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Clinical Presentation of Carbon Monoxide Poisoning

Carbon monoxide exposed patients commonly present with nonspecific symptoms that mimic influenza-like illnesses (Table 1). Symptoms typically include headache, dizziness, nausea, vomting, weakness, and fatigue. The most common symptom reports is headache.

Because these symptoms are so nonspecific, the treating physician must retain a high level of suspicion for carbon monoxide poisoning as delays in recognition and treatment are common.

Table 1. Common Symptosm of Carbon Monoxide Poisoning 

Headache                      Visual disturbances
Nausea                     Chest pain
Vomiting                     Loss of consciousness
Dizziness                     Myalgias
Weakness                     Coma
Difficulty concentrating                     Death
Shortness of breath                      

Similar to the symptoms patients report, physical exams findings also very greatly in carbon monoxide poisoned patients. Physical exam findings depend on the time between exposure adn presentation to the hospital. They also depend on the duration and magnitude of exposure. The most common physical findings include tachycardia and tachypnea. However, the majority of patients have normal vital signs upon presentation. Like carboxyhemoglobin levels, vital sign abnormalities do not predict the severity of poisoning. It is extremely rare to find the cherry-red color that is classically described in carbon monoxide poisoning. This sign represents a true soaking  of the tissues with carbon monoxide over a significant length of time and is typically found at autopsy. Any evidence of smoke should be considered as an indicator of exposure to carbon monoxide. Blistering of the skin over pressure-bearing areas may be present, especially if the patient was unconscious for an extended period of time. This is thought to be due to local tissue ischemia from pressure combined with tissue hypoxia from carbon monoxide. Reginal hemorrhages can occur, especially after exposures greater than 12 hours. 

Source: Whelan, Harry T; Kindwall, Eric P. (2017). Hyperbaric Medicine Practice, 4th Edition. North Palm Beach, FL. Best Publishing Company.  

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