In October 2016, the ACEP Board of Directors approved a clinical policy on the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide (CO) poisoning. Developed by ACEP’s Clinical Policies Committee, this clinical policy can also be found on ACEP’s website and has been submitted for inclusion on the National Guideline Clearinghouse website.
There are approximately 50,000 ED visits per year as a result of CO poisoning. Acute poisonings have extremely varied presentations, from minimal symptomatology to unresponsiveness, hypotension, severe acidemia, or acute respiratory failure. CO poisoning is also known to be associated with longer-term morbidity and mortality. Neurologic sequelae have been described in 12 percent to 68 percent of poisoned patients, and mortality rates increase threefold compared with matched unexposed individuals at a median follow-up of 7.6 years after exposure.