In suspected carbon monoxide poisoning, what is the nurse's initial intervention?

• A. Administer epinephrine
• B. Start CPR
• C. Place on nasal cannula at 2 L/min
• D. 100% oxygen at 15 L/min via nonrebreather mask

Answer: (D)

When carbon monoxide poisoning is suspected, the priority is to rapidly maximize oxygen delivery to tissues and displace CO from hemoglobin. Carbon monoxide binds to hemoglobin with a much higher affinity than oxygen, forming carboxyhemoglobin and causing tissue hypoxia. The fastest and most effective way to reverse this is to provide 100% oxygen as quickly as possible using a nonrebreather mask at high flow (about 15 L/min). This markedly speeds up the clearance of CO from the body and restores oxygen delivery to organs, especially the brain and heart. In more severe cases, hyperbaric oxygen may be considered, but the initial, immediate step is high-flow 100% oxygen.

A nasal cannula at 2 L/min cannot deliver near 100% oxygen, so it won’t adequately treat CO poisoning. Epinephrine isn’t indicated for CO exposure, and CPR is only the initial step if there is no pulse or the patient is in cardiac arrest.