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Quick Bite: Carbon Monoxide

Cold weather incoming! This is just a quick review of carbon monoxide poisoning treatment options, as well as what differentiates cold water immersion from regular drowning.

We anticipate an increase in the number of Carbon Monoxide (CO) related calls in the system as people use charcoal grills and generators for heating. Symptoms include headache, nausea, vomiting, dizziness, syncope, altered mental status, and neurologic symptoms such as weakness, numbness, or paresthesia. During these winter events we frequently have calls with multiple patients.

Anyone with RED FLAGS should be treated with 100% oxygen and transported to the hospital. These include:


Cardiac history like arrhythmia, MI, CHF

Significant pulmonary history like COPD or pulmonary fibrosis

Neurological symptoms, even mild ones like paresthesias or numbness

Altered mental status

Emotional changes, which could be indicative of altered mental status

Chest pain

Difficulty breathing

Neurologic symptoms may be subtle so it is vital that you do a thorough neurologic exam and ask specifically about numbness, tingling, and weakness.

Treatment for CO poisoning is administration of 100% oxygen. For those with priority symptoms, hyperbaric treatment may be indicated.

CO >25%: Start 100% oxygen and transport to the hospital, regardless of whether or not they have red flags.

CO <25%:  Start 100% oxygen. If they have red flag symptoms, transport to the hospital. If no red flags, may treat in place with oxygen until symptoms resolve and then complete a refusal. 

CO <15% with no symptoms: No treatment or transport is indicated.

Consider STARFlight and direct transport to University Hospital in San Antonio for hyperbaric treatment for anyone with elevated CO level who is severely ill (unconscious, arrest with ROSC, stroke-like symptoms)