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Carbon monoxide poisoning
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of carbon monoxide poisoning are prepared by our editorial team based on guidelines from the Association of the Scientific Medical Societies in Germany (AWMF 2021), the American Heart Association (AHA 2020), the American College of Emergency Physicians (ACEP 2017), and the British Thoracic Society (BTS 2017).
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Screening and diagnosis
Diagnosis: as per AWMF 2021 guidelines, diagnose CO poisoning based on clinical symptoms and proven or probable exposure to CO.
B
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Differential diagnosis
Classification and risk stratification
Settings of exposure: as per AWMF 2021 guidelines, recognize that CO can occur in numerous situations and ambient conditions, including:
fire smoke
loss of consciousness without apparent cause in enclosed spaces with fireplaces (such as heaters, stoves, fireplaces, barbecues)
attempted suicide - often with corresponding indicators (suicide note, taped-off rooms)
in silos with large quantities of wood pellets
engine exhaust (without catalytic converter)
hookah use.
B
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Classification
Diagnostic investigations
History and physical examination
As per AWMF 2021 guidelines:
Determine the source of CO exposure, especially in patients with CO poisoning not being brought in by emergency medical services, in order to identify other poisoned persons and, if necessary, prevent further CO poisoning from as yet unknown sources.
B
Perform a neurological examination, including the mini-mental state examination, in patients with clinical symptoms.
B
Obtain further specific evaluation if there is sufficient suspicion of a relevant differential diagnosis. B
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CO pulse oximetry
Blood gas analysis
Evaluation for cardiac injury
Toxicological screening
Respiratory support
Supplemental oxygen and ventilation
As per AWMF 2021 guidelines:
Initiate immediate administration of 100% oxygen or ventilation in patients with suspected CO poisoning. Initiate oxygen administration in the prehospital phase of care.
B
Administer oxygen immediately at the highest possible concentration with any of the following techniques, regardless of the oxygen saturation:
mask CPAP
demand valve
constant dosing (high-flow) via tight-fitting mask with reservoir bag
invasively using appropriate airway protection if protective reflexes are inadequate
B
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Hyperbaric oxygen therapy
Medical management
Prehospital care: as per AWMF 2021 guidelines, instruct first responders by the emergency dispatch center to observe measures of self-protection if signs of a potential hazard involving CO are detected and relay the information to the emergency medical services team.
B
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Indications for hospital admission
Inpatient care
Clinical monitoring
As per AWMF 2021 guidelines:
Obtain clinical monitoring in accordance with the disease severity as long as patients are symptomatic.
B
Recognize that clinical symptoms do not correlate with COHb clearance from the blood. Do not obtain COHb monitoring alone for treatment management.
B
Patient education
Preventative measures
CO detectors
As per AWMF 2021 guidelines:
Ensure the use of early-warning detectors (smoke and CO alarms) in every household.
B
Use a multi-stage approach depending on the concentration indicated when CO warning devices are used by emergency services.
B
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Alerting fire department