Abstract
A considerable number of patients who made a carbon monoxide (CO) suicidal attempt are treated with urgent hyperbaric oxygen therapy (HBOT). For these patients at potential persistent risk of suicide, the hyperbaric chamber is a dangerous environment and their management a complex challenge for the Emergency Department (ED) and Hyperbaric Medicine Unit (UMH) teams. We aimed to (1) identify cases of intentional CO poisoning treated with urgent HBOT in the UMH of the University Hospitals of Geneva (HUG) during 2011–2018 and (2) test a proposed operational and integrated somatic-psychiatric protocol based on acquired experience. A total of 311 patients with CO poisoning were treated using urgent HBOT, for which poisoning was assumed suicidal in 40 patients (12.9%). This percentage appears greater than in other European countries. Both the excess of cases of intentional CO poisonings and difficulties encountered in their management resulted in the implementation of an operational and integrated somatic-psychiatric protocol addressing the entire patient’s clinical trajectory, from the admission at ED-HUG to the treatment at the UMH-HUG. The established institutional protocol includes (1) clinical evaluation, (2) suicide risk assessment, and (3) safety measures. This is the first report—at our best knowledge—of a protocol detailing a practical procedure algorithm and focusing on multidisciplinary and mutual collaboration between the medical-nursing teams at the ED, psychiatric ED, and UMH. Improvements in patient’s safety and care team’s sense of security were observed. In conclusion, the opportunity to refer to a standardized protocol was beneficial in that it offers both reduced risks for suicidal patients and reduced stress for care teams operating in very acute and complex situations. Further studies are needed.
Highlights
Carbon monoxide (CO) is one of the leading causes of morbidity and mortality of toxic origin [1]
The risk of repeating a suicide attempted in a hyperbaric chamber is low, the hyperbaric chamber is a hazardous environment for these patients, potentially still presenting an acute suicide risk, because of the presence of cables, devices, and other medical equipment (Fig. 1)
The percentage of intentional CO poisoning treated using urgent hyperbaric oxygen therapy (HBOT) appears greater in our sample compared to other European countries
Summary
Carbon monoxide (CO) is one of the leading causes of morbidity and mortality of toxic origin [1]. About 40– 70% of American CO poisonings are intentional, whereas the majority of European cases are accidental [2]. Suicide is the fourth leading cause of early death in Switzerland, CO-specific epidemiologic data is sparse [3, 4, 5]. CO poisoning represents a challenge for the staff of the Department of Emergency (ED). Among suicidal patients, this diagnosis is complicated by frequent simultaneous consumption of alcohol and drugs. In contrast to the standard decompression protocol (requiring at least 15 min), the necessity of applying a faster decompression procedure (requiring 3 min) in cases of acute psychomotor agitation—not rare in these patients—increases the risk of decompression sickness [2, 7, 8]
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