Carbon Monoxide Poisoning

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.

Critical Questions

  • 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.
  • 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.
  • 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.

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