CARBON-MONOXIDE POISONING

Carbon monoxide (CO) poisoning still represents a frequent and severe casualty in France. Aside from the well-known effect of CO on hemoglob in, the role of CO binding to other hemoproteins like myoglobin and cy tochrome a3 has been more recently recognized. Moreover, in addition t o these hypoxic injuries, the reoxygenation phase may itself induce to xic effects by a mechanism close to the ischemia-reperfusion phenomeno n. Clinical manifestations include neurologic disturbances, cardiac ar rhythmia, respiratory and circulatory failures which usually disappear with removal from toxic atmosphere and administration of oxygen. Howe ver, long term neurologic manifestations may occur and lead to importa nt functional impairment and disability. Hyperbaric oxygen is actually the treatment of choice to avoid the occurrence of delayed sequelae. HBO is advocated in every patient who remains comatose on hospital adm ission, who has lost consciousness during toxic exposure or with persi sting neurologic abnormalities. CO poisoned pregnant women should also undergo HBO.