Carbon Monoxide Poisoning

Question 1

What is carbon monoxide and what causes carbon monoxide poisoning?

Answer 1

• Carbon monoxide is a colorless, odorless gas produced by faulty appliances burning organic fuels.
• ​It is also present in vehicle exhaust fumes and sometimes in smoke from house fires.
• It binds with hemoglobin and cytochrome oxidase reducing tissue oxygen delivery and inhibiting cellular respiration.

It is a common cause of death by poisoning and most patients die before reaching the hospital.

Question 2

What are some subjective/physical exam findings associated with carbon monoxide poisoning?

Answer 2

• Subjective: shortness of breath, headache, confusion, irritability, clumsiness, mental status changes, N/V/D, weakness, blurred vision, psychosis, Parkinsonism, paralysis
• Physical: Dysrhythmias, cardiac arrest, heart failure, hypoxia

Question 3

What lab findings are associated with carbon monoxide poisoning?

Answer 3

Elevated carboxyhemoglobin level, sinus tachycardia, ST depression, PVCs, metabolic acidosis

Question 4

How do you manage patients with carbon monoxide poisoning?

Answer 4

• Management: 100% oxygen by mask/positive pressure mask or ETT. Hyperbaric oxygen therapy is controversial as it has not shown to consistently improve clinical outcomes. The logistical difficulties of transporting patients to a facility that has a hyperbaric oxygen chamber are substantial.
• Hyperbaric oxygen may be needed if carboxyhemoglobin levels are greater than 25%, if patient is pregnant or if they have an altered mental status