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Carbon monoxide binds haemoglobin and disrupts cellular oxygen use, so a normal conventional pulse oximeter reading does not exclude serious toxicity.
Ask about indoor heaters, fires, generators, shared symptoms in household members, headache, dizziness, vomiting, confusion, syncope or chest pain.
Remove from exposure without endangering rescuers; give high-concentration oxygen, assess ABCDE and seek emergency senior/toxicology advice, particularly for pregnancy, neurological signs or myocardial injury.
Obtain blood gas co-oximetry for carboxyhaemoglobin where available, ECG and cardiac investigations as indicated. Explore the environmental source and ensure safe discharge planning.
Do not use an apparently normal SpOโ to dismiss poisoning. Carboxyhaemoglobin may fall after oxygen or a delay, so correlate with history and clinical severity.
UK reference: NHS carbon monoxide poisoning. Focused editorial source check, 7 November 2026; this is not independent clinical or pharmacy sign-off. Verify current local policy, BNF/BNFC and specialist advice before treatment. Not a prescribing protocol.
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