Some patients with carbon monoxide (CO) poisoning benefit from hyperbaric oxygen (HBO) therapy. The decision to use HBO therapy is based on the CO exposure as well as signs and symptoms consistent with CO poisoning, including:

• Mode and length of exposure
• Symptoms initially present
• Length of time since the individual was removed from the CO environment

Comatose or severely symptomatic patients require rapid transfer for treatment, while less severely poisoned individuals may or may not require hyperbaric oxygen therapy.

The decision to transfer a patient to the HBO facility are based on the following:

Central Nervous System

• Ataxia
• History of unconsciousness
• Altered mentation on simple CNS testing and/or abnormal psychometric testing

Cardiovascular

• A history of ischemic heart disease especially with significant CO levels
• Chest pain
• EKG evidence of myocardial ischemia
• Hypotension

Other

• Exposure in a pregnant woman leading to concern about the effects on the fetus
• Symptoms in a conscious patient with suspected CO poisoning, where no facility exists for COHb measurement
• Exposure in a patient who may appear asymptomatic when first seen, but the history raises suspicions of a significant and/or prolonged exposure of the CNS