Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning (2016)
Scope of Application
This guideline is intended for physicians working in emergency departments.
Inclusion Criteria
This guideline is intended for adult patients presenting to the emergency department with suspected or diagnosed acute carbon monoxide poisoning.
Exclusion Criteria
This guideline is not intended to be used for out-of-hospital emergency care patients, pediatric populations, pregnant patients and fetal exposures, those with chronic carbon monoxide poisoning, or patients with delayed presentations (more than 24 hours after cessation of exposure) of carbon monoxide poisoning.
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.
Critical Questions
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In emergency department patients with suspected acute carbon monoxide (CO) poisoning, can noninvasive carboxyhemoglobin (COHb) measurement be used to accurately diagnose CO toxicity?
Recommendations
Level A Recommendations
None specified.
Level B Recommendations
Do not use noninvasive COHb measurement (pulse CO oximetry) to diagnose CO toxicity in patients with suspected acute CO poisoning.
Level C Recommendations
None specified.
Level A Recommendations
None specified.
Level B Recommendations
Do not use noninvasive COHb measurement (pulse CO oximetry) to diagnose CO toxicity in patients with suspected acute CO poisoning.
Level C Recommendations
None specified.
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In emergency department patients diagnosed with acute carbon monoxide (CO) poisoning, does hyperbaric oxygen (HBO2) therapy as compared with normobaric oxygen therapy improve long-term neurocognitive outcomes?
Recommendations
Level A Recommendations
None specified.
Level B Recommendations
Emergency physicians should use HBO2 therapy or high-flow normobaric therapy for acute CO-poisoned patients. It remains unclear whether HBO2 therapy is superior to normobaric oxygen therapy for improving long-term neurocognitive outcomes.
Level C Recommendations
None specified.
Level A Recommendations
None specified.
Level B Recommendations
Emergency physicians should use HBO2 therapy or high-flow normobaric therapy for acute CO-poisoned patients. It remains unclear whether HBO2 therapy is superior to normobaric oxygen therapy for improving long-term neurocognitive outcomes.
Level C Recommendations
None specified.
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In emergency department patients diagnosed with acute carbon monoxide (CO) poisoning, can cardiac testing be used to predict morbidity or mortality?
Recommendations
Level A Recommendations
None specified.
Level B Recommendations
In ED patients with moderate to severe CO poisoning, obtain an ECG and cardiac biomarker levels to identify acute myocardial injury, which can predict poor outcome.
Level C Recommendations
None specified.
Level A Recommendations
None specified.
Level B Recommendations
In ED patients with moderate to severe CO poisoning, obtain an ECG and cardiac biomarker levels to identify acute myocardial injury, which can predict poor outcome.
Level C Recommendations
None specified.
