Algorithm
- Remove from exposure; ABC; high-flow oxygen 100% via non-rebreather immediately (or intubate/ventilate with FiO₂ 1.0).
- Suspect with headache, nausea, confusion, syncope, household/fire/generator exposure; multiple victims same scene.
- Measure COHb on co-oximetry (pulse oximetry unreliable for CO); ECG / troponin if chest pain or risk.
- Continue 100% O₂ until symptoms resolve and COHb falls per local targets.
- Consider hyperbaric oxygen for severe CO (loss of consciousness, high COHb, pregnancy, cardiac ischemia, persistent neuro deficit) per local HBO criteria.
- Do not miss cyanide in smoke inhalation (soot, lactic acidosis, coma) — hydroxocobalamin if indicated.
Red flags
- • Normal SpO₂ despite severe CO poisoning
- • Pregnancy — lower threshold for HBO
- • Cerebral edema / coma
- • Combined cyanide toxicity in fires
Medications by step
Oxygen / antidotes
- Oxygen 100% · inhaled
Non-rebreather or FiO₂ 1.0 until cleared
- Hyperbaric oxygen · HBO
If severe criteria met / available
- Hydroxocobalamin · i.v.
If concomitant cyanide suspected (smoke)
References
- • ERC / toxicology — CO poisoning principles (2025)
- • EAPCCT / clinical toxicology — CO and smoke inhalation (2023)
Updated: Июль 2026