Urgent hyperbaric oxygen therapy for suicidal carbon monoxide poisoning: from a preliminary survey to a proposal for an
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(2020) 13:61
International Journal of Emergency Medicine
PRACTICE INNOVATIONS IN EMERGENCY MEDICINE
Open Access
Urgent hyperbaric oxygen therapy for suicidal carbon monoxide poisoning: from a preliminary survey to a proposal for an integrated somatic-psychiatric protocol Alessandra Costanza1,2*† , Julia Ambrosetti3†, Philippe Spagnoli4, Andrea Amerio5,6,7, Andrea Aguglia5,6, Gianluca Serafini5,6, Mario Amore5,6, Guido Bondolfi1,8, François Sarasin1,9 and Rodrigue Pignel4
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 EDHUG 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. Keywords: Hyperbaric medicine, Emergency medicine, Emergency psychiatry, Risk management, Suicide, Suicidal behavior, Suicide attempt, Intentional carbon monoxide intoxication
* Correspondence: [email protected] † Alessandra Costanza and Julia Ambrosetti contributed equally to this work. 1 Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland 2 Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distr
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