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    Carbon Monoxide Poisoning (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Recommendations

    Diagnosis
    1. Do not use noninvasive carboxyhemoglobin (COHb) measurement (pulse carbon monoxide [CO] oximetry) to diagnose carbon monoxide toxicity in patients with suspected acute carbon monoxide poisoning.
    Intervention
    1. Emergency physicians should use hyperbaric oxygen (HBO2) therapy or high-flow normobaric therapy for acute carbon monoxide (CO)-poisoned patients. It remains unclear whether hyperbaric oxygen therapy is superior to normobaric oxygen therapy for improving long-term neurocognitive outcomes.
    Risk Stratification
    1. In emergency department (ED) patients with moderate to severe carbon monoxide (CO) poisoning, obtain an electrocardiogram (ECG) and cardiac biomarker levels to identify acute myocardial injury, which can predict poor outcome.
    What do the icons mean?  
    Research PaperWolf SJ, Maloney GE, Shih RD, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning. Ann Emerg Med. 2017;69(1):98-107.e6.