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Acute Carbon Monoxide Poisoning


Treatment must be initiated during the acute episode.


Oxygen inhalation to hasten dissociation of carbon monoxide from hemoglobin as well as to provide tissue oxygenation is the one time-honored and fully accepted treatment. Hyperbaric oxygen as high does inhalation therapy and, as expected, has yielded vastly improved clinical results.

If it is available, hyperbaric oxygen is mandatory for CO poisoned patients who do not recover fully at once with sea level oxygen breathing. Carboxyhemoglobin dissociation is further hastened over that possible with one atmosphere (sea level) oxygen; physically dissolved oxygen in plasma is delivered to hypoxic tissue and CO bound to cytochrome oxidase in tissue is more rapidly eliminated.  Over 780 cases reported in the literature and additional hundreds of as yet unreported but well-documented cases treated by UMS committee members, all have yielded the same positive results -- rapid improvement of symptoms and signs and probable reduction of the incidence of late sequelae.

A caution is that treatment with hyperbaric oxygen must be predicated more on the history and clinical picture than on carboxyhemoglobin levels to try to minimize the late psychiatric disability.

Cost Impact

Cost of hyperbaric oxygen in this condition is modest since it is the primary mode of therapy and used only in cases which do not respond at once to sea level oxygen inhalation. Our opinion now holds that more than one treatment is often indicated in the hours or days immediately following acute poisoning, but this should not exceed seven days without peer review. Prevention of late psychiatric deficits can represent significant savings to the health care system.

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