Carbon monoxide toxicity - Revision history

Cmb23: /* Workup */

2023-12-22T16:59:23Z

Workup

← Revisión anterior		Revisión del 16:59 22 dic 2023
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	*Pulse CO-oximetry		*Pulse CO-oximetry
	**Special pulse CO-ox can accurately determine CO level<ref>Coulange M, et al. Reliability of new pulse CO-oximeter in victims of carbon monoxide poisoning. Undersea Hyperb Med. 2008; 35(2):107-111. </ref>		**Special pulse CO-ox can accurately determine CO level<ref>Coulange M, et al. Reliability of new pulse CO-oximeter in victims of carbon monoxide poisoning. Undersea Hyperb Med. 2008; 35(2):107-111. </ref>
	*Lactate		*Lactate (usually not significantly elevated, and if so should raise concern for cyanide toxicity) <ref> Wardi G, Brice J, Correia M, Liu D, Self M, Tainter C. Demystifying Lactate in the Emergency Department. Ann Emerg Med. 2020 Feb;75(2):287-298. doi: 10.1016/j.annemergmed.2019.06.027. Epub 2019 Aug 29. Erratum in: Ann Emerg Med. 2020 Apr;75(4):557. PMID: 31474479. </ref>
	*Chemistry		*Chemistry
	*[[Troponin]]		*[[Troponin]]

Rossdonaldson1 at 16:34, 10 August 2022

2022-08-10T16:34:58Z

← Revisión anterior		Revisión del 16:34 10 ago 2022
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	==Management==		==Management==
	===General ~~Mangement~~===		===General Management===
	*If smoke inhalation, good pulmonary toilet is very important		*If smoke inhalation, good pulmonary toilet is very important
	*'''NEVER''' use steroids in smoke inhalation injury; intubate early if concern for obstructing edema		*'''NEVER''' use steroids in smoke inhalation injury; intubate early if concern for obstructing edema
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	**Early PEEP prevents progressive atelectasis and improves O2 diffusion		**Early PEEP prevents progressive atelectasis and improves O2 diffusion
	**In general, COhemoglobin levels fall rapidly to < 10% within 30 min of 100% O2		**In general, COhemoglobin levels fall rapidly to < 10% within 30 min of 100% O2
	**Maintain 100% O2 for additional 2-3 hrs after < 10%, since anaerobic ~~Cometabolism~~ is occuring due to cytochrome oxidase poisoning<ref>MetroHealth Medical Center Burn ICU Handbook (Not a policy manual), Cleveland, OH</ref>		**Maintain 100% O2 for additional 2-3 hrs after < 10%, since anaerobic COmetabolism is occuring due to cytochrome oxidase poisoning<ref>MetroHealth Medical Center Burn ICU Handbook (Not a policy manual), Cleveland, OH</ref>
	***Anaerobic metabolism universally seen with COhemoglobin > 40%		***Anaerobic metabolism universally seen with COhemoglobin > 40%
	***Monitor for return of aerobic metabolism with normal serum bicarbonate levels		***Monitor for return of aerobic metabolism with normal serum bicarbonate levels
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	**[[Coma]]		**[[Coma]]
	**[[Focal neuro deficit]]		**[[Focal neuro deficit]]
	**[[Pregnancy]] with ~~Cohemoglobin~~ level >15%		**[[Pregnancy]] with COhemoglobin level >15%
	***Fetal Hb tends to bind more CO		***Fetal Hb tends to bind more CO
	**Blood level >25%		**Blood level >25%
	**[[Acute myocardial ischemia]]		**[[Acute myocardial ischemia]]
	**[[Prolonged CO exposure with minor clinical findings (“soaking”)]]<ref>Marx, John A., and Peter Rosen. Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book: Edition 9. Philadelphia, PA: Elsevier/Saunders, 2017. Pg 2387</ref>		**Prolonged CO exposure with minor clinical findings (“soaking”)<ref>Marx, John A., and Peter Rosen. Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book: Edition 9. Philadelphia, PA: Elsevier/Saunders, 2017. Pg 2387</ref>

	==Disposition==		==Disposition==
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	*[[Headache]], [[vomiting]], elevated COhemoglobin level		*[[Headache]], [[vomiting]], elevated COhemoglobin level
	*Discharge after 4hr obs and symptom resolution and assurance that the discharge environment is safe		*Discharge after 4hr obs and symptom resolution and assurance that the discharge environment is safe

	===Severely symptomatic===		===Severely symptomatic===
	*[[Ataxia]], [[syncope]], [[chest pain]], [[focal neuro deficit]], [[dyspnea]], [[ECG]] changes, pregnant with COhemoglobin >15%		*[[Ataxia]], [[syncope]], [[chest pain]], [[focal neuro deficit]], [[dyspnea]], [[ECG]] changes, pregnant with COhemoglobin >15%

Ejb711: /* Hyperbaric Therapy (HBO) */

2021-12-03T19:31:18Z

Hyperbaric Therapy (HBO)

← Revisión anterior		Revisión del 19:31 3 dic 2021
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	*There is controversy regarding benefit<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116883/pdf/1083.pdf</ref><ref>Juurlink, D. N., Isbister, G., Bennett, M. H. and Lavonas, E. J. (1996) ‘Hyperbaric oxygen for carbon monoxide poisoning’, Cochrane Database of Systematic Reviews</ref>		*There is controversy regarding benefit<ref>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116883/pdf/1083.pdf</ref><ref>Juurlink, D. N., Isbister, G., Bennett, M. H. and Lavonas, E. J. (1996) ‘Hyperbaric oxygen for carbon monoxide poisoning’, Cochrane Database of Systematic Reviews</ref>
	**Three HBO treatments within 24hrs shown to reduce risk of cognitive sequelae 6 weeks and 12 months after CO poisoning<ref>Weaver, L. et al. Hyperbaric Oxygen For Acute Carbon Monoxide Poisoning. NEJM. 2002:347(14):1057 http://emed.wustl.edu/Portals/2/Answer%20Key%20PDF/2012/January2012/SecondYear.pdf</ref>		**Three HBO treatments within 24hrs shown to reduce risk of cognitive sequelae 6 weeks and 12 months after CO poisoning<ref>Weaver, L. et al. Hyperbaric Oxygen For Acute Carbon Monoxide Poisoning. NEJM. 2002:347(14):1057 http://emed.wustl.edu/Portals/2/Answer%20Key%20PDF/2012/January2012/SecondYear.pdf</ref>
	**However, another study showed no benefit and suggested worse outcomes in HBO therapy<ref> Scheinkestel C. et al. Med J Aust 1999; 170 (5): 203-210. Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a ~~randomised~~ controlled clinical trial http://www.mja.com.au/journal/1999/170/5/hyperbaric-or-normobaric-oxygen-acute-carbon-monoxide-poisoning-randomised</ref>		**However, another study showed no benefit and suggested worse outcomes in HBO therapy<ref> Scheinkestel C. et al. Med J Aust 1999; 170 (5): 203-210. Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomized controlled clinical trial http://www.mja.com.au/journal/1999/170/5/hyperbaric-or-normobaric-oxygen-acute-carbon-monoxide-poisoning-randomised</ref>
	*Patient must be stable prior to transport since response to acute medical conditions while undergoing hyperbaric therapy in a chamber is difficult.		*Patient must be stable prior to transport since response to acute medical conditions while undergoing hyperbaric therapy in a chamber is difficult.
	*'''Indications (generally accepted guidelines):''' <ref>Practice Recommendations in the Diagnosis, Management and Prevention of Carbon Monoxide Poisoning. Hampson NB et al. Am J Respir Crit Care Med 2012 Oct 18</ref>		*'''Indications (generally accepted guidelines):''' <ref>Practice Recommendations in the Diagnosis, Management and Prevention of Carbon Monoxide Poisoning. Hampson NB et al. Am J Respir Crit Care Med 2012 Oct 18</ref>
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	**Blood level >25%		**Blood level >25%
	**[[Acute myocardial ischemia]]		**[[Acute myocardial ischemia]]
			**[[Prolonged CO exposure with minor clinical findings (“soaking”)]]<ref>Marx, John A., and Peter Rosen. Rosen's Emergency Medicine - Concepts and Clinical Practice E-Book: Edition 9. Philadelphia, PA: Elsevier/Saunders, 2017. Pg 2387</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Further Considerations */

2021-09-25T11:11:02Z

Further Considerations

← Revisión anterior		Revisión del 11:11 25 sep 2021
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	===Further Considerations===		===Further Considerations===
	*[[Cyanide toxicity]]
	*[[Hydrocarbon toxicity]]
	*[[Hydrogen sulfide toxicity]]
	*[[Dichloromethane methylene chloride toxicity]]		*[[Dichloromethane methylene chloride toxicity]]
	**Consider when level not decreasing as expected, or is increasing due to prolonged absorption through skin/respiratory tract.		**Consider when level not decreasing as expected, or is increasing due to prolonged absorption through skin/respiratory tract.

	{{Toxic gas exposure DDX}}		{{Toxic gas exposure DDX}}

	{{Burn DDX}}		{{Burn DDX}}

Rossdonaldson1: /* Further Considerations */

2021-09-25T11:03:31Z

Further Considerations

← Revisión anterior		Revisión del 11:03 25 sep 2021
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	*[[Cyanide toxicity]]		*[[Cyanide toxicity]]
	*[[Hydrocarbon toxicity]]		*[[Hydrocarbon toxicity]]
	*[[Smoke inhalation injury]]
	*[[Hydrogen sulfide toxicity]]		*[[Hydrogen sulfide toxicity]]
	*[[Dichloromethane methylene chloride toxicity]]		*[[Dichloromethane methylene chloride toxicity]]

Rossdonaldson1: /* Further Considerations */

2021-09-25T11:03:13Z

Further Considerations

← Revisión anterior		Revisión del 11:03 25 sep 2021
Línea 121:		Línea 121:

	===Further Considerations===		===Further Considerations===
	*[[Carbon monoxide toxicity]]
	*[[Cyanide toxicity]]		*[[Cyanide toxicity]]
	*[[Hydrocarbon toxicity]]		*[[Hydrocarbon toxicity]]

Rossdonaldson1: /* Further Considerations */

2021-09-25T11:02:54Z

Further Considerations

← Revisión anterior		Revisión del 11:02 25 sep 2021
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	*[[Dichloromethane methylene chloride toxicity]]		*[[Dichloromethane methylene chloride toxicity]]
	**Consider when level not decreasing as expected, or is increasing due to prolonged absorption through skin/respiratory tract.		**Consider when level not decreasing as expected, or is increasing due to prolonged absorption through skin/respiratory tract.

			{{Toxic gas exposure DDX}}

	{{Burn DDX}}		{{Burn DDX}}

Elcatracho: /* See Also */

2021-02-24T02:15:54Z

Elcatracho: /* See Also */

2021-01-13T17:41:57Z

ElavemanMD: /* Delayed Neurological SequelaNikkanen H, Skolnik A. Diagnosis and management of carbon monoxide poisoning in the emergency department. Emerg Med Practice 2011;13(2):1-14. */

2020-12-04T20:05:01Z

Delayed Neurological SequelaNikkanen H, Skolnik A. Diagnosis and management of carbon monoxide poisoning in the emergency department. Emerg Med Practice 2011;13(2):1-14.

← Revisión anterior		Revisión del 20:05 4 dic 2020
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	*Can occur days to weeks after apparent resolution of acute symptoms in up to 46% of patients. The globus pallidus is the most commonly affected area.		*Can occur days to weeks after apparent resolution of acute symptoms in up to 46% of patients. The globus pallidus is the most commonly affected area.
	*Persistent, disabling, or permanent		*Persistent, disabling, or permanent
			*Cognitive sequelae lasting one month or more appear to occur in 25-50 percent of patients with loss of consciousness or CO levels > 25%.
	*Includes:		*Includes:
	**Cognitive effects		**Cognitive effects

← Revisión anterior		Revisión del 02:15 24 feb 2021
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	*[[Burns]]		*[[Burns]]
	*[[Cyanide]]		*[[Cyanide]]
			*[[Methemoglobinemia]]

	==External Links==		==External Links==

← Revisión anterior		Revisión del 17:41 13 ene 2021
Línea 208:		Línea 208:
	*[[Burns]]		*[[Burns]]
	*[[Cyanide]]		*[[Cyanide]]

			==External Links==
			[https://www.acep.org/patient-care/clinical-policies/carbon-monoxide-poisoning/ ACEP Clinical Policy Statement on Carbon Monoxide Poisoining]

	==References==		==References==