Carbon monoxide toxicity: audit on dysglycaemia link and guideline compliance

Background: Carbon monoxide (CO) toxicity is a significant cause of morbidity and mortality. Preliminary evidence suggests a relationship with dysglycaemia. This audit investigated this association in the prehospital setting and evaluated compliance with clinical guidelines on acute CO toxicity. Methods: Records from a regional NHS ambulance service over 8 months identified 452 cases of potential CO toxicity, 49 of which were deemed severe. Data collection focused on blood glucose monitoring, high-flow oxygen administration, electrocardiogram (ECG) recording and pre-alert documentation. Results: Of the 49 severe cases, 17 had blood glucose recorded and three cases of dysglycaemia were identified. Compliance with clinical guidelines was low: 22.4% of severe cases received high-flow oxygen therapy; 32.7% had an ECG; and 34.4% had a documented pre-alert to hospital. Conclusion: There are significant deficiencies in the prehospital assessment and treatment of patients with suspected CO poisoning. This audit was underpowered to establish an association with CO toxicity owing to poor compliance with blood glucose monitoring. This study provides the first evidence on the incidence of CO toxicity in the prehospital setting and underscores the need for education and adherence to guidelines to enhance care while highlighting a role for increased prehospital carboxyhaemoglobin monitoring.