Management of carbon monoxide poisoning in the absence of hyperbaric oxygenation chamber

Manifestations of carbon monoxide poisoning are mostly attributable to acute hypoxic insult. In the absence of immediately available hyperbaric oxygen chamber, 100% oxygen should be delivered to the patient until carboxyhemoglobin levels in the blood are less than 5%. Presence of abnormal motor activity or prolonged abnormal consciousness are indications for proceeding with hypothermia and mechanical ventilation. Reversal of these manifestations was achieved in 3 reported cases though induction of hypothermia was delayed for as long as 24 hours. However, no beneficial effects were obtained in a fourth patient who did not receive hypothermia until 5 days after exposure. The duration of hypothermia varied between 60-70 hours in patients who showed near-complete recovery.