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.
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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:
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Stimulating
small blood vessel growth |
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Promoting
new skin growth |
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Helping
to fight infection |
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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:
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Air
or gas embolism |
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Carbon
monoxide poisoning and smoke inhalation |
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Carbon
monoxide complicated by cyanide poisoning |
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Clostridial
myonecrosis (gas gangrene) |
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Crush injury,
compartment syndrome and other acute traumatic ischemias |
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Decompression
sickness |
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Intracranial
abscess |
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Necrotizing
soft tissue infections (subcutaneous tissue, muscle, fascia) |
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Osteomyelitis
(refractory) |
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Radiation
tissue damage (osteoradionecrosis, soft tissue radionecrosis) |
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Selected
problem wounds |
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Severe
blood loss (anemia) |
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Skin graft
and flaps (compromised) |
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Thermal
burns |
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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.
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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