Hyperbaric oxygen therapy for carbon monoxide poisoning in Jordan
علاج التسمم بأول أكسيد الكربون بالأكسجين المضغوط
Hyperbaric oxygen therapy for carbon monoxide poisoning means placing the patient in a pressurised chamber to breathe high-concentration oxygen, clearing carbon monoxide from the blood and cells faster and reducing the likelihood of delayed neurological complications. This is one of the clearest evidence-based uses of hyperbaric oxygen, and it is an emergency treatment in which timing matters. Carbon monoxide is a gas with no colour, taste or smell. It is produced by incomplete combustion in gas, kerosene, charcoal and wood heaters, in water heaters, and in car engines and generators running in poorly ventilated spaces. Because it is odourless, relying on smell to detect it is a fatal mistake; the smell people notice with a gas leak comes from an odorant added to the fuel, not from carbon monoxide itself. Its symptoms mimic a cold or ordinary tiredness: headache, dizziness, nausea, exhaustion, confusion, and in severe cases loss of consciousness. Several people in one household developing the same symptoms at the same time should raise immediate suspicion. The first steps are not the chamber. Move the person into fresh air, shut off the source, open windows, and call emergency services. The highest possible concentration of oxygen is given immediately by ambulance and emergency staff, consciousness and cardiac status are assessed, and carbon monoxide is measured in the blood with a dedicated test. One dangerous myth must be corrected here: **a fingertip pulse oximeter can show a reassuringly normal reading in carbon monoxide poisoning, so it must never be used to rule the poisoning out.** Hyperbaric oxygen is then considered for selected patients, including those who lost consciousness, developed neurological signs or confusion, showed cardiac involvement, had a high carbon monoxide level, or are pregnant. Pregnancy is an important exception: it is a relative barrier for most other hyperbaric indications, but in carbon monoxide poisoning it is a reason to treat rather than to delay, because the fetus is more vulnerable. The limits are explicit. Hyperbaric oxygen does not undo brain injury that has already become established, does not replace treatment of burns or associated injuries in house fires, and does not prevent every delayed complication. Feeling better after breathing fresh air does not mean the danger has passed, since neurological symptoms can appear days or weeks later.
Procedure steps
- 1
Removing the person from the source and calling for help
Get the person into fresh air at once, shut off the heater, water heater or engine, open doors and windows, and do not enter a suspect space alone. Call emergency services even if the person seems better after coming out. Bring out everyone else who was in the space, including those with no complaints, because symptoms appear unevenly among people in the same household.
- 2
Immediate oxygen and emergency assessment
The highest available concentration of oxygen is started immediately, without waiting for a chamber. In the emergency department consciousness, breathing and cardiac status are assessed, and tests are ordered to measure carbon monoxide in the blood along with blood gases and an ECG. A fingertip oximeter is not used to exclude the poisoning, because it can give a misleadingly normal reading.
- 3
Deciding on hyperbaric oxygen
The decision is medical and made quickly, based on loss of consciousness, neurological signs or confusion, cardiac involvement, a high blood carbon monoxide level, or pregnancy. Benefit is greater the sooner treatment starts after exposure, so referral to a centre with a chamber is arranged without delay, with oxygen continued throughout transfer.
- 4
The session inside the chamber
A conscious patient is shown how to equalise ear pressure before entry, and fire-safety rules apply, so no oil-based product, perfume or electronic device goes in. Pressure is then raised gradually, oxygen is breathed for a set period under observation, and pressure is lowered gradually. **Severe ear pain or bleeding from the ear stops the session**, and in an unconscious patient additional arrangements are made to equalise the ears.
- 5
Neurological follow-up after apparent recovery
Follow-up is arranged after discharge, because neurological symptoms can emerge days or weeks after the poisoning, including poor concentration and memory, mood change and slowed movement. The cause of exposure is corrected before returning home: servicing the heater, flue and ventilation, never sleeping in a closed room with a combustion source, and fitting a carbon monoxide alarm where possible.
Before the procedure
This is an emergency, so preparation must never mean waiting. Move the person into fresh air and call for help rather than waiting for spontaneous improvement. Tell the emergency team the details that change decisions: the type of source (gas, kerosene or charcoal heater, water heater, generator, vehicle), how long the exposure lasted, whether the space was closed, whether the person lost consciousness even briefly, whether there was a seizure, and whether children, a pregnant woman, an elderly person or someone with heart disease was in the space. Report medications and chronic illnesses, any lung disease, previous collapsed lung or ear surgery, and pregnancy or the possibility of it. If the patient is conscious and will enter the chamber, listen to the ear-equalisation explanation and practise it, and report any cold, blocked nose or ear infection. All oil-based products, perfumes and deodorants are removed before entry, and no phone, lighter or smart watch goes into the chamber, as this is a fire-safety rule rather than a formality. Do not return to the space until the source is repaired and ventilation secured.
After the procedure
Complete every session and follow-up requested and do not rely on feeling better, because carbon monoxide poisoning can leave symptoms that appear late. Watch yourself and everyone who shared the space over the following weeks for poor concentration or memory, changes in mood or sleep, recurring headache, dizziness, slowed or heavy movement, or personality change noticed by family. Report any of these to your doctor even if they seem minor. Do not drive or operate machinery until headache, dizziness and blurred vision have gone. Fix the cause before going back: service the heater, water heater and flue, keep permanent ventilation, never sleep in a closed room with a combustion source, never run a generator or vehicle in an enclosed space, and fit a carbon monoxide alarm where possible. **Seek care immediately for a seizure, loss of consciousness, confusion, weakness or numbness on one side, difficulty speaking, chest pain or breathlessness, a severe headache that will not settle, severe ear pain, bleeding from the ear or hearing loss, or any worrying change in vision.**
Expected duration
An emergency session usually runs about sixty to one hundred and twenty minutes depending on the protocol used, plus assessment and observation time. One session may suffice in less severe cases, while others need one to three closely spaced sessions over the first day or two, with the decision made clinically and as soon as possible after exposure.
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