Carbon Monoxide/Smoke Inhalation

Table of Contents

Aliases

CO

Patient Care Goals

  1. Remove patient from toxic environment.
  2. Assure adequate ventilation, oxygenation and correction of hypoperfusion.
  3. Consider use of environmental carbon monoxide (CO) monitors on “first in” bags to assist in detection of occult CO toxicity.

Patient Presentation

Carbon monoxide is a colorless, odorless gas which has a high affinity for binding to red cell hemoglobin, thus preventing the binding of oxygen to the hemoglobin, leading to hypoxia (pulse oximetry less than 94%). A significant reduction in oxygen delivery to tissues and organs occurs with carbon monoxide poisoning. Carbon monoxide is also a cellular toxin which can result in delayed or persistent neurologic sequelae in significant exposures. With any form of combustion (fire/smoke [e.g. propane, kerosene, or charcoal stoves or heaters], combustion engines [e.g. generators, lawn mowers, motor vehicles, home heating systems]), carbon monoxide will be generated. People in a fire may also be exposed to cyanide from the combustion of some synthetic materials. Cyanide toxicity may need to be considered in the hemodynamically unstable patient removed from a fire.

Inclusion Criteria

  1. Patients exposed to carbon monoxide may present with a spectrum of symptoms:
    1. Mild intoxication:
      1. Nausea
      2. Fatigue
      3. Headache
      4. Vertigo
      5.  Lightheadedness
    2. Moderate to severe:
      1. Altered mental status
      2. Tachypnea
      3. Tachycardia
      4. Convulsion
      5. Cardiopulmonary arrest

Exclusion Criteria

No recommendations

Patient Management

Assessment

  1. Remove patient from toxic environment
  2. Assess ABCDs and, if indicated, expose patient and re-cover to assure retention of body heat
  3. Vital signs including pulse oximetry, temperature, and ETCO2 if available
  4. Apply a cardiac monitor, examine rhythm strip for arrhythmias, and obtain a 12-lead EKG if available
  5. Check blood glucose level
  6. Monitor pulse oximetry and ETCO2 for respiratory decompensation
  7. Patient pertinent history
  8. Patient physical examination

Treatment and Interventions

  1. 100% oxygen via non-rebreather mask or bag valve mask or advanced airway as indicated
  2. If seizure, treat per Seizures guideline
  3. Consider transporting patients with severe carbon monoxide poisoning directly to a facility with hyperbaric oxygen capabilities if feasible and patient does not meet criteria for other specialty care (e.g. trauma or burn)
    1. St. Luke’s Hospital ED

Notes – Carbon Monoxide/Smoke Inhalation