Poisoning                Carbon Monoxide Poisoning
                         =========================

þ "Magic numbers"
 - CO poisoning as of 3/96 is reportable in Allegheny County
  + CO > 15%
  + CO > 5% and symptoms of CO poisoning
 - Critera for hyperbaric treatment?
  + COHb >25%
  + Cardiac or Neurological signs
  + pregnancy.
   (Extrapolate back to initial levels.)
 - Maximum number to expect from heavy smoker:  9%

þ "Flu-like" illness as presentation of CO poisoning:
  <P-CO-Flu.TXT>

þ Smoke Inhalation:
  <P-Smoke.TXT>

þ Oxygen Saturation/Pulse Ox in CO Poisoning:
  <P-Sat.TXT>

þ Methylene Chloride is metabolized to CO in the body

þ May have delayed sequelae from CO; hope is that hyperbaric may prevent this.
  High-risk for delayed sequale:
  - pregnant (fetal levels 10-15% higher than maternal due to different
    binding affinity)
  - >40%
  - coma
  - neurological abnormalities
  - LOC more than 20 minutes?
  - arrhythmias?
  - chest pain?
  - neuro abnormalities not responding to 2 hours high-flow O2.
  Summary:
  - Age, LOC, and intercurrent cardiovascular disease, not COHb level
    [Arch Neurol 40:433, 1983]
    [Acta Psychiatr. Scand. 73: 80, 1986]
    [Clin Toxicol. 23: 315, 1985]


þ Evidence for/against HBO working for CO poisoning:
  <CO-HBO.TXT>

þ Fetal hemoglobin may cause falsely elevated CO levels
  <L-CO.TXT>

þ Half-life of CO
 - with 100% oxygen:  80 minutes (others say 60-70 minutes)
   usual plan is to keep on high-flow O2 until CO should be about 5% and then
   repeat.
 - with hyperbaric oxygen:  23 minutes

þ Good CO References:
  <P-COA.TXT>