Carbon monoxide: silent killer and expert imitator (Part II)

Carbon monoxide is still the most common unintentional poisoning in the Western Countries, and it may often produce potentially serious or lethal acute and delayed clinical manifestations. The considerable variety of symptoms of presentation is the main reason of the non infrequent diagnostic errors at admission. In emergency medicine it is essential to consider this diagnosis every time a patient is found in state of unconsciousness in an environment with possible exposure to CO, as well as in patients presenting with non-specific syndromes. The prompt identification of the intoxication is essential in order to plan a correct therapy at the proper time, and for preventing of risks of a late neurologic syndrome. After confirmation of the diagnosis through determination of COHb, that may nowadays be performed in a fast and non-invasive way both outside and inside hospitals thanks to a new generation of specific pulsoxyimeters, the patient has to be classified with a grading score for the severity depending on clinical presentation, that may be useful also for choice between normobaric or hyperbaric oxygen treatments. Eventually, it is essential to plan the follow-up for the patient during the months following the acute event.