Différences entre versions de « Intoxication au monoxyde de carbone »
| Ligne 12 : | Ligne 12 : | ||
== Traitement == | == Traitement == | ||
=== Carboxyhémoglobinémie inconnue === | === Carboxyhémoglobinémie inconnue === | ||
| − | * Traitement présomptif par O2 100% durant '''4-6 heures'''<ref>ATLS 11e | + | * Traitement présomptif par O2 100% durant '''4-6 heures'''<ref name="atls">Advanced Trauma Life Support (ATLS) 11e edition 2025</ref> |
| − | === Carboxyhémoglobinémie | + | === Carboxyhémoglobinémie <20% === |
| + | * <u>Clinique:</u> peut être asymptomatique<ref name ="atls" /> | ||
| + | === Carboxyhémoglobinémie >20% === | ||
| + | * <u>Clinique:</u> céphalées et nausées (20-30%), confusion (30-40%), coma (40-60%), décès (>60%)<ref name="atls" /> | ||
* Patients with high levels of carboxyhemoglobin (25% and greater) and evidence of organ ischemia should be treated with hyperbaric oxygen if possible. | * Patients with high levels of carboxyhemoglobin (25% and greater) and evidence of organ ischemia should be treated with hyperbaric oxygen if possible. | ||
* Methylene blue would be recommended for toxic levels of methemoglobin, usually 20% to 30% or higher. | * Methylene blue would be recommended for toxic levels of methemoglobin, usually 20% to 30% or higher. | ||
Version du 13 août 2026 à 22:41
Cited indications for hyperbaric oxygen therapy include loss of consciousness, ischemic cardiac changes, neurological deficits, significant metabolic acidosis, or carboxyhemoglobin level greater than 25%. A carboxyhemoglobin level of 50% is critical and needs to be reduced as quickly as possible. Breathing 100% oxygen at normal atmospheric pressure, this patient will clear the carboxyhemoglobin with a half-life of 90 minutes, but hyperbaric oxygen therapy will lower the half-life to 30 minutes. Also, there is considerable risk of delayed neurocognitive impairment following a severe exposure such as this, and hyperbaric oxygen is believed to lower the risk of this long-term complication, although the strength of this evidence is disputed.[1]
Définition
- Carboxyhémoglobinémie normale: <3%
- Carboxyhémoglobinémie chez les fumeurs: 10%-15%
Physiopathologie
- Demi-vie approximative d'élimination du CO[2]:
- à l'air ambiant 4 heures
- sous masque à réserve 100%: 40-50 minutes
Traitement
Carboxyhémoglobinémie inconnue
- Traitement présomptif par O2 100% durant 4-6 heures[3]
Carboxyhémoglobinémie <20%
- Clinique: peut être asymptomatique[3]
Carboxyhémoglobinémie >20%
- Clinique: céphalées et nausées (20-30%), confusion (30-40%), coma (40-60%), décès (>60%)[3]
- Patients with high levels of carboxyhemoglobin (25% and greater) and evidence of organ ischemia should be treated with hyperbaric oxygen if possible.
- Methylene blue would be recommended for toxic levels of methemoglobin, usually 20% to 30% or higher.
