Author: Katie Sprinkle, MD

Educational Pearl:

• Carbon monoxide (CO) is the leading cause of death from poison world-wide
• CO forms from the combustion of any carbon based product
• Patients often present with non specific symptom like headache, vomiting, and malaise
• Consider this diagnosis with multiple people presenting with similar symptoms from a single location
• Treatment is with high flow oxygen (i.e. non-rebreather)
• Hyperbaric therapy is controversial and up for debate - discussion with local consultants may help guide this management/transfer
• Tobacco smokers typically have elevated levels of carbon monoxide at baseline

Editor's Note: smoking hookah for one hour may be the equivalent of smoking nearly 100 cigarettes

References:

Jacob P, Abu Raddaha AH, Dempsey D, et al. Nicotine, carbon monoxide, and carcinogen exposure after a single use of a water pipe. Cancer Epidemiol Biomarkers Prev. 2011;20(11):2345-53.

Ng PC, Long B, Koyfman A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med. 2018 Mar;13(2):223-229. doi: 10.1007/s11739-018-1798-x. Epub 2018 Feb 12. Review. Erratum in: Intern Emerg Med. 2018 Mar 22;:. PubMed PMID: 29435715.

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning:., Wolf SJ, Maloney GE, Shih RD, Shy BD, Brown MD. 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 Jan;69(1):98-107.e6. doi: 10.1016/j.annemergmed.2016.11.003. PubMed PMID: 27993310.

Guzman JA. Carbon monoxide poisoning. Crit Care Clin. 2012 Oct;28(4):537-48. doi: 10.1016/j.ccc.2012.07.007. Review. PubMed PMID: 22998990.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD