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Last Updated: 8/13/2014  

Carbon Monoxide Poisoning

Prevention
  • Educate all individuals about how to prevent CO poisoning by installing CO detectors and knowing the signs of CO poisoning.

Diagnosis
  • Obtain a careful history of neurologic and cardiac symptoms consistent with CO poisoning and ask about sick housemates or pets and possible sources of CO exposure. Note that the most common symptoms include headache, dizziness, weakness, and nausea.

  • Use the physical exam to confirm neurologic or cardiac signs and to exclude alternative diagnoses and concomitant illnesses.

  • Determine levels of blood carboxyhemoglobin; confirm CO exposure in nonsmokers with levels greater than 3% and in smokers with levels greater than 10%.

  • Check other diagnostic tests, including ECG, ABG, and chest x-ray, to assess complications and concomitant problems.

  • Do not use CO levels from noninvasive pulse oximeters to rule out CO poisoning.

  • Use neuroimaging in patients in whom alternative diagnoses are likely but not as a primary diagnostic test for CO poisoning.

Therapy
  • Use high-flow 100% normobaric oxygen as the initial treatment for CO poisoning.

  • Consider using hyperbaric oxygen therapy in patients with severe CO poisoning who are at risk for neuropsychiatric complications.

DOI: 10.7326/d988
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Jeffrey T. Chapman, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lindell K. Weaver, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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