The goal should be to try and eliminate CO and provide oxygen to the tissues of the body to prevent cellular dysfunction.
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Administer 100% O2 - to compete for Hb binding and improve tissue oxygenation
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Ensuring adequate ventilation – hypoventilation will delay the elimination of CO
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Consider deep sedation +/- paralysis - reduces cellular demand for oxygen in severe cases
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Temperature control/ therapeutic cooling – pyrexia leads to an increase in the metabolic demands of the brain and can lead to cerebral vasodilation which can worsen brain injury
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Consider exchange transfusion - which could reduce COHb levels. However, this would need to be rapid given the half-life of CO in oxygen-rich environments
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Maintain good perfusion of end organs to limit damage done
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Consider hyperbaric oxygen - an increase in ambient pressure increases oxygen binding to haemoglobin thus faster elimination of CO and improved tissue oxygenation. However, hyperbaric oxygen is associated with risks including increased production of free radical species due to hyperoxia causing oxidative damage to cells.
