Observation and patient disposition after carbon monoxide poisoning

Admit patients with carbon monoxide poisoning if they have altered conscious state, neurological deficits, clinical instability, lactic acidosis, myocardial ischaemia or end organ hypoxia.

Patients can be discharged if they are asymptomatic and meet all the following criteria:

• clinically stable
• normal end-organ perfusion
• a normal conscious state
• a carboxyhaemoglobin fraction of less than 5%.

Ensure all patients have clear documentation of their neurological examination and Mini Mental State Examination findings before discharge.

Sedative agents can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after dischargeDassanayake et al, 2012Dassanayake et al, 2012.

Consider referring the patient for neuropsychiatric testing 6 to 8 weeks after carbon monoxide poisoning, to assess for persistent or delayed onset of neurological deficits.