Toxicology 16: Hyperbaric Oxygen and Normobaric Oxygen*
Non-pregnant Carbon Monoxide Patients with Access to Hyperbaric Chamber
Normobaric Oxygen (NBO)
Indications
- Patients without indications for HBO
- Patients with contraindications for HBO
- Patients refusing HBO
Protocol
- 100% oxygen by non-rebreather mask
- Continue until patient asymptomatic and COHgb ≤ 3%
- Admit or D/C as appropriate
- F/U Neurology as appropriate
Hyperbaric Oxygen (HBO)
Indications
- History of loss of consciousness
- Serious toxicity including lethargy, confusion, disorientation on arrival to medical facility, history of seizures, focal neurologic deficit, ischemic chest pain, new dysrhythmias, ECG changes, or hypotension
- COHgb ≥ 25% plus any of the following: history of cardiovascular disease, history of cerebrovascular disease, age ≥ 60 years, age ≤ 2 years, Hgb ≤ 10, exposure duration ≥ 2 hours
- COHgb ≥ 40%
Protocol
- 100% oxygen by non-rebreather mask until beginning of HBO
- 100% oxygen at 2.4 ATA x 90 minutes
- 100% oxygen by non-rebreather mask until patient asymptomatic and COHgh ≤ 3%
- Admit or D/C as appropriate
- F/U Neurology 1 month
* Reprinted with permission from Hennepin County Medical Center.
Non-pregnant Carbon Monoxide Poisoned Patients Requiring Long Transfer
General Principles
- Accept patients in transfer with any of usual indications for HBO in carbon monoxide poisoning.
- Weigh risks-costs-benefits of transfer for HBO with the referring physician.
- Offer adjusted guidelines for discussion.
- Provide HBO to any patient accepted for HBO unless new information comes to light.
Hyperbaric Oxygen (HBO)
Adjusted indications
- Patients unconscious on arrival of rescue workers.
- Serious toxicity including: persistent lethargy, confusion, disorientation after 1 hour of 100% oxygen, history of focal neurologic deficits, ischemic chest pain, new dysrhythmias, ECG changes, or hypotension.
- COHgb ≥ 40% plus exposure ≥ 2 hours.
Protocol
- 100% oxygen by non-rebreather mask until beginning HBO.
- 100% oxygen at 2.4 ATA x 90 minutes
- 100% oxygen by non-rebreather mask until patient asymptomatic and COHgb ≤ 3%.
- Admit, return to referring hospital, or D/C as appropriate.
- F/U Neurology 1 month
Pregnant Carbon Monoxide Poisoned Patients Regardless of Location
Normobaric Oxygen (NBO)
Indications
- Patients without indications for HBO.
- Patients with contraindications for HBO.
- Patients refusing HBO.
Protocol
- 100% oxygen by non-rebreather mask
- Continue treatment 5 times longer than needed to reach maternal COHgb ≤ 3%.
- F/U OB/GYN 1 week.
- F/U Neurology 1 month
Hyperbaric Oxygen (HBO)
Indications
- Patients meeting any of the above indications for HBO.
- COHgb ≥ 20%.
- Exposure duration ≥ 5 hours.
- Signs of fetal distress
Protocol
- Check for fetal distress prior to HBO
- 100% oxygen by non-rebreather mask until HBO
- 100% oxygen at 2.4 ATA x 90 minutes
- Continue 100% oxygen by non-rebreather mask until patient asymptomatic and COHgb ≤ 3%.
- L&D for fetal monitoring if gestation ≥ 28 weeks
- Admit or D/C as appropriate
- F/U OB/GYN 1 week
- F/U Neurology 1 month