Overview
Carbon monoxide (CO) poisoning can occur from various sources, including fire smoke, engine exhaust, and indoor heating devices 1. Symptoms are nonspecific and range from headache and dizziness to unconsciousness and death 1. Neurological damage can occur even after COHb levels normalize due to impaired cellular respiration and immunomodulatory processes 1.Diagnosis
Diagnosis is based on clinical symptoms and confirmed or probable CO exposure 1.
Negative carboxyhemoglobin (COHb) levels do not exclude CO poisoning if symptoms and history are suggestive 1.
COHb monitoring alone is insufficient for treatment management as clinical symptoms do not correlate with COHb elimination 1.
If symptoms persist despite treatment, reevaluation for other differential diagnoses is recommended 1.Management
Immediate administration of 100% oxygen should be initiated in the prehospital setting if CO poisoning is suspected 1.
Evidence regarding the benefit of hyperbaric oxygen therapy (HBOT) is scant and controversial due to study heterogeneity 1.Key Recommendations
If CO poisoning is suspected, initiate 100% oxygen breathing immediately in the prehospital setting 1. (Evidence: Expert opinion)
Negative carboxyhemoglobin levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon 1. (Evidence: Expert opinion)
COHb monitoring alone is unsuitable for treatment management because clinical symptoms do not correlate with COHb elimination from the blood 1. (Evidence: Expert opinion)
If required, HBOT should be considered, but evidence for its benefit is scant and controversial 1. (Evidence: Weak)References
1 Jüttner B, Busch HJ, Callies A, Dormann H, Janisch T, Kaiser G et al.. S2k guideline diagnosis and treatment of carbon monoxide poisoning. German medical science : GMS e-journal 2021. link