Onsite patient management

Immediate management of CO poisoning patients starts with the removal of the patient from the toxic atmosphere (without exposing the rescuers to CO in doing so). Vital signs must be determined with basic life support measures undertaken as needed.

Clinical evaluation must include a neurological examination: consciousness, motor function, reflexes and muscle tone should be assessed as well as a general physical examination checking for other injuries, intoxication, or underlying disease (e.g., diabetes and ischaemic heart disease).

On-site, oxygen delivery is crucial via a high concentration, airtight oronasal mask with either a demand valve or high delivery (i.e., 12 to 15 L/min for adult patients). Endotracheal intubation and assisted ventilation with an FiO2 of 1 (100% O2) are indicated whenever the airway or breathing are compromised. Oxygen administration should be continued during transfer to hospital and the rescue teams should search for other casualties and terminate the source of exposure with adequate ventilation of the area or premises.

Table 2.2.3-4. CO poisoning patient management

1- Assessment

Diagnosis

3- Treatment

4- Prevention

Vital signs : cardiorespiratory condition Neurological condition :

• consciousness,

• motor response to stimulation

• reflectivity

Clinical examination, check for :

• associated trauma or poisoning

• pre-existing disease Laboratory tests :

• arterial blood gases as required Circumstances of CO poisoning Compatible clinical picture COHb > 10 %

Optional : • CO measurement in expired air • CO measurement in atmosphere Emergency measures :

• immediate removal of the patient from toxic atmosphere

• cardiopulmonary resuscitation as required

• oxygen by facial mask or controlled ventilation

• stop source of CO, aerate the place, seek out other casualties

Supportive measures :

• controlled ventilation with FiO2 = 1

• fluid resuscitation guided by central venous pressure

• inotropic drugs as required Oxygen therapy :

• HBO in patients with

- loss of consciousness during CO exposure,

- or whenever objective neurological anomalies are observed on clinical examination

- pregnancy

• NBO therapy: using a high concentration airtight face mask with demand valve or high delivery flow rate (12 to 15 L/min for adult patients), minimum duration 12 hours

Patient and relatives should be education on risks of CO poisoning

On-site technical inquiry as to the source to prevent reoccurrence

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