1. Leenard Michael A. Sajulga, RN
Carbon Monoxide Poisoning

2. Carbon monoxide poisoning
• An example of an inhaled poison
• The result of the inhalation of the products of
incomplete hydrocarbon combustion
• May occur as an industrial or household accident or
as an attempted suicide

3. Carbon monoxide
• Exerts its toxic effect by binding to circulating
hemoglobin to reduce the oxygen-carrying capacity of
the blood
• Combines with hemoglobin to form carboxyhemoglobin
• The affinity between carbon monoxide and hemoglobin
is 200-300x that between oxygen and hemoglobin
• As a result, tissue anoxia occurs.

4. PRIMARY ASSESSMENT

5. • Assess airway and breathing.
–Respiratory depression may be present.
–If the carbon monoxide poisoning is due to smoke
inhalation, stridor (indicative of laryngeal edema
due to thermal injury) may be present.

6. PRIMARY INTERVENTIONS

8. • Provide 100% oxygen by tight-fitting mask
• The elimination half-life of carboxyhemoglobin, in
serum, for a person breathing room air is 5 hours 20
minutes
• If the patient breathes 100% oxygen, the half-life is
reduced to 80 minutes

9. • 100% oxygen in a hyperbaric chamber will reduce
the half-life to 23 minutes [treatment of choice
• Intubate, if necessary, to protect the airway.

10. SUBSEQUENT ASSESSMENT

11. • A thorough history is important: determine the type
and length of exposure as well as possible other
fumes inhaled
• An underlying anemia, cardiac disease, or pulmonary
disease may place a person at higher risk.
• Determine LOC—the patient may appear intoxicated
from cerebral hypoxia; confusion may progress
rapidly to coma.

12. • Assess complaints of headache, muscular weakness,
palpitation, dizziness.
• Inspect skin: may be pink, cherry red, or cyanotic and
pale—skin color is not a reliable sign.
• Monitor vital signs: increased respiratory and pulse
rates are generally present. Be alert for altered
breathing patterns and respiratory failure.

13. • Listen for rales or wheezes in the lungs (with smoke
inhalation, indicates acute respiratory distress
syndrome).
• Obtain arterial blood samples for carboxyhemoglobin
levels.
–Normal is less than 12%.
–Severe carbon monoxide poisoning is present
when levels are greater than 30% to 40%.

14. GENERAL INTERVENTIONS

15. • History of exposure to carbon monoxide justifies
immediate treatment.
• GOALS: to reverse cerebral and myocardial hypoxia
and hasten carbon monoxide elimination.
• Give 100% oxygen at atmospheric or hyperbaric
pressures to reverse hypoxia and accelerate
elimination of carbon monoxide

16. • Patients should receive hyperbaric oxygen for CNS
or cardiovascular system dysfunction.
• Use continuous ECG monitoring, treat dysrhythmias,
and correct acid-base and electrolyte abnormalities.
• Observe the patient constantly—psychoses, spastic
paralysis, vision disturbances, and deterioration of
personality may persist after resuscitation and may
be symptoms of permanent CNS damage.