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Carbon Monoxide Toxicity Follow-up

  • Author: Guy N Shochat, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: May 06, 2016
 

Further Outpatient Care

Asymptomatic patients with HbCO levels below 10% may be discharged. In cases of accidental CO poisoning, patients should be followed up in 4-6 weeks to screen for cognitive sequelae. With intentional poisoning, psychiatric follow-up is mandatory, given the high rate of subsequent completed suicide.[2]

 

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Further Inpatient Care

See the list below:

  • Admitted patients generally require monitored settings, telemetry beds, or cardiac care unit/medical intensive care unit (CCU/MICU) beds for more severe cases.
  • Patients with cerebral edema may be most appropriately treated in a neurosurgical ICU setting; this may dictate transfer to another facility. Admission or consult by toxicology service is helpful in these cases.
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Prognosis

Considerations regarding prognosis include the following:

  • Variability of clinical severity, laboratory values, and outcome limits prognostic accuracy
  • Cardiac arrest, coma, metabolic acidosis, and high HbCO levels are associated with poor outcome
  • Abnormal CT or MRI findings are associated with persistent neurologic impairment
  • Neuropsychiatric testing may have prognostic efficacy in determining delayed sequelae
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Patient Education

See the list below:

  • Carbon monoxide (CO) detectors: Home CO detectors with audible alarms are available. One study of 911 calls for suspected CO poisoning showed in 80% of calls for detector alarms, verifiable ambient CO levels were present in the home; the mean concentration of CO was 18.6 ppm in homes tested because of detector alarms but was 96.6 ppm in homes without alarms where calls were prompted by suspicious symptoms.[33]
  • Discuss the possibility of delayed neurologic complications, although they are much more common in patients with toxicity severe enough to require hospital admission.
  • Suggest minimizing physical activity for 2-4 weeks.
  • Advise patient to stop smoking.
  • For patient education information, see the First Aid and Injuries Center, as well as Carbon Monoxide Poisoning.
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Contributor Information and Disclosures
Author

Guy N Shochat, MD Associate Clinical Professor of Emergency Medicine, University of California, San Francisco, School of Medicine

Guy N Shochat, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Lucchesi, MD Chair, Associate Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center

Michael Lucchesi, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Undersea and Hyperbaric Medical Society, Wilderness Medical Society, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Peter MC DeBlieux, MD Professor of Clinical Medicine and Pediatrics, Section of Pulmonary and Critical Care Medicine, Program Director, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Peter MC DeBlieux, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Radiological Society of North America, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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Monoplace hyperbaric chamber. Courtesy JG Benitez, MD, MPH.
 
 
 
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