Every time I’ve had a patient with carbon monoxide poisoning, I’ve never really known exactly what to do. The ACEP has some guidelines on carbon monoxide poisoning I want to talk about today.
Remember, you can always call Poison Control when you think you have a patient who is sick from a toxin, which is a wonderful safety net. If someone is bleeding and they’re on Xarelto and you’re not sure what to do, call Poison Control. When someone is sick from a medicine, call Poison Control. Carbon monoxide is no different. They’ll help you; they’re experts at it.
ACEP Inclusion Criteria for CO Poisoning
The inclusion criteria for carbon monoxide poisoning is all adult patients presented to the ED with suspected carbon monoxide exposure or poisoning. We’re not talking about out-of-hospital emergency care patients, peds, pregnant females and fetal exposure, those with chronic carbon monoxide poisoning or patients with delayed presentations of greater than 24 hours.
Diagnosing and Treating CO Poisoning
How do we screen patients for CO poisoning? The ACEP suggests we don’t use noninvasive carbon monoxide hemoglobin (COHb) measurements. That would be pulse CO oximetry. With patients with moderate to severe CO poisoning, you should obtain an EKG and cardiac biomarkers to identify acute myocardial injury. That can be a prediction of poor outcome.
Let me paraphrase what I just said. Carbon monoxide poisoning can affect the heart, so treat patients accordingly with EKG cardiac enzymes. How do we intervene medically? You use hyperbaric oxygenation therapy or high flow normobaric therapy for acute carbon monoxide poisoning. That means someone who you think has been exposed gets high flow oxygen.
It remains unclear whether hyperbaric oxygen therapy is superior to normobaric oxygen therapy for long-term neurocognitive outcomes. Hyperbaric oxygen is probably a good thing, but we really don’t know for sure.
I find carbon monoxide really tricky. Typically, these cases occur when someone is in a house and the carbon monoxide detector goes off. I often ask, “Who else was in the house? How did they feel?” However, this can be tricky. My hope is this review of the ACEP guidelines on CO poisoning is helpful to you.