Management of Carbon Monoxide Poisoning
Causes
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House Fire
Portable heaters
Ovens
Fires
Car exhaust
Cigarette Smoke
Suicide attempt
IF CO POISONING SUSPECTED TAKE IMMEDIATE HbCO LEVEL
(cap,ven,art sample, Gas and EDTA Bottle) AND PUT ON 100% OXYGEN
History
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History of exposure – time since exposure
Possible source
Co-morbidity – including cardiac or respiratory disease
Pregnancy
Cold weather/exposure
Other members of family exposed?
Clinical Features
General
Flu-like
Malaise
Lethargy
Respiratory
Dyspnoea
Cardiovascular
Chest pain
Palpitations
Syncope
Gastrointestinal
Nausea
Vomiting
Diarrhoea
Faecal/urinary
incontinence
Psychiatry
Confusion
Depression
Impulsiveness
Distractibility
Hallucinations
Confabulation
Agitation
Neurology
Headache
Drowsy
Visual
disturbance
Seizure
Memory
Gait
Disturbance
Bizarre
neuro
symptoms
Coma
Examination
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General
Other
injuries
Immediate ABC
GCS
Resp
 RR
Late  RR
CVS
pulse
Arrhythmias
 BP
BP
Psychiatric
Amnesia
Test short
memory
term
Neurology
Full Examination
Conscious level
Hyperreflexia/
 plantars
Poor coordination
Blindness
Ataxia
Eyes
papilloedema
Signs of severe intoxication in Bold
Important points
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Babies may just be floppy and poor feeding
Need to assess full neurological status including orientation, memory,
visual-spatial awareness, concentration.
Be more cautious in pregnancy as increased risk to fœtus.
Investigations
Bloods
 COHb if not already performed
 FBC – mild leucocytosis
 U+E/LFT
 Glucose
 CK/ LDH/Troponin – if HbCO
ischaemia/infarction)
level
raised
CXR – pulmonary oedema
ECG – sinus tachycardia, arrhythmias
Consider
 Paracetamol/salicylate levels if suicide attempt
 Cyanide level if in fire
(CO
can
cause
Management
Assess ABCD - glucose
If unable to maintain airway
 Senior help
 Intubate and Ventilate
 Liaise with PICU
If concerns re raised ICP
(eg bradycardia, hypertension, variable/low GCS, pupillary abnormalities, abnormal
posture )
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Senior Help
Intubate and Ventilate
CT scan
Liaise with PICU
Correct Hypoglycaemia
Acidosis – corrects with O2 therapy no need to give sodium bicarbonate
Removal of Carbon Monoxide
CO level does not correlate well with severity of poisoning.
All children should be initially commenced on 100% oxygen.
Liaise with Poisons Information.
All symptomatic children should be admitted with regular review
Hyperbaric Oxygen
Use of hyperbaric oxygen therapy is controversial.
A recent Cochrane Review suggested that there is no evidence, in adults, to
support use of Hyperbaric Oxygen for treatment of patients with CO poisoning.
National Poisons Information recommends that patients should be referred for
HBO if there is easy and rapid access. They do not recommend it if transfer
over long distance is required.
The British Hyperbaric Association currently suggests immediate discussion
with Hyperbaric Unit if CO poisoning with clinical features below:
Any neurological abnormality
Cognitive impairment (memory)
Personality Change
Reduced GCS
Chest Pain – abnormal ECG, cardiac enzymes
Pregnancy
Loss of consciousness
If any of these features are present associated with Carbon Monoxide
Poisoning liaise with Consultant on Call and PICU.
Follow up
Neurological features can become apparent 3-4 weeks post exposure. Parents
need to be made aware of this on discharge. Follow-up may need to be
arranged.
Public Health
Advised to contact Public Health
These may need to be informed to trace contacts, monitor levels etc.
Suspected CO
poisoning
Assess
ABC
YES
Maintaining own
airway?
NO
Call for Senior help
HbCO level
Gas/EDTA
Bottle
Commence 100% O2
(if self ventilating via CPAP,
anaesthetic mask or at least
non-rebreathe mask with
10L/min flow.
NO
Consider Intubation and Ventilation
and Liaise with PICU
History re time of exposure,
length of O2 therapy
Full clinical examination
Abnormal neurological signs
(see main text)
Chest pain
Pregnant
Investigations:
FBC, U+E, LFT,glucose
Blood Gas
ECG
Consider CT/CXR/Cardiac enzymes if
significant intoxication or clinical
abnormalities
Consider co-morbidity eg cyanide
levels if fire, paracetamol/salicylate
levels if self harm
Liaise with:
TOXBASE
If severe intoxication
(see notes)
Consider d/w DDRC re:
Hyperbaric Oxygen
01752 209999
YES