The ABCs (airway, breathing, and circulation) of resuscitation apply to the seriously ill or injured victim with presumed CO intoxication. Normobaric oxygen (NBO) therapy should be administered as soon as possible with 100% oxygen by mask [nonrebreathing mask with reservoir (NRMR)]. Patients who require ventilatory assistance should have bag-valve-mask (BVM) ventilation with 100% oxygen until spontaneous ventilation recovery or endotracheal intubation can be performed in the field or the ED.

Once the patient reaches the ED, decisions about further treatment are guided by the clinical evaluation ( T§bl§...19.8.-..1..). Patients with only mild symptoms (nausea, headache, weakness, or flulike malaise) should receive 100% NBO for a period of about 4 h, with periodic reassessment. The ability of oxygen treatment to eliminate CO from the body has often been estimated using the half-life of HbCO with different treatment regimens. As noted above, HbCO may be a poor marker of the severity of CO poisoning. The half-life of HbCO is about 320 min by breathing room air, 60 min by breathing 100% NBO, and 23 min with 100% hyperbaric oxygen (HBO) at 2.8 atmospheres of pressure (2.8 ATA). Failure of mild symptoms to resolve after 4 h of NBO administration, if no other likely cause for the symptoms can be found, should lower the emergency clinician's threshold for the use of HBO therapy.

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