In October 2016, the ACEP Board of Directors approved a clinical policy on the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide (CO) poisoning. Developed by ACEP’s Clinical Policies Committee, this clinical policy can also be found on ACEP’s website and has been submitted for inclusion on the National Guideline Clearinghouse website.

There are approximately 50,000 ED visits per year as a result of CO poisoning. Acute poisonings have extremely varied presentations, from minimal symptomatology to unresponsiveness, hypotension, severe acidemia, or acute respiratory failure. CO poisoning is also known to be associated with longer-term morbidity and mortality. Neurologic sequelae have been described in 12 percent to 68 percent of poisoned patients, and mortality rates increase threefold compared with matched unexposed individuals at a median follow-up of 7.6 years after exposure.

Based on feedback from the ACEP membership, the committee focused on three clinical questions about the evaluation and management of acute CO poisoning in the emergency department. A systematic review of the evidence was conducted, and the committee made recommendations (Level A, B, or C) based on the strength of evidence available (see Table 1). This clinical policy underwent internal and external review from emergency physicians, medical toxicologists, hyperbaric medicine specialists, the Council of Undersea and Hyperbaric Medicine Fellowship Directors, and the ACEP Undersea and Hyperbaric Medicine Section leadership during the 60-day open-comment period. These responses were used to refine and enhance the final policy but do not imply endorsement of the clinical policy.