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Carbon monoxide poisoning - Management
How do I manage suspected lower level carbon monoxide poisoning?

If features of lower level poisoning are present:

  • Remove the person (and all others) from suspected sources of poisoning until all potential sources of carbon monoxide are shut down and the area has been ventilated.
  • If a woman is pregnant, arrange immediate hospital assessment by an obstetrician.
  • Establish a working diagnosis by simultaneously arranging assessment of:
    • The potential sources of carbon monoxide poisoning for raised environmental carbon monoxide levels. Contact the local Health Protection Unit (HPU) who will organize this. For local contact details see www.hpa.org.uk.
    • The person's carboxyhaemoglobin level for evidence of recent carbon monoxide exposure.
      • Take an anticoagulated venous sample as soon as possible after potential exposure and send to the biochemistry laboratory for measurement of carboxyhaemoglobin levels.
      • A rapid assessment of expired carbon monoxide can be made using a carbon monoxide breath monitor, as used in smoking cessation clinics. Some monitors are capable of converting carbon monoxide concentrations into carboxyhaemoglobin levels, but the clinical value of these devices has not been verified.
  • Necessary control measures and secondary prevention will be carried out by the HPU once the diagnosis has been established following investigations of the potential sources of poisoning and carboxyhaemoglobin level. The HPU will coordinate with the Local Authority Environment Services, and Health and Safety, Social, and other services to protect your patient and others.
  • If in doubt, seek specialist advice.
    • Advice is available 24 hours a day from the UK National Poisons Information Service (NPIS) by telephoning 0844 892 0111.
    • Advice about suspected poisoning of pregnant women is available during the day from the UK Teratology Information Service (UKTIS), formerly the National Teratology Information Service (NTIS), by telephoning 0844 892 0909, or out-of-hours from the NPIS.

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