Circulation
Following carbon monoxide poisoning, if hypotension is problematic, first-line treatment is intravenous fluid resuscitation. If hypotension persists, start inotropic support.
Inotropic or other circulatory support may be required for patients with myocardial depression—discuss this with a clinical toxicologist. For cardiorespiratory arrest, follow advanced life support protocols1.
Patients who have severe carbon monoxide poisoning require continuous ECG monitoring and serial 12-lead ECGs, measurement of serial serum troponin concentrations, and bedside echocardiography to assess for the presence of myocardial injury. Long-term mortality risk is increased in patients with myocardial injury. Refer patients with evidence of myocardial ischaemia on ECG or abnormal echocardiographic findings to a cardiologist for consideration of coronary angiography.