Carbon monoxide poisoning: an update.

oxygen. Anecdotal reports of alternative approaches have not been followed up.'0 There is little evidence from clinical studies that normobaric oxygen is effective, and even the evidence concerning hyperbaric oxygen is difficult to interpret despite animal studies and cellular research which provide strong evidence in its favour. One important factor is that it reduces free radical concentrations, and this means that the benefit from hyperbaric oxygen may be far reaching. It provides an explanation why hyperbaric oxygen prevents the delayed manifestations of carbon monoxide poisoning. The presentation by Hamilton-Farrell of the British Hyperbaric Association's carbon monoxide database (p98) provides an impressive panorama of the use of hyperbaric oxygen in Britain." The indications for referral are clearly set out, and the reasons for delay to referral and delay to arrival in a hyperbaric facility are listed. Many of these can be reduced by making a critical examination at a local level and addressing the deficiencies identified. The rising number of referrals may be a result of increased awareness, since the number of cases of fatal poisoning is falling. It has been suggested that this is due to the introduction of catalytic converters in motor vehicles. 2 Those working in any branch of emergency medicine would do well to study the articles presented in this issue of the journal. One certainly wants to avoid the error of telling a patient with undiagnosed carbon monoxide poisoning to "go home and stay warm", with the result that they suffer even worse poisoning.