💨 Acute Carbon Monoxide Poisoning Management
This tool gives the oxygen and hyperbaric-oxygen direction for acute carbon monoxide poisoning, by hyperbaric indications and pregnancy.
Pulse oximetry cannot distinguish carboxyhemoglobin, so arterial COHb must be measured rather than relying on SpO₂. (original synthesis · not guideline verbatim)
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When to use
Use to start high-flow 100% oxygen for everyone and to decide who needs hyperbaric oxygen, with a lower threshold in pregnancy.
How it works
All → high-flow 100% oxygen until symptoms resolve and COHb < 10%. HBO if loss of consciousness/neurologic abnormality/myocardial ischemia/COHb ≥ 25%/severe acidosis, ideally within 6 h. Pregnancy → HBO at COHb ≥ 15–20% or fetal distress.
Key points
- Pulse oximetry cannot distinguish carboxyhemoglobin, so arterial COHb must be measured rather than relying on SpO₂. (original synthesis · not guideline verbatim)
- Hyperbaric oxygen targets reduction of delayed neurocognitive sequelae and is given as early as possible within 6 h.
- Enclosed-fire smoke inhalation raises suspicion of concomitant cyanide poisoning warranting hydroxocobalamin.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Hyperbaric-oxygen indications (loss of consciousness/neurologic abnormality/myocardial ischemia/COHb ≥ 25%/severe acidosis) | Any present |
|---|---|
| Pregnancy | No |
→DispositionHyperbaric oxygen (HBO) evaluation + 100% oxygen
- Immediate (all)：Remove from exposure; high-flow 100% oxygen (non-rebreather reservoir mask, regardless of pulse oximetry/PaO₂) until symptoms resolve and COHb < 10% (lower threshold with cardiopulmonary impairment); intubate and give 100% oxygen if comatose/unable to protect the airway (CO half-life: room air 4–6 h, 100% oxygen 60–90 min, hyperbaric oxygen 20–30 min)
- HBO indications：Consider hyperbaric oxygen (HBO, on top of 100% oxygen) as early as possible within 6 h for any of: loss of consciousness/syncope, neurologic abnormality (focal/cognitive/altered consciousness/seizure), myocardial ischemia (chest pain/ECG/troponin), COHb ≥ 25%, severe metabolic acidosis — this case qualifies, transfer to HBO promptly
- Monitoring/assessment：ECG, troponin; arterial COHb (pulse oximetry cannot distinguish COHb, SpO₂ unreliable); assess neurocognition
Frequently asked questions
- What is Acute Carbon Monoxide Poisoning Management?
- This tool gives the oxygen and hyperbaric-oxygen direction for acute carbon monoxide poisoning, by hyperbaric indications and pregnancy.
- How is Acute Carbon Monoxide Poisoning Management calculated? What is the core formula?
- All → high-flow 100% oxygen until symptoms resolve and COHb < 10%. HBO if loss of consciousness/neurologic abnormality/myocardial ischemia/COHb ≥ 25%/severe acidosis, ideally within 6 h. Pregnancy → HBO at COHb ≥ 15–20% or fetal distress.
- When is Acute Carbon Monoxide Poisoning Management used?
- Use to start high-flow 100% oxygen for everyone and to decide who needs hyperbaric oxygen, with a lower threshold in pregnancy.
- What are the key clinical points for Acute Carbon Monoxide Poisoning Management?
- Pulse oximetry cannot distinguish carboxyhemoglobin, so arterial COHb must be measured rather than relying on SpO₂. (original synthesis · not guideline verbatim) Hyperbaric oxygen targets reduction of delayed neurocognitive sequelae and is given as early as possible within 6 h. Enclosed-fire smoke inhalation raises suspicion of concomitant cyanide poisoning warranting hydroxocobalamin.
- What are the limits and cautions when using Acute Carbon Monoxide Poisoning Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Acute Carbon Monoxide Poisoning Management calculated in practice? Can you show a worked example?
- Inputs: Hyperbaric-oxygen indications (loss of consciousness/neurologic abnormality/myocardial ischemia/COHb ≥ 25%/severe acidosis) Any present, Pregnancy No → Result: Disposition Hyperbaric oxygen (HBO) evaluation + 100% oxygen（Immediate (all): Remove from exposure; high-flow 100% oxygen (non-rebreather reservoir mask, regardless of pulse oximetry/PaO₂) until symptoms resolve and COHb < 10% (lower threshold with cardiopulmonary impairment); intubate and give 100% oxygen if comatose/unable to protect the airway (CO half-life: room air 4–6 h, 100% oxygen 60–90 min, hyperbaric oxygen 20–30 min), HBO indications: Consider hyperbaric oxygen (HBO, on top of 100% oxygen) as early as possible within 6 h for any of: loss of consciousness/syncope, neurologic abnormality (focal/cognitive/altered consciousness/seizure), myocardial ischemia (chest pain/ECG/troponin), COHb ≥ 25%, severe metabolic acidosis — this case qualifies, transfer to HBO promptly, Monitoring/assessment: ECG, troponin; arterial COHb (pulse oximetry cannot distinguish COHb, SpO₂ unreliable); assess neurocognition）