 |
| |
 | | Non-drug Therapy | |
- Use NBOT as the primary treatment of CO poisoning.
- Consider using HBOT in specific circumstances.
- Provide supportive care as needed.
|
|
Use NBOT as the primary treatment of CO poisoning.  |
- Intubate patients who are unable to protect their airway or who are at risk for aspiration because of impaired neurologic status and ventilate with 100% oxygen.
- Treat all patients with normobaric supplemental oxygen via a nonrebreathing facemask as soon as a diagnosis of CO poisoning is entertained and while evaluating the severity of the poisoning and concurrent illnesses.
- In patients with moderately elevated HbCO (between 5% and 25%) and only nausea, treat with oxygen for 6 hours and then reassess and discharge if symptoms have abated and HbCO has normalized.
- In patients with moderately elevated HbCO and other symptoms, treat with NBOT and admit to the hospital for overnight observation and therapy.
- Admit patients with symptoms related to CO toxicity but normal HbCO (less than 5%) who may have ongoing cellular ischemia and treat with NBOT until symptoms resolve or another cause is defined.
- Discontinue supplemental oxygen therapy and discharge admitted patients once symptoms resolve.
| Background | Back to top
|
Consider using HBOT in specific circumstances.  |
- Although controversial, consider using HBOT to treat patients with severe CO poisoning (defined as HbCO greater than 25%), loss of consciousness, persistent neurologic deficit other than nausea or headache, or evidence of cardiac ischemia.
- Treat all pregnant patients, comatose patients, and possibly children with HBOT.
- Although no treatment protocol has been proven best, if HBOT is deemed necessary, use 100% oxygen at 2 to 3 atmospheres for 120-minute periods until symptoms have resolved and HbCO is normal.
- Monitor for side effects such as seizures, tympanic membrane damage, and claustrophobia during HBOT.
| Background | Back to top
|
Provide supportive care as needed.  |
- Intubate patients with decreased mental status who are unable to maintain a safe airway or have ventilatory compromise and place them on mechanical ventilation.
- Provide chronotropic support with transvenous pacing in patients with bradycardia unresponsive to standard medical therapy.
| Background | Back to top
| | | FAQs |
|
| Jeffrey T. Chapman, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
|
|
|
The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
|
PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
|
|
|
Carbon Monoxide Poisoning
