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Emergency Department

 

Hyperbaric Medicine -   The only service of its kind north of Appleton Wisconsin, the hyperbaric chamber is used to treat victims of carbon monoxide poisoning, underwater diving accidents and patients with chronic wounds.
What is hyperbaric oxygen therapy? Hyperbaric oxygen therapy (HBOT) is a medical treatment where a patient breathes 100% oxygen while in a pressurized chamber. Large doses of oxygen are dissolved into blood or body tissues at these pressures. This increased oxygen promotes wound healing by:   * Stimulating small blood vessel growth * Promoting new skin growth * Helping to fight infection

 

For most conditions HBOT is a supplemental therapy to be used in addition to current medical and surgical therapy. HBOT is definitive therapy for carbon monoxide poisoning, gas embolism and decompression illness. We treat patients with UHMS approved conditions only.

 

When is hyperbaric oxygen therapy appropriate?

The Hyperbaric Oxygen Committee of the Undersea and Hyperbaric Medical Society (UHMS) has approved treatment for these conditions:

 

*	Air or gas embolism
*	Carbon monoxide poisoning and smoke inhalation
*	Carbon monoxide complicated by cyanide poisoning
*	Clostridial myonecrosis (gas gangrene)
*	Crush injury, compartment syndrome and other acute traumatic ischemias
*	Decompression sickness
*	Intracranial abscess
*	Necrotizing soft tissue infections (subcutaneous tissue, muscle, fascia)
*	Osteomyelitis (refractory)
*	Radiation tissue damage (osteoradionecrosis, soft tissue radionecrosis)
*	Selected problem wounds
*	Severe blood loss (anemia)
*	Skin graft and flaps (compromised)
*	Thermal burns
*	Certain diabetic wounds

 

Preparing for HBOT treatments

 

Patients being treated should not use any tobacco products. Tobacco products of any kind will cause your blood vessels to narrow, making treatments less beneficial.

There are no eating restrictions when receiving hyperbaric treatments. Continue any special diet for diabetes, kidney failure, etc.

 

Hyperbaric treatments should not change the effectiveness of most medications.

 

What to expect

Routine hyperbaric treatments last approximately 2 hours. Treatments should be painless. Because of the air pressure changes in the chamber, a patient’s ears will have a sense of fullness when the chamber compresses, similar to flying in an airplane. If there is any pain during the treatment, patients should notify the hyperbaric attendant.

If wound care is required, the wound care and/or hyperbaric staff will perform dressing changes on patients prior to or immediately after their treatment. Patients will be assigned a specific time for their care. The hyperbaric physician will see a patient based on his/her condition. The hyperbaric staff will update the physician on the patient’s progress.

 

Rarely, some patients may experience temporary visual changes due to hyperbaric treatments. Patients should not buy any new glasses or contact lenses during hyperbaric treatment. Vision status will stabilize 6–8 weeks after treatments have ended.

 

How exactly is HBOT administered?

Monoplace chamber: Before going into the monoplace chamber, the patient is required to remove all clothing and put on a 100% cotton gown. Once they are lying comfortably on the transfer gurney, it will be slid into the chamber. After the door closes, the gentle “hiss” of the incoming oxygen used to pressurize the chamber will be heard. The hyperbaric nurse is in the room at all times while a patient is receiving treatment, and the nurse and patient can talk to each other at all times.

 

As pressure develops in the chamber, the patient will notice a slight warming. They will also feel a fullness in their ears and should begin ear clearing procedures. When compression is complete, the need for ear clearing ceases. The patient may now rest, watch TV, view a video tape or listen to music.

 

During decompression, the chamber becomes cooler and the patient will feel a slight popping sensation in their ears as they adjust to the changing pressure. There is no need to clear the ears during decompression. No oxygen mask is required in this chamber because the entire chamber is filled with oxygen.

 

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Frequently Asked Questions -

 

What does HBOT feel like?

The sensation can be similar to that experienced while flying and/or landing in an airplane. As pressure builds, it is common to feel pressure in the ears. As the pressure is released, the ears “pop” automatically. Most patients rest comfortably throughout treatment. Many read, sleep or listen to music. Because the temperature increases during pressurization, HBOT chambers are equipped with air conditioning to ensure patient comfort.

 

How long does a hyperbaric oxygen treatment last?

Most treatments, including those for wound healing, last about 2 hours. Treatments for acute indications, such as carbon monoxide poisoning, may last as long as 4 hours, and under rare circumstances, some diving injuries may require treatment even longer than 8 hours.

 

How much pressure will be used for HBOT treatment?

Treatments for most chronic conditions, including wound healing, are usually at 2.4 Atmospheres Absolute Pressure (ATA). Most emergencies are treated with greater pressures, but usually at 3 ATA or less. Treatment for cerebral gas embolism may require compression to pressures up to 6 ATA.

 

How many HBOT treatments does a patient need?

The treatment’s pressure and duration, as well as the number of treatments received, is determined by the hyperbaric doctor. This decision is based on the patient’s diagnosis and their body’s response to the therapy. Most wound healing patients receive one treatment per day (Monday – Friday) for 20–30 days. In general, patients with chronic conditions usually receive a longer series of treatments than patients with acute conditions.

 

Does insurance cover the cost of HBOT treatments?

Most insurance companies cover hyperbaric oxygen therapy. We will assist in obtaining verification of coverage from an insurance company prior to starting treatments.

 

Will the referring doctor still remain the patient’s doctor?

Yes. The hyperbaric doctor serves as a consultant who will work closely with the patient’s doctor to manage the treatment program.

 

What are the risks or possible side effects of HBOT?

Under proper supervision, the risks of HBOT are very minimal. The most common side effect is ear pain, and patients are monitored closely for this. Rarely, oxygen toxicity, pulmonary barotrauma and vision change can be experienced.

 

The following list of potential side effects is reviewed with each patient prior to beginning therapy.

 

Otic Barotrauma (pain in the ears or sinuses).

Some patients may experience pain in their ears or sinuses. If they are not able to equalize their ears or sinuses, the pressurization will be slowed or halted and suitable remedies will be applied.

 

Serous Otitis.

Fluid in the ears sometimes accumulates as a result of breathing high concentrations of oxygen. It may occasionally feel like having a “pillow over the ear.” This disappears after hyperbaric treatment ceases and often can be eased with decongestants.

 

Oxygen Toxicity.

The risk of oxygen toxicity is minimized by never exposing patients to greater pressure or longer times than are known to be safe for the body and its organs. The risk is less than one in 10,000 treatments.

 

Visual Changes (blurring, worsening of near-sightedness [myopia], temporary improvement in far-sightedness [presbyopia]).

After 20 or more treatments, especially for those over 40 years old, some patients may experience a change in vision. This is usually temporary and in the majority of patients, vision returns to its pre-treatment level about six weeks after the cessation of therapy. It is not advisable to get a new prescription for glasses or contacts until at least eight weeks after ending hyperbaric oxygen therapy.

 

Maturing or Ripening Cataracts.

Individuals with cataracts have occasionally had a maturing or ripening of cataracts.

 

Cerebral Air Embolism and Pneumothorax.

Whenever there is a rapid change in ambient pressure, there is the possibility of rupture of the lungs with escape of air into the arteries or into the chest cavity outside the lungs. This can only occur if the normal passage of air out of the lungs is blocked during decompression. Only slow decompressions are used in HBOT to prevent this possibility. It is important for patients to breathe normally during during treatment and not hold their breath.

 

Fatigue.

Some people may feel fatigue following hyperbaric treatment, but this is not a consistent finding.

 

Risk of Fire.

With the use of oxygen in any form there is always an increased risk of fire. However, strict precautions (including the use of 100% cotton gowns and liners) have been taken to prevent this and all applicable codes have been complied with.

 

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