HCMC Guidelines For Hyperbaric Oxygen (HBO) and Normobaric Oxygen
(NBO) Treatment Of Carbon Monoxide Poisoning.
Non- pregnant CO Poisoned Patients with Access to Hyperbaric Chamber.
Hyperbaric Oxygen (HBO) Indications:
* Hx loss of consciousness
*Serious toxicity including lethargy, confusion, disorientation on arrival
to medical facility, hx of seizures, focal neurologic deficit, ischemic
chest pain, new dysrhythmias, ECG changes, or hypotension
*COHgb> 25% plus any of the following: hx cardiovascular
disease, hx cerebrovascular disease, age > 60 yrs, age <
2 yrs, Hgb < 10, exposure duration > 2 hours
*COHgb > 40%
Protocol:
1. 100% oxygen by non-rebreather mask until
beginning of HBO
2. 100% oxygen at 2.4 ATA x 90 minutes
3. 100% oxygen by non-rebreather mask until patient asymptomatic and COGgb
<3%
4. Admit or D/C as appropriate
5. F/U Neurology 1 month
HCMC Guidelines for Treatment of Carbon Monoxide Poisoning
It is well known
that COHgb levels correlate poorly with clinical toxicity and outcome.
Treatment decisions for CO victims should, therefore, take into consideration
several factors in addition to measured COHgb level.
Patients with a history of loss of consciousness or seizure, patients
with persistent altered mental status upon arrival to the hospital, patients
with chest pain or ECG changes, should be considered candidates for hyperbaric
oxgen (HBO) despite low COHgb levels.
Patients with long exposure (e.g., overnight to low concentrations of
CO may be at greater risk of neurologic sequelae than those with brief
exposure to high concentration, despite the fact that measured COHgb levels
may be higher in the latter patients.
Patients who are at the extremes of age or have underlying diseases which
compromise oxygen delivery (e.g. CAD, CVD, anemia) are more vulnerable
to CO exposure than those without such underlying diseases. An unborn
child is more susceptible than it's mother.
The risk, expense, and delay of long distance transport for HBO treatment
of CO victims should be addressed in making treatment decisions. However,
it should be kept in mind that patients may respond to HBO treatments
even after COHgb levels have returned to normal.
Every case should be considered individually. The following guidelines
are offered to assist decision making. Please feel free to call the HCMC
Emergency Department at any time with Questions (612) 873-3131.
