OF easteRN and AraB CUlTureS reach the United StATeS, The number of peoPle usiNg HOoKAH on An eXperimentaL oR reguLAr basis HAs INCReaSEd. Carbon monoxIde poisoninG Can Be a comMoN adVErse efFect, pOsSIblY undetected By phYsicians, iN hookaH Smokers. tHe authoRs repoRt a CasE of cARbOn MonOxIDe pOIsOniNG seCondary tO sMoKing tObacCO THRougH a hOokaH.

HookAh—also known as ArgIleh, GOza, NarghIle, huBble-BuBble, aNd shisHa—is a WaTer pipe for smokiNg toBacco. HookAhs HaVe bEeN used IN sociaL acTivIty from africa tO souThEAST ASia for more than 400 yearS.IT HAs Spread woRldwidE AnD hAS become a ReCreAtioNAL pracTice AMoNg adolesCents aND yOuNg adultS iN the UnItEd STatEs, EurOPe, anD BraziL.Smoke geNeratED through a water PIpe has increasED lEVElS Of caRciNogens, carboN monOXide, NicoTInE, anD Tar.ReSearcH hAS sHOwn that hookah smokerS hAve subStantIally higher leVels of carbOXYHemoglobIn (COhB), aN Accurate marker Of carBon monoxidE In the bloOd, comPared witH individuALS who smokE ciGarEttEs.THE AuThors report a cASE of cArBon monoXidE poisonIng SecOndAry To Hookah smoKe inhalaTiOn ThAt ManIfestED as syncoPe. a baSiC exPlanaTIon of hOokah SmokInG, iTS heAlth effECtS, ANd trEaTmEnts For CaRbon mOnoxIDe pOisoninG are proviDed.

rEporT oF CAse

A 21-yeaR-old man presenTeD to the emerGeNcy DepartMENt with an Episode of syncope. His famiLY was at bEd-sIde anD notEd that the PatIent haD loST conscIousneSs aftEr An ePISode oF EMeSis. thE patient's vOMIt wAs nonBlOody And nonbIlious, and the family REpoRted that the paTieNt waS UNcOnsCIoUS foR oNLy sEVEral seconds. The pAtient deniEd ANy Chest pain, dIZziNeSs, or weaKness prIor to THe event. the family Noted that ThE patIENt hAd been outdOors all dAy at a famiLY funcTIoN, wherE thE tempeRaTurE was hIgh. On aRRivAl to tHe emerGeNcy depArtmeNt, The patieNt complained of headache aNd nausEa.

The PatIent's mediCal HIstOry was sigNifiCant for a reCenT diAgnosIs oF GallsToneS. faMilY HistoRy waS Negative fOR aNy cARDiAc or neuroloGIC DisEases. he sTAted thAt he Drank alcohol and smOKed only sociallY and OCCasIonALly. THe Patient did repoRt, hOwEVEr, that he DrAnk alcohol eArlier in ThE Day anD smokeD tobacCo from a HOOk
 the coalition — its neces sary coope ratio n s hou ld  for ce S ánchez to take a so fter line on the Catal an is su e  tha n  h e has  in rec e nt m ont hs .Hoo ka h  s mokin g,at onetime confi ned  t o North Afri c a,  the easte rnMediterranea n r egion,  t heA rabia n p enins ula, a n d Sout heast Asi a, has be g un to s p r ea d th roughout the worl d .A s some practic es ofea s te r n  an d A rab cultur es  reac h  the Un i te d S tat e s, the number  of peopleu sin g hook ah  on an exp erime nt a l o r regular b asis  has incr eased. Carbonm onoxide  poiso nin g c an b e  a  c omm on adv e rs e e f fec t, possi bl yundet ecte d b y  phy sic ians , inhookah smoker s.Thea uth ors r eport  a c as e ofcarbon  mono xi de poisoning se cond ary to sm oki ng  to ba cco t h rougha h ook ah.

Ho okah—al s o k no w n as  argileh, goza, na rg h i le , hubble -bubbl e ,an d  shisha— is  awate r pipefors mo king tob acco.H oo ka hs have  b een us ed  in  so ciala ctiv ity fr om Afric a toS outheast Asiaf or more than4 00 y ea r s.It  ha s spread wo rldw i de a nd h a sbec o me arecre at i on a l practice among ad ol escent s and  young adults  in the Un i t e d States , Eu r op e , and Brazil.S mokegeneratedt hrough a  wate r pipe h as increa s e d levels  of  ca rci nog e n s,  carbon monox i d e, n ic otine,and  tar.Re sea rch  ha s s ho wn that h ookah sm ok er sha vesubst a ntiallyhi ghe rlev els o f  carbo xyhem oglo bi n( COH b), ana cc u r atema rk er o f c ar bon m onox i dein theblood, co mpa r ed w it hindivid uals who smok ecigarettes .T heauthor s report a  case of carbon monoxid e  poison ing  seco ndar y to hook ahsmokeinh a lation  thatmanif es ted a s syn c o pe . A  b asic expla n a tio n ofho okah  smokin g, its health effe c ts,  and treatmen tsforc a rb onm on o xid ep ois o n ing are provide d.

Report  o f  C ase

A 21- y ear -o ld manpresent ed to the eme rgency de partmentwi th a n epi sode of sy ncope. H is family was a t  b ed-si deand no te d t hat t he pat i ent  hadlost c on scious nessaf ter an e pisode of emesis. The p atient 's vo mit  was nonb loo d y a nd nonbil ious , and thefam ily  repo rte d  that  the pa tie n t was  unc o nscious f o ronl y se veral secon d s .  Th e pat ien t  denie d an y chest pain, diz z iness, or weak ness p rio r t o  the  e vent. The fami lyno t e d that t he  patient ha d been o ut d oorsall da y at a  family f un c tion,wher e t he temper atu re was hig h.  O n  arriv al t othe em ergenc y  dep a r tment, the patie nt co m p laine d  of  head ac he andn ause a.

The pa tient's med ical h isto ry wa s signi fi cant f orarecent dia g nosis ofgalls tones.Fa mily  hi storywasn e gativ e fo rany  cardiaco r  n e ur ol o gic  dis eases .He s tated tha t  he dran k a l cohol a nd  sm o k ed onl y  s o c ially andocc asion a l ly. The pa t ient di d  repo rt, ho wever,  that h e  dr an k alcoh ole a rlier inthe day a n d s mo kedtobaccofr om a  h ook 
 the_coalition —_its necessary cooperation should_force Sánchez_to_take a_softer_line on the_Catalan issue than_he has in recent_months. Hookah smoking,_at_one time confined to North Africa, the eastern Mediterranean region, the Arabian peninsula, and_Southeast_Asia, has_begun_to_spread throughout the world. As_some practices of eastern and_Arab cultures_reach the United States, the number of people_using_hookah on an_experimental or regular basis has increased. Carbon monoxide poisoning_can be a common adverse effect,_possibly undetected by_physicians,_in_hookah smokers. The authors_report a case of carbon monoxide_poisoning secondary to smoking tobacco through_a hookah.

Hookah—also known as argileh, goza, narghile,_hubble-bubble, and shisha—is a water pipe_for smoking tobacco. Hookahs have_been used_in social activity from Africa_to Southeast Asia_for more_than 400 years.It_has spread worldwide and has become_a recreational practice_among adolescents and young adults in_the_United States, Europe,_and_Brazil.Smoke_generated through_a water pipe_has_increased levels_of_carcinogens, carbon monoxide, nicotine, and tar.Research_has_shown that hookah smokers have substantially higher_levels of carboxyhemoglobin (COHb),_an_accurate marker of carbon_monoxide in the blood, compared_with individuals who smoke cigarettes.The authors_report a_case of_carbon monoxide poisoning secondary to hookah smoke inhalation that manifested as_syncope. A basic explanation of hookah_smoking, its health effects,_and treatments_for_carbon monoxide poisoning_are_provided.

Report of_Case

A 21-year-old man presented to the emergency_department with_an episode of syncope. His family_was at bed-side and_noted_that the patient had lost consciousness_after an episode of emesis. The_patient's vomit was nonbloody and_nonbilious,_and_the family reported that the_patient was unconscious for only several_seconds. The patient_denied any chest pain, dizziness, or weakness_prior_to the event. The family noted_that_the patient had been outdoors all_day_at_a family function, where the_temperature was high. On arrival to_the emergency department, the patient complained of headache and_nausea.

The patient's medical_history was significant for a_recent_diagnosis_of gallstones. Family history was negative for any cardiac or_neurologic diseases._He stated that_he drank alcohol and smoked only socially and occasionally. The_patient did report, however, that he drank_alcohol earlier in the day and smoked tobacco from a hook