Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning

Abstract

This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: 1) In emergency department patients with suspected acute carbon monoxide poisoning, can noninvasive carboxyhemoglobin measurement be used to accurately diagnose carbon monoxide toxicity? 2) In emergency department patients diagnosed with acute carbon monoxide poisoning, does hyperbaric oxygen therapy as compared with normobaric oxygen therapy improve long-term neurocognitive outcomes? 3) In emergency department patients diagnosed with acute carbon monoxide poisoning, can cardiac testing be used to predict morbidity or mortality? Evidence was graded and recommendations were made based on the strength of the available data. MEDLINE InProcess, Scopus, Web of Science, and the Cochrane Database were performed. All searches were

Untitled

“…Every patient with clinical symptoms of CO intoxication should be treated with high oxygen partial pressure until the COHb concentration has dropped to 3% or clinical symptoms have resolved completely. Eichhorn, et al [1], Wolf, et al [13], Mathieu, et al [14] The level of carboxyhemoglobin values in all patients who received NBO therapy in our hospital was <25%, as confirmed by a pulse CO-oximeter in the prehospital setting, and no patients had any severe symptoms. Accordingly, SpCO monitoring may be useful for selecting the treatment and appropriate medical facility for conveyance in the management of patients with CO poisoning by the DH.…”

“…Given this situation, HBO therapy should be the method of choice in adult patients with neurological deficits, cardiac ischemia, loss of consciousness, metabolic acidosis, and carboxyhemoglobin values >25%. Eichhorn, et al [1], Wolf, et al [13], Mathieu, et al [14] However, regardless of these inclusion criteria, any decision to treat is always an individual decision. Every patient with clinical symptoms of CO intoxication should be treated with high oxygen partial pressure until the COHb concentration has dropped to 3% or clinical symptoms have resolved completely.…”

“…The indications of HBO for patients with CO poisoning have been described. Eichhorn, et al [1], Wolf, et al [13], Mathieu, et al [14] However, who should be transported by air or ground services remains a clinical question. Thus, future prospective studies involving a greater number of patients with a comparison with transportation by ground ambulance or only NBO therapy are needed.…”

Versorgung von Patienten mit Kohlenmonoxidvergiftung

“…negativer COHb-Anteil darf, bei schlüssigen Symptomen und entsprechender Anamnese, nicht zum Verwerfen der Verdachtsdiagnose führen. Bei Nichtrauchern kann der COHb-Anteil ≤ 3 % und bei Rauchern ≤ 10 % betragen [11,13].…”

“…Trotz der noch unzureichenden Studienlage scheint Methylenblau, als individueller Heilversuch, ähnlich der Therapie einer ausgeprägten Vasoplegie im maldistributiven Schock in einer Dosierung von 1-3 mg/kgKG als Kurzinfusion hilfreich zu sein [3,18]. genommen, so kann dies auch ohne gekühlten Transport verwendet werden [11,13].…”