Rx Pad

We receive a number of phone calls each week from folks inquiring how to become a Certified Hyperbaric Technologist (CHT).  The added qualification of CHT is administrated by the National Board of Diving and Hyperbaric Medical Technology (NBDHMT).

Clinic and Hospital Administrators: Do you need to get your staff trained in hyperbaric medicine but have a limited budget?

Sinus and internal and external ear disorders are the most common side effects of hyperbaric oxygen therapy (HBO₂).¹ These spaces are the cranium’s pneumatic sockets and, particularly those of the middle and inner ear, are most frequently involved in the pressure stress caused by compression and decompression maneuvers during exposure to altered pressures in the hyperbaric chamber. Barotrauma is the mechanical tissue damage produced by environmental pressure variation, and the middle ear is the most frequently involved structure in this kind of damage. According to Boyle’s law (the product of pressure and volume is a constant for a given mass of confined gas) it is easy to understand why all enclosed air cavities are more susceptible to this kind of lesion. Barotraumas can occur due to an increase or decrease of gas volume. To avoid gas volume decrease during the compression phase, the patient must perform some compensatory maneuvers aimed at inhaling and forcing gas (air or oxygen) into the nasal and sinus cavities. During decompression in the chamber or even underwater, the body’s gas expands and is expelled from cavities to the outside, usually without any active maneuver. It is essential to teach the patient about the functions of the hyperbaric chamber and the correct maneuvers of baro compensation. In this article, we will describe the main barotraumas that can occur during hyperbaric oxygen therapy.

We conduct and announce a lot of courses in hyperbaric medicine throughout the year. Each course is a little different, with unique aspects we would like to highlight to help you decide which course might be a good fit for you to attend.

We get a lot of questions from hospital administrators and clinic directors asking what makes our Introductory Course in Hyperbaric Medicine unique. While there are many benefits to hosting hyperbaric team training through Wound Care Education Partners (WCEP), we have broken out the four most valuable reasons why hosting a live, classroom-based Introductory Course in Hyperbaric Medicine with WCEP may be right for your facility. Watch this short, insightful video to find answers before you book hyperbaric team training with any organization.

Many refer to Dr. Eric Kindwall at the "Father of Hyperbaric Medicine," and his contributions to hyperbaric medicine are legendary. Dr. Kindwall was born on January 17, 1934 and passed away on January 18, 2012. For this reason, we find it fitting to highlight his contributions to the field of hyperbaric medicine during the month of January.

We all learn about barotrauma in the Introductory Course in Hyperbaric Medicine. The question we have for you today is whether or not you remember the mechanisms of what causes barotrauma and how to properly pre-screen HBOT patients.

Question: "I would be interested in the current perspective regarding supervision of hyperbaric dives by Nurse Practitioners.

Question. Is myocardial irritability a complication frequently experienced by patients with clostridial myonecrosis?

Cardiac arrest is a rarity in the chamber, as most arrhythmias seem to improve under hyperbaric conditions. Anecdotally, it can be noted that one patient with a myocardial infarction, who was being treated with hyperbaric oxygen as part of a research study, suffered 30 cardiac arrests during the 48 hours he was being treated with the chamber. The schedule being followed called for two hours at pressure in the chamber followed by one hour on the surface. This cycle was repeated for two days. It can be seen that the patient spent only 1/3 of his time breathing air on the surface. During the study, the patient suffered 28 cardiac arrests while breathing air on the surface, but only two arrests while at pressure in the chamber. The patient eventually recovered and returned to work. (Thurston, J. Westminster Hosp, London, Personal Communication, 1973.)

The cardiovascular assessment of a critical care patient receiving hyperbaric oxygen therapy is similar to any cardiovascular assessment of a critical care patient. Cardiac rhythm should be assessed and monitored during the treatment. If the patient would experience a cardiac emergency during HBO treatment, the staff should be trained to handle such an emergency. It is important to remember that a patient at depth is well oxygenated and will remain so for 5 to 8 minutes. The safest way to bring a patient that has had a cardiac arrest to the surface is to bring them up at 5 psig (fastest rate on a monoplace chamber), while the staff prepares to deliver emergency care. Performing a rapid ascent using the emergency ascent button on monoplace chambers places the person at grave risk for air embolism due to expansion injuries. Once the patient has surfaced, move them to the point farthest away from the open chamber, remove the hyperoxygenated clothing, and if appropriate, defibrillate. Cold oxygen will fall to the floor and dissipate in 30 seconds, so do not place the area at an increased fire risk with the use of a defibrillator. The staff needs to be able to respond quickly and appropriately to such an emergency, so it is our recommendation that the staff be Advanced Cardiac Life Support (ACLS) certified.

Hyperbaric oxygen exposure can produce significant hemodynamic changes. An increase in systemic afterload due to hyperoxic vasoconstriction in well perfused tissues can lead to a decrease in left ventricular function and a decrease in ejection fraction in some patients. When this decrease in left ventricular function occurs in the setting of pulmonary arterial vasodilatation due to improved alveolar oxygenation with increased left atrial and left ventricular filling, acute left ventricular dysfunction and pulmonary edema can result. Cases have been reported in patients with a history of pulmonary edema or low left ventricular ejection fractions or in patients with sudden fluid shifts from volume overload. Acute pulmonary edema appears to be more common in monoplace than multiplace treatment settings, perhaps because of the requirement for patients to be in a more supine position in the monoplace chamber rather than the sitting position with legs dependent available in the multiplace chamber.

Question. What sparked the dawn of the modern hyperbaric era?

Question: Each winter many hyperbaric oxygen therapy patients have difficulty getting to their scheduled treatments due to inclement weather. What recommendations do you have for helping keep patients' treatment schedules on track when the weather is a barrier to treatment?