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

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 principal 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 prevention of risks of a late neurologic syndrome. Nowadays the diagnosis may be performed through determination of COHb in a fast and non-invasive way, both outside and inside hospitals, thanks to a new generation of specific pulsoxymetrers. After confirmation the patient has to be classified with a grading score for severity depending on clinical presentation, that may be useful also for the 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.