Medical practitioners guidance on diagnosis and treatment of CO in patients

Medical awareness on CO

In the Chief Medical Officer’s January 2006 update to all doctors registered with the General Medical Council in England, information and advice was given on CO poisoning:

• CMO Update 43: A communication to all doctors from the Chief Medical Officer (Winter 2005) “Recognising carbon monoxide poisoning”

• Recognising the symptoms of CO poisoning is not easy.  The most common – headache, nausea and vomiting, tiredness – are also symptoms of a number of other conditions such as food poisoning, flu, migraine or depression.  Patients who present with these symptoms should be asked key questions to identify whether CO poisoning may be the cause.
• Tests to check for CO poisoning include measuring the concentration of the gas in expired air and the concentration of carboxyhaemoglobin in venous blood.
• Treatment is straightforward – removal from the source of exposure.  In addition, the patient should be provided with an increased inspired concentration of oxygen.  In many cases, providing 100% oxygen using a well-fitting mask is adequate.  In severe cases of poisoning, and in cases involving pregnant women, doctors should consider using hyperbaric oxygen.

In February 2002, the Chief Medical Officer and Chief Nursing Officer issued an updated letter to key audiences highlighting the dangers of carbon monoxide poisoning.  This provides additional key information to that covered in the CMO Update such as in the management of suspected cases of CO poisoning, it is important to arrange for the checking of appliances and flues and measurement of CO concentration in the patients property, before allowing anyone back.

It also dispells the common myth that cherry red skin colour is always present in cases of CO poisoning.  The cherry red skin colour produced when COHb concentrations exceed about 20% is rarely seen in life.  Neurological signs must be looked for: a neurological examination, including tests of fine movement and balance, a mini-mental state examination and testing of short term memory and the ability to subtract 7, serially, from 100, are vital.  

• PL CNO (2002)2: Carbon monoxide: The forgotten killer

Both the above CMO Update and the updated letter are available from the Department of Health website

Leaflet on indoor air pollution

Carbon Monoxide. Risks to health and how to avoid them

The Department of Health produced a public information leaflet, distributed in early 2006 to all GP surgeries in England. This provides information on the symptoms of CO poisoning, ways in which to prevent poisoning and the contact details of organizations and other government departments involved with the prevention of CO poisoning. The Leaflet is available free from the Department of Health’s website or their publication stores.

Keep Warm Keep Well: Winter guide 2006/2007

In October 2006, the Department of Health launched updated information on its Keep Warm Keep Well campaign offering help and guidance to vulnerable people throughout the winter months, including guidance and useful advice on the maintenance of appliances and protection from CO poisoning.

For more information on this scheme and their booklet “Keep Warm Keep Well, a winter guide 2006/2007” please visit the Keep Warm Keep Well campaign website.