Carbon Monoxide Poisoning — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Immediate 100% oxygen · assess HBO
   Are there indications for hyperbaric oxygen? (Diagnose by carboxyhemoglobin (COHb) — pulse oximetry is unreliable and may read falsely normal. All suspected/confirmed cases get immediate high-flow 100% normobaric oxygen (non-rebreather mask) to shorten the COHb half-life; intubate and ventilate with 100% oxygen if comatose/hypoventilating. Remove from the source, supportive care, monitor for delayed neuropsychiatric sequelae.)
   • HBO indication present → Hyperbaric oxygen
   • Not present (normobaric oxygen) → Normobaric 100% oxygen
2. [End] Hyperbaric oxygen
   HBO indications (any): loss of consciousness/coma, neurological deficit or altered mentation, COHb >25% (>20% in pregnancy or fetal distress), cardiac involvement (ischemia/ECG changes/raised troponin/arrhythmia), severe metabolic acidosis. → On top of continuous 100% normobaric oxygen, transfer for hyperbaric oxygen (ideally early; may reduce delayed neurological sequelae).
3. [End] Normobaric 100% oxygen
   No HBO indication: continuous high-flow 100% normobaric oxygen until symptoms resolve and COHb is normal (~<3–5%); monitor ECG and mentation; remove from the source, screen co-exposed individuals, supportive care. On discharge, advise follow-up for delayed neuropsychiatric sequelae.

Source guidelines & references

• Weaver LK. Carbon monoxide poisoning. N Engl J Med 2009; hyperbaric oxygen indications (Am J Respir Crit Care Med 2007)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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