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Hyperbaric Medicine
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Chest xrays for all hyperbaric patients? 3 S. Sherr I have read that this may not be necessary unless the patient has risk factors.We require a chest x-ray on every patient before treatment.  It would be interesting to see a study on this - how often do we catch a contraindication for hyperbaric therapy via the mandatory pre-treatment chest x-ray.
by J. Cormier
Friday, February 15, 2013
treatment protocol for ORN when additional extractions are needed 1 R. Byrne We are currently diving a patient under the Marx protocol 20/10. This particular patient was with us about a year ago (or slightly more) for the same diagnosis and completed the entire 20/10 Marx protocol then as well. This is the plan of care both her physicians felt would be most beneficial. I am not sure how other clinics may handle this scenario. Just sharing our recent experience.
by J. Cormier
Friday, February 15, 2013
AICD in monoplace 5 L. Hezel We have had no problems treated patients with AICD. I always get a copy of the patients card, call the manufacturer and have them fax me the relevant approval paperwork. Most I have come across have been approved to 2.5 ATA or 3 ATA.
by J. Cormier
Friday, February 15, 2013
CO poisoning study 0 J. Cormier Recently (Jan 2013) I was attending a two day medical management of CBRNE (chemical, biological weapons, etc) course in Arlington TX. It is tied to emergency preparedness and FEMA. One of the instructors briefly brought up a study he stated had been completed at Hopkins. He said the study was about the effectiveness of using oscillating ventilators for treating carbon monoxide poisoning. He implied the results showed this therapy to be just as effective or more effective than hyperbaric therapy. I have looking for this study to read it myself but have had no luck. Is anyone out there familiar with this? I contacted the course instructors to see if they could send me in the right direction but I have not heard anything back as of yet.
by J. Cormier
Friday, February 15, 2013
Diabetic Foot Ulcers; criteria for "diabetic" 2 P. Benson We treated a patient using the diabetic foot wound diagnosis who was no longer diabetic post pancreatic transplant. This patient did not take any diabetes medications and had a normal a1c. The patient had been diabetic for many years and our physician argued the vessel damage from the diabetes still existed and, therefore, hyperbaric therapy was warranted. We had documentation of his diabetic history.
by J. Cormier
Friday, February 15, 2013
Insurance company requiring negative pressure wound therapy before HBOT 3 V. Ferrini I know I am posting this late and you have probably already dealt with this particular patient. If it helps for future patients - whenever we have had, what we have felt, are unjustified denials from insurance companies we usually request a physician to physician review and resubmit with a letter of medical necessity. This has worked well for us so far.
by J. Cormier
Friday, February 15, 2013
athrosclerosis 0 L. Cox Was wondering what the protocal for  athrosclerosis (peripheral ischemia) would be.
by L. Cox
Friday, February 08, 2013
Duragesic Patch 0 J. Twigg A colleague at another center told me she read a safety update on Mededonline (no longer available) regarding Duragesic patches in hyperbaric chambers. I've searched in other engines but have not found any reference to the subject. Do other centers remove the patches? Thank you, 
by J. Twigg
Tuesday, February 05, 2013
Fibromyalgia 0 J. Whitlark I work at a free standing wound clinic and we have been contacted by a patient's mother about treating her 17 year old daughter with fibromyalgia... does anyone have any input on this as far as it being beneficial or possibly a treatment protocol?? I have tried to look for supporting articles and have found limited information and none of it is current.  Thanks for any help you have to offer! Samantha B. CHT
by J. Whitlark
Friday, January 04, 2013
Corneal laceration ?caused by HBOT? 1 R. Byrne To update on this: the patient was found to have a corneal infection that was misdiagnosed as a corneal abrasion. She was admitted to ICU and has currently no vision in the affected eye. It is likely that HBOT had no impact on this unfortunate situation.
by R. Byrne
Wednesday, January 02, 2013
2 people in monoplace chamber 3 M. O'Donnell Thank you for your answers, While I  remain uncomfortable with this situation, I feel somewhat more comfortable with your input.
by M. O'Donnell
Thursday, December 27, 2012
monoplace fire safety protocol 2 L. Hezel Steve Fabus called today and may yet jump in with his comments.  It is important to note that what I meant by "stop the supply to the chamber" meant...switch to emergency vent and decompress the chamber ( as in the attached policy).  Many monoplace assemblies require a minimum supply pressure to work.  If you shut off the zone valve to the chamber then the chamber will not have enough supply pressure to operate the emergency vent.   Tnanks Steve for the catch...  
by J. Bell
Tuesday, December 04, 2012
Apligrafts 4 V. Ferrini not allowable by Medicare.
by P. Benson
Sunday, December 02, 2012
Upper extremity wound secondary to arterial insufficiency 2 V. Ferrini Read the Local Coverage Determinant LCD where you practice. Some spell out lower extremity, some require the patient to be an inpatient. It varies by region.
by P. Benson
Sunday, December 02, 2012
STRN frequency of treatment 3 J. Davis Working at VM... I tend to agree that one treatment a week is likely to not be as effective and would take a long time to complete.  But we do allow flexiblity in scheduling and I like to have a minimum of 3 a week if possible. The data from Dr. Hampson's study (Hampson NB. Rate of delivery of hyperbaric oxygen treatments does not affect response in soft tissue radionecrois. UHM 2007; 34(5): 329-34) looked at this.  The group of 3 or less a week were looked at and there was no significant difference in outcome (rad cystitis and proctitis patients) compared to the group with 7 or more treatments a week.  It was also looked at with 5 or less a week vs. > 5 a week... and no difference.  They did not have enough patients that only did one a week to look at this specifically.   J Holm
by J. Holm
Thursday, November 01, 2012
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, 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:
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
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
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
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