carbon monoxide testing

13 May

RAGING HYPOTHETICAL:

Your next patient is a 30 yo who is brought in by EMS after being pulled out of a burning apartment building.  They’re awake, but complaining of a headache, and of course, you’re worried about carbon monoxide. 

How do you want to test for this, and what number/percent are you ok with?

 

CARBON MONOXIDE TESTING (QUICK PEARLS):

2 most commonly found options in the ED: co-oximetry & serum carboxyhemoglobin testing

 

noninvasive pulse co-oximetry (similar to your pulse-ox, but for CO)

  • via some small studies: mean absolute error of 3.15% (vs. serum testing)
  • frame of reference: mean absolute variation between various blood gas analyzers – 2.4%

 

carboxyhemoglobin testing

  • relationship between COHb levels and poisoning severity is generally poor
  • no clinically relevant difference between arterial and venous COHb levels
    • 95% of samples range between 2.4% and -2.1% of each other
  • COHb level > 3% in non-smokers or > 10% in smokers suggests an abnormal CO exposure

 

References: EBMedicine article, picture

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