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Carbon Monoxide Poisoning, Emergency Medicine

Trevonne M. Thompson Reviewed 06/2017
 


Basics

Description

  • Carbon monoxide (CO) is a colorless, odorless, nonirritating gas.

  • Binds to hemoglobin to form carboxyhemoglobin:

    • Decreases O2-carrying capacity

  • Direct cellular toxin

  • Impairs cellular O2 ...

Diagnosis

Signs and Symptoms

History

  • CNS:

    • Headache

    • Dizziness

    • Ataxia

    • Confusion

    • Syncope

    • Seizures

  • GI:

    • Nausea

    • Vomiting

  • Cardiovascular:

    • Chest pain

    • Palpitations

  • Respiratory:

    • Dyspnea

  • Ophthalmologic:

    • Decreased visual acuity

Physical Exam

Treatment

Pre-Hospital

Administer 100% O2 

Initial Stabilization/Therapy

  • ABCs

  • Establish IV access

  • 100% oxygen

  • Cardiac monitor

Ed Treatment/Procedures

  • Oxygen:

    • Administer 100% normobaric O2:

      • Via face mask or endo...

Follow-Up

Disposition

Admission Criteria

  • Persistent symptoms after 4 hr of treatment with 100% oxygen

  • Evidence of myocardial ischemia or cardiac instability

  • Seizures

  • Persistent metabolic acidosis

  • Syncope

Discharge Criteria

Pearls and Pitfalls

  • Suspect CO poisoning in patients who present with headaches when home heaters are initiated.

  • Suspect CO poisoning when family members living in the same enclosed space have similar ...

Additional Reading

  • Buckley  NA, Juurlink  DN, Isbister  G, et al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev.  2011;13(4):CD002041.

  • Guzman  JA. Carbon monoxide poi...

Codes

ICD9

986 Toxic effect of carbon monoxide 

ICD10

  • T58.11XA Toxic effect of carb monx from utility gas, acc, init

  • T58.91XA Toxic effect of carb monx from unsp source, acc, init

  • T58.92XA Toxic effect of ...

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