Algorithm for using normobaric and hyperbaric oxygen following carbon monoxide exposure

Maintain high level of suspicion for CO poisoning (even if no reported exposure) in patients with flu-like symptoms with atypical course during winter months and after natural disasters, especially if any other cohabitants or pets are also feeling ill, and in patients with smoke inhalation or with unexplained altered mental status or lactic acidosis.

In any patient with CO poisoning, make sure to address source of exposure to prevent recurrent poisoning or exposure to others.

For further information, refer to UpToDate content on carbon monoxide poisoning.

HBO: hyperbaric oxygen; COHb: carboxyhemoglobin; CO: carbon monoxide; NBO: normobaric oxygen; CBC: complete blood count; ECG: electrocardiogram.

* Even though elevated COHb levels correlate imprecisely with the degree of poisoning, a normal COHb level does not explain persistent altered mental status, focal neurology deficit, or ischemia, so alternate etiologies needs to be explored.

¶ If asymptomatic, can stop NBO as soon as COHb results. Patient may still need to address source of exposure.

Δ HBO treatment may still provide benefit up to 24 hours after CO exposure, even if COHb has decreased to below recommended thresholds. Refer to UpToDate content on hyperbaric oxygen treatment.

◊ Calculate duration of NBO therapy based on 90-minute half-life of COHb with 100% oxygen.

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Algorithm for using normobaric and hyperbaric oxygen following carbon monoxide exposure