Recognition
- Cherry-red lips, oral mucosa, and nail beds (carboxyhemoglobin has a bright red color)
- Bright cherry-red flushing on face and upper torso
- Persistent headache and dizziness (cerebral hypoxia)
- Profound fatigue and unexplained lethargy
- Tachypnea (increased breathing rate) or shortness of breath
- Cheyne-Stokes breathing: Progressively deeper breaths followed by periods of apnea — indicates severe distress
- Confusion, disorientation, or syncope in advanced cases
- Standard pulse oximeters give falsely high readings — they cannot distinguish carboxyhemoglobin from oxyhemoglobin
- Sources: Automobile exhaust, faulty gas furnaces, space heaters, wood smoke. Particularly dangerous during sleep
MT Relevance
- Massage is not appropriate during acute CO poisoning — this is a medical emergency requiring 100% oxygen or hyperbaric treatment
- Post-recovery: Once medically stabilized and cleared, standard massage considerations apply based on any residual neurological deficits
- Recognition in the clinic: Therapists should be aware of signs (cherry-red skin, headache, confusion) in case a client or colleague is exposed in a treatment setting with gas heating
Required Actions
- If CO poisoning is suspected: Call 911 immediately. Move the person to fresh air. Do not delay for further assessment
- If symptoms appear in the clinic: Evacuate the treatment area (possible environmental CO source). Open windows. Call emergency services
- Post-recovery clients with residual neurological deficits may require modified treatment for cognitive impairment, motor dysfunction, or peripheral neuropathy
Key Takeaways
- CO binds hemoglobin with 200 times the affinity of oxygen, causing severe anemic hypoxia even at low concentrations.
- Standard pulse oximeters give falsely normal readings. Arterial blood gas is the only accurate test.
- Cherry-red lips, nail beds, and facial flushing are the hallmark visual signs.
- Cheyne-Stokes breathing indicates severe distress and impending death.
- CO poisoning is a medical emergency. Massage is not appropriate during acute poisoning.