Oxygen therapy carbon monoxide poisoning

Thom, S.R., Keim, L.W. (1989). Carbon monoxide poisoning a review. Epidemiology, pathophysiology, clinical findings, and treatment options including hyperbaric oxygen therapy. J. Toxicol. Clin. Toxicol. 27 141-56. 

In addition to antidotal therapy, administration of 100% oxygen can help with cyanide detoxification, possibly by affecting the binding of cyanide to cytochrome oxidase (13). Hyperbaric therapy may be considered, but only after standard treatment has failed, or if the patient has concurrent carbon monoxide poisoning (13). 

The Glasgow group in recent years has successfully used 2 ata oxygen routinely for treating carbon monoxide poisoning in man (D18, D19, L8, L9, S18, S22). The clinical success of this therapy has been confirmed (S14). 

The frequent occurrence of carbon monoxide poisoning necessitates the availability of rapid and accurate methods for the determination of HbCO in human blood samples. These methods may also be of value in evaluating the results of the usual oxygen therapy in severely poisoned patients, and in the detection of cases of chronic poisoning of moderate degree. A review... 

B. Carbon monoxide poisoning. Provide 100% oxygen by tight-fitting mask or via endotracheal tube. Consider hyperbaric oxygen therapy if the patient has serious poisoning (see Indications, above) and the patient can be treated within 6 hours of the exposure. Consult with a poison center ([800] 222-1222) or hyperbaric specialist to determine the location of the nearest HBO facility. Usually, three HBO treatments at 2.5-3 atm are recommended over a 24-hour period. 

Carbon monoxide poisoning is a familiar situation in emergency medical practice, and the treatment depends on reversing the attachment of carbon monoxide to haemoglobin as carboxyhaemoglobin using free flow or hyperbaric oxygen therapy. The reader is referred to specialised texts for more details. 

Hyperbaric therapy uses 100% oxygen at pressure to help heal wounds and infections, and to treat carbon monoxide poisoning. A hyperbaric chamber has a volume of 1510 L. How many kilograms of Oi gas are needed to give an oxygen pressure of 2.04 atm at 25 °C (8.5, 8.6)... 

Carbon monoxide (CO) binds tightly to the Hb iron. It stabilizes the R form of Hb and, thus, prevents release of 02 to the tissues. CO toxicity is, in large part, a result of tissue hypoxia. CO poisoning is treated with 100 percent oxygen therapy, which facilitates the dissociation of CO from the Hb, allowing more 02 to be bound to Hb. 

A 92-year-old African-American woman suffered from smoke inhalation during a house fire. The patient was transferred from a cross-town hospital to receive hyperbaric oxygen (HBO) therapy for carbon monoxide intoxication. Before arrival she was sedated, intubated, and administered with 5g hydroxocobalamin intravenously for suspected cyanide poisoning. In the emergency department (ED) a Foley s catheter was placed and, upon inspection, her urine was tinted a deep red colour. She received prompt HBO treatment and was transferred to the intensive care unit (ICU). Despite mechanical ventilation, HBO therapy and treatment for cyanide toxicity, the patient suffered cardiopulmonary arrest while in the ICU and died days later. 

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