CO Poisoning should be considered in any patient with history of exposure to fire in a confined space. Fire source is not pertinent, be it auto exhaust, defective gas water heater venting, wood stoves, hibachi grill, trash or structure fire. Initial symptoms can be vague and commonly include; headache, dizziness, weakness, SOB, chest pain, palpitations, visual disturbances and nausea. CO has much higher affinity for hemoglobin than O2. The toxic effects of CO do not correlate with blood COHb levels, therefore the primary goals of treatment are removal from the source and initiation of high flow O2 therapy. Hyperbaric oxygen may be needed in more severe cases.

1. Perform patient assessment and ABC's. Refer to Mininal Decontamination Procedures in POISONING protocol.
2. Evacuate patient and all personnel from area to fresh air.
3. Administer high flow oxygen via NRM. Patient respiratory distress level is not considered in terms of reducing oxygen percentage delivered. Do not stop high flow O2 until patient is delivered to physician.
4. Monitor vital signs in accordance with S.O.P. protocol.
5. You may apply pulse oximetry, HOWEVER, CO poisoning typically will yield normal pulse oximetry levels, despite significant intoxication. Treatment should not be guided in any way by readings obtained.
6. Initate transport as soon as possible.

INTERMEDIATE LIFE SUPPORT

1. If vital signs are significantly altered or unstable, initiate IV access using an isotonic solution. Titrate infusion to support vital signs.
2. If LOC is altered in any way, measure blood glucose level with Glucometer. Refer to DIABETIC EMERGENCIES protocol for management of hypoglycemia.

ADVANCED LIFE SUPPORT

1. Attach and monitor ECG. Treat dysrhythmias as applicable, keeping in mind cause is probably induced by cellular hypoxia.
2. If cardiac dysrhythmias are present, situation is critical, transport code 3.