Because the acuity of a child with CO poisoning can range from a complaint of mild symptoms (headache or “viral-like”) to severe (prearrival notification of a child en route who might be comatose or in cardiopulmonary arrest), the approach in the ED will be variable. Often the diagnosis of CO poisoning is based on a combination of having a known or suspected exposure, consistent signs or symptoms, and laboratory evaluation of COHb. On initial presentation, the differential should remain broad, and emergency clinicians must remain suspicious for the presence of comorbidities, co-intoxicants, or trauma that may have led to the exposure or happened as a result of the CO poisoning.
The American Association of Poison Control Centers (1-800-222-1222) should be contacted in all cases of suspected CO poisoning. Poison control centers are available to offer assistance in ED management as well as to coordinate and recommend transfer to an HBO facility. Cases reported to local poison control centers are reported to the American Association for Poison Control Centers National Poison Data System for epidemiologic tracking.
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