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Hyperbaric Medicine
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Hydrogensulfide poisoning 0 O. Hyldegaard Hydrogen Sulfide poisoning. Dear Collegues!   Case of Hydrogensulfide (H2S) poisoning in Denmark. I adress you, as we are having a serious problem concerning the diagnosis and treatment of employees at the emergency ward at Bornholm Hospital (A Danish island located in the Baltic Sea of Northern Europe).The Bornholm Hospital is a regional hospital serving the 42.000 inhabitants on the island. The hospital is known as a well functioning unit. On Sunday the 7th of October 4 persons - nurses and secretary - went into a room in the emergency ward. The persons got serious CNS-sympthoms including near fainting. Afterwards they were extremely tired, dizzy, and had nausea. Some had irritation of the eyes. They all complained about feeling short of breath. The persons were given oxygen on mask and experienced relief of sympthoms. When they were taken off oxygen support the sympthoms aggravated.As no explanation was found concerning the initial cases work continued in the same part of the hospital. Unfortuntely 8 more persons were having the same symptoms.The first 4 persons were referred to Rigshospitalet and in the early hours of October 10th. They were referred for immediate hyperbaric treatment. 6 more patients were referred in the following days. The patients have been given 2 to 8 treatments with initial alleviation of the symptoms, but later the extreme tiredness reapper.The patients we send home 19th and 21st. One of the patients who were considered very little affected and without any complaints on the 19th was readmitted to Bornholm Hospital on the 22nd. This patient experienced relief by administration of oxygen on mask.As mentioned, the patients are still extremely tired, dizzy, and have nausea. No focal neurology has been found. The neurologists are of the opinion that the pnenomena are functional. All biochemical analyses are normal. Only the respiratory capacity is reduced as an expression of the reduced physical capacity.The rationale for hyperbaric treatment was exposure to hydrogen sulfide. The construction of the sewers of the hospital supports this hypothesis, - but no definitve proof is found. Bornholm is surrounded by various substances from WWII and the cold war, but none of these substances to our knowledge give rise to provide a relation to the incident.The questions are therefore:Do you have had similar incidents ?Do you have any clue to what substance/gas/agent/virus/bacteria could cause the incident?If the intoxication is H2S, hydrogensulfide, which treatment do you consider most appropiate? Sincerely, Ole Hyldegaard, MD, Ph.D, DM.sc Ole Hyldegaard, MD, Ph.D., Dr.Med.Sci.Anaesthesiology, Diving and Hyperbaric MedicineDirector of Research - Laboratory of Hyperbaric MedicineCenter of Head and Orthopedics, Dept. of Anaesthesia,University Hospital - RigshospitaletE-mail: ole.hyldegaard@rh.regionh.dk
by O. Hyldegaard
Tuesday, October 23, 2012
Treating Patients that have Cochlear Implants 0 F. Steffich We have a patient that is a candidate for HBOT (Radiation Proctitis).  He has bi-lateral cochlear implants.  The manufacturer is AB Bionics, I called them to ask if what is implanted beneath the skin is safe for therapy, their answer was basically, "they cannot say if it is safe or not and not sure if they can handle the pressure and to check with the surgeon who implanted them."  Now we checked on another manufacturer, "Cochlear Americas" and their products are safe up to 120ft of seawater.  Has anyone treated a patient with cochlear implants from AB Bionics?
by F. Steffich
Thursday, September 27, 2012
Ulcerative Colitis and HBOT 4 V. Ferrini Thanks for your help everyone, unfortunately the patient's insurance company was not very accomodating.  Maybe I did not say the right thing.  It is very frustrating especially when I see the great results.  Any one willing to send me a letter that you submitted to the insurance company. Thanks Again  
by V. Ferrini
Wednesday, September 26, 2012
Protocol for diabetics 1 E. Slisher We use a minimum of 110.  However, the first dive I like to see them at least in the mid 100 range. I monitor the diabetic carefully the first few dives to get an idea of their individual drop rate. If they tend to drop significantly (80-100 pts) I give them some fiber and fat pre dive to ensure when they come out of the camber they will be in that 100 - 110 range post dive. We are fortunate to have the diabetic educators located next door to the HBO room. I often consult them for individual pt menu planning for the HBO pts.
by L. Cheesebrough-Pegg
Tuesday, September 04, 2012
Hyperbaric earthquake preparedness 2 C. Pascual We live in an earthquake zone here in UT.  Operating both monoplace and multiplace. These chambers have different concerns, the monoplace is a ton or so of equipment, loss of head wall gas etc, the patients are probably not at risk for decompression sickness so we can safely decompress and evacuate to a place of safety. The multiplace has different concerns as far as risk for the inside attendant. We have no specific earthquake policy for our department other than the evacuation policy.  The hospital has an earthquake policy and we would terminate the treatments in accordance with our evacuation policy then fall in with the hospital emergency proccesses.
by J. Bell
Friday, August 24, 2012
Looking for Dr. MR Reillo 1 R. Duncan Has this research been written up in a journal yet?  I do not know how to contact Dr. Reillo
by V. Ferrini
Thursday, August 23, 2012
Safety procedure videos 3 L. Cheesebrough-Pegg try http://www.emedsim.com/
by R. Byrne
Friday, August 10, 2012
Avascular necrosis treatment? in children? 0 R. Byrne I was wondering if anyone is treating AVN with HBOT?  and more specifically, if anyone is treating children with AVN?  if so, what protocol?  any results?  has insurance paid?thanks!
by R. Byrne
Friday, August 10, 2012
transverse myelitis 0 L. Golembeski has anyone ever treated a pt with transverse myelitis with HBO? Is it an indiacation of such that is covered? Any info would be greatly appreciated. Thanks. Lori G... Sarasota Memorial Hospital/ Hyperbaric dept. 941-917-1866
by L. Golembeski
Monday, August 06, 2012
Video monitoring of patients. 2 E. Voss I'm always in the same room. Due to area constraints the desk can't be located between the chambers.My desk is approximately 10 feet away. The problem is I am looking at the patients from the chamber door end. I can't see their faces. Problem, can't see facial twitching or other si igns of distress on patients faces. I am using the monitors and the video screen is located directly under my computer monitor. Their faces and chests are is crystal clear viewing. (Watching chest rise and fall when the patients are sleeping. Any other suggestions are greatly appreciated.
by E. Voss
Saturday, June 30, 2012
Bisphosphonate induced osteonecrosis of Mandible 0 S. Shah I have a patient requesting HBOT for bisphosphonate induced osteonecrosis of mandible. Is providing HBOT appropriate ? Can  someone suggest any publications in this area ? Is there a specific ICD code that can be used for Medicare billing ? Thanks   Sid Shah
by S. Shah
Saturday, May 26, 2012
TCOM protocols 2 S. Wood According to Highmark Medicare (now Novita-Soultions) in NJ, anyone undergoing HBOT for a DFU Wagner Grade III or higher must have the following criteria met: Diabetic wounds of the lower extremities in patients who meet the following three criteria: A) Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes; B) Patient has a wound classified as Wagner grade III or higher; and C) Patient has failed an adequate course of standard wound therapy. The use of HBO therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. Continued treatment with HBO therapy is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment. For diabetic wounds of the lower extremity, the Wagner classification of the wound and the failure of an adequate course (at least 30 days) of standard wound therapy must be documented at the initiation of therapy: A) Documentation must demonstrate an ulcer with bone involvement (osteomyelitis), or localized gangrene, or gangrene of the whole foot. B) Documentation of standard wound care in patients with diabetic wounds per the NCD must include: assessment of a patient’s vascular status and documentation of correction of any vascular problems in the affected limb; documentation of optimization of nutritional status; documentation of optimization of glucose control; documentation of debridement by any means to remove devitalized tissue; documentation of maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings; documentation of efforts for appropriate off-loading; anddocumentation of necessary treatment to resolve any infection that might be present. Usually the starting point for any DFU/Wagner III during a TCOM should be around 35mmHg - 50mmHg, that number should double or triple after the 10 minute O2 challenge.  If it starts our less than 35mmHg and does not respond after the O2 challenge they may need vascular intervention.  Also, if you can do "in-chamber" TCOMS, do them, they are very helpful.
by F. Steffich
Thursday, May 24, 2012
Prior Hx of Pneumothorax 0 J. Toth In the past, a one time CXR, PA & Lat screening study and exam was all that was required in a pt with no pre-existing lung pathology, who sustained one pneumothorax from trauma, which was small, and which spontaneously resolved within a few months. Is anyone aware of any changes to these recommendations?John Toth D.O.
by J. Toth
Tuesday, May 01, 2012
APAI approval 1 J. Castro We have several hyperbaric centers in the different states so it depends on the state. I have used the code 440.23 with and ulcer code for coverage in Ohio but in Tennessee, the CMS does not recognize that code. It makes no sense but it is the fact.Thanks Vince
by V. Ferrini
Tuesday, April 24, 2012
TCOM coding (U.S. ICD-9 for CMS) 0 A. Johnston I have been reviewing coding integrity and have come against a roadblock as to whether a normobaric TCOM with an oxygen challenge and/or an in-chamber TCOM on 100% oxygen meet the requirements for 93923 as a "provocative maneuver." Historically we have taken it to count, but all examples in coding books available to us use physical exercise examples such as toe elevations or treadmill walking, although they are obviously directing their attention toward ultrasound studies and their examples are neither stated to be exclusive or exhaustive. The only internet item I've found to specifically address the question is a blog posting from December 2010 by Dick Clarke (http://www.baromedical.com/blog_Dec2010.php) where the question is raised, but there doesn't seem to be a follow up posted. Does anyone have something in writing from any source stating an answer?
by A. Johnston
Monday, April 16, 2012
Missing Cribriform plate and HBOT 0 C. Waltz Somebody inquired if she, having nasal cancer and having had her cribriform plate removed through surgery, and now undergoing radiation therapy would be a possible candidate for hyperbaric therapy in the future (if warranted) or would it be contraindicated because of the missing plate? She will be undergoing 6.5 weeks of radiation to the nasal area.  Her surgeon told her that the pressure from the hyperbaric would travel through her sinuses and cause her brain to herniate because she is missing the cribriform plate.  Thoughts?  Connie Waltz ACHRN
by C. Waltz
Wednesday, April 11, 2012
Osteonecrosis of jaw (OJN) 1 P. Dionne I think Duke was doing a study...I don't know if that is still the case.
by K. Fowler
Monday, April 02, 2012
curious case 1 D. McCluskey We had a patient with breast implants that had similar breast pain complaints.  She did not have pain anywhere else and her pain didn't start until she had around 10 treatments. Kari
by K. Fowler
Monday, April 02, 2012
Any problems with a patient taking Taxol? 0 P. Schell We have a potential hyperbaric patient with breast cancer and taking Taxol.  Has anyone seen any problems allowing a patinet to dive taking Taxol? OakLeaf Advanced Wound Care & Hyperbaric Medicine Center
by P. Schell
Friday, March 09, 2012
Equine Chamber Explosion in Florida 0 H. Hodes Is anyone going to talk about the Equine chamber explosion in Florida where we lost a CHVT? Seems to me that this horrible accident needs some discusion. Guess I'll start it. >>>        Why is it from all the photos and videos of that system that are available on the internet does the Equine Chamber look like an accident waiting to happen? Really, 100% oxygen chamber of that size and from what I saw it was not even close to being clean enough for pumping it with %100!  If horse hoofs will chip the coating and create the spark that blew this one up, wouldn't some type of covering for the horse hoofs be required then? Also, why are there viewports low enough that an aggitated horse could kick one if it got unstable? Seems to me the viewports would be higher and have some of safety guard. And lastly, the reports say this horse was not "sedated as usual" that time, really? , Why would that not be standard operating procedures just like normal check lists used in People Vessles?   I know that we operate under the PVHO-1 standards because of the human element to our procedures, but clearly humans will always be running Class C chambers and if they fail, as did this one, humans will be around the carnage when it goes.   Hal
by H. Hodes
Friday, February 24, 2012
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