EMS Protocol of the WEEK!! CO poisoning

Keeping the theme of last weeks cyanide poisoning/smoke inhalation injuries… the EMS protocol of the week is on carbon monoxide poisoning!

What is CO?

A colorless, odorless, tasteless gas produced by burning gasoline, wood, propane, charcoal, or fuels.

Common causes of CO poisoning?

Appliances such as furnaces, heaters, or stoves burning in an enclosed space, as well as smoke inhalation during a fire.

Symptoms?

Headache, dizziness, nausea/vomiting, AMS, weakness.

Initial management is the same as cyanide poisoning (and tbh most other things)... ABCs, supplemental O2, cardiac/vital sign monitoring, IV access.

Treatment

Transport to hyperbaric center if:

-      SpCO > 25% and asymptomatic

-      High index of suspicion of CO poisoning AND headache, AMS, or syncope

-    Pregnant and SpCO > 15%

Key points:

-      Also consider cyanide poisoning if exposed to smoke

-      SpO2 from pulse ox is not accurate and can be falsely elevated

-    Continue giving high concentration O2 even if signs/symptoms have resolved 

See attached protocol; check out https://nycremsco.org/ for more!

Jennifer Wolin, MD

Emergency Medicine PGY-2 Resident Physician

Maimonides Medical Center