Carbon Monoxide Poisoning

Carbon Monoxide Poisoning from Sun YaiCheng

Carbon Monoxide Poisoning
N Engl J Med 2009;360:1217-25.

Short-Term Management

• Non-rebreather reservoir face mask supplied with high-flow O2, or 100% O2.
• It should be provided until the CO-Hb <5%.

Evaluation

• Neurologic examination
• Exposure history (duration, source, and whether others were exposed)
• ABG, CO-Hb (CO-Hb >3% in nonsmokers or >10% in smokers confirms exposure to CO)
• ECG and cardiac enzymes
• Intentional poisoning: alcohol, BZD, narcotics, amphetamines...

Guidelines

The Undersea and Hyperbaric Medical Society recommends HBO therapy for patients with serious CO poisoning (transient or prolonged unconsciousness, abnormal neurologic signs, cardiovascular dysfunction, or severe acidosis) or patients who are >36 years of age, were exposed >24 hours (including intermittent exposures), or have a CO-Hb level >25%.

A Clinical Policies Subcommittee of the American College of Emergency Physicians states that hyperbaric oxygen "is a therapeutic option for CO poisoned patients; however, its use cannot be mandated....

Conclusions and Recommendations

• Patients who have had CO poisoning should be treated immediately with normobaric oxygen (with a fraction of inspired oxygen as high as possible).
• Clinicians evaluating patients with acute poisoning should consider HBO therapy.
• Patients should be informed that they may not fully recover after poisoning, and they should be given referrals as appropriate for their sequelae.
• Patients should be informed that they may not fully recover after poisoning.
• In one randomized trial, 46% of poisoned patients treated with normobaric oxygen had cognitive sequelae 6 weeks after poisoning, and 45% had affective sequelae.

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