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Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning

Internal and Emergency Medicine volume 13, pages 223–229 (2018)Cite this article

An Author Correction to this article was published on 22 March 2018

This article has been updated

Abstract

Carbon monoxide (CO) is a colorless, odorless gas that is found in the environment, in the home, and in the human body as a normal part of mammalian metabolism. Poisoning from CO, a common exposure, is associated with significant morbidity and mortality if not recognized and treated in a timely manner. This review evaluates the signs and symptoms of CO poisoning, conditions that present similar to CO poisoning, and an approach to the recognition and management for CO poisoning. CO poisoning accounts for thousands of emergency department visits annually. If not promptly recognized and treated, it leads to significant morbidity and mortality. CO poisoning poses a challenge to the emergency physician because it classically presents with non-specific symptoms such as headache, dizziness, nausea, and vomiting. Due to nonspecific presentations, it is easily mistaken for other, more benign diagnoses such as viral infection. The use of specific historical clues such as exposure to non-conventional heat sources or suicide attempts in garages, as well as the use of targeted diagnostic testing with CO-oximetry, can confirm the diagnosis of CO poisoning. Once diagnosed, treatment options range from observation to the use of hyperbaric oxygen. CO poisoning is an elusive diagnosis. This review evaluates the signs and symptoms CO poisoning, common chameleons or mimics, and an approach to management of CO poisoning.

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Change history

  • 22 March 2018

    In the original publication, first author’s name was incorrectly published as ‘Patrick Chow Yuen Ng’ instead of ‘Patrick Chow Ng’.

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Acknowledgements

This manuscript did not utilize any grants, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. Government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program.

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Affiliations

  1. Medical Toxicology, Rocky Mountain Poison and Drug Center, Denver Health and Hospital, 1391 Speer Blvd, Denver, CO, 80204, USA

    Patrick Chow Yuen Ng

  2. Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, San Antonio, TX, 78234, USA

    Brit Long

  3. Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA

    Alex Koyfman

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  1. Patrick Chow Yuen Ng
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A correction to this article is available online at https://doi.org/10.1007/s11739-018-1832-z.

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Ng, P.C.Y., Long, B. & Koyfman, A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med 13, 223–229 (2018). https://doi.org/10.1007/s11739-018-1798-x

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Keywords

  • Carbon monoxide
  • Headache
  • Chameleon
  • Vomiting
  • Hyperbaric oxygen