HBOT Safety/Review Questions #2
A young canine is referred after a cardiopulmonary arrest/resuscitation and an iliac saddle thrombus. You are completing caudal abdominal ultrasound exam (immediately prior to a scheduled HBOT session) when the technician arrives to take the patient directly to the chamber.
Describe how to prepare the patient in this situation for a safe HBOT session:
ANSWER: Some brands of ultrasound gel have propylene glycol and ethanol compounds in their ingredients. Most ultrasonographers use alcohol to prepare the coat and skin for ideal contact with the probe. These substances all support combustion, and are not allowed in the chamber. The patient should be washed with a gentle soap and water solution, and wiped with a 100% cotton towel prior to the treatment session. This is especially important to remember in this situation where the session immediately follows the ultrasound exam.
You have been referred a canine patient for adjuvant HBOT in the treatment of acute "Bell's Palsy.” The patient had an extensive diagnostic work up by a veterinary neurologist which revealed no evidence for an underlying cause for the clinical signs. The client is a donor to your hospital, and devoted to her pet. The daily HBOT treatments will be done as an outpatient.
The head of the hospital lets you know how important this client is to the practice. For the first session the client brings a special 100% cotton "Snuggie" with her to place in the chamber and "keep her dog warm." She states that "her dog always lays on this Snuggie". She gives it directly to the technician who will be attending the treatment. The technician finds a body warmer packet (typically used in cold weather sports) heating up in a pocket in the "Snuggie."
What are the issues and how will you handle this?
ANSWER: The technician did an excellent job in preparing the patient for a safe treatment session. The overwhelming majority of chamber fires in the world (rare, but devastating) have occurred as the result of prohibited items in the chamber or incomplete preparation of the patient. In this case, the chemical body warmer is a prohibited item, as these devices have been known to be associated with chamber combustion (Raleigh, G. et al, Undersea & Hyperbaric Medical Society Website Online Safety Article, "Air Activated Chemical Warming Devices: Effects of Oxygen and Pressure"). Investigations into adverse events during HBOT have revealed situations where household members have unwittingly enabled the introduction of prohibited items into the chamber while trying to "enhance" the comfort of their family member.
In the article published in Undersea Hyperb Med, 1997:24[1]:35-8, Racic et al studied a randomized group of 79 human patients, and concluded that HBOT was more effective than prednisone in the treatment of Bell's Palsy.
A two month old toy breed puppy was presented HBC, and scheduled in the same day for HBOT to treat a traumatic brain injury. Which of these diagnostic procedures is not absolutely indicated before the treatment session?
Rectal temperature just prior to HBOT treatment
Chest X-rays
Spinal X-rays
Blood glucose just prior to HBOT treatment
Neurologic examination
ANSWER: 3. Spinal X-rays
These are not absolutely necessary prior to this treatment session. All patients must have a rectal temperature just prior to each session to reduce the potential for oxygen toxicity. The puppy was hit by a car, and chest X-rays are required to rule out untreated pneumothorax (a contraindication for HBOT). This toy breed puppy with trauma and head injury has probably not been eating as usual (and therefore at risk for hypoglycemia), consequently a blood glucose determination is vital prior to the treatment session. A neurologic examination is indicated in a patient with traumatic brain injury to determine the progression or regression of neurologic status.
Rockswold, Rockswold, et al (J Neurosurg. 2010 May; 112(5): 1080-94) employed a prospective, randomized clinical trial in human patients with severe traumatic brain injury. They found that hyperbaric oxygen therapy at 1.5 ATA significantly reduced intracranial pressure and increased cerebral blood flow/brain tissue oxygen levels compared to control groups. The clinician may consider adjuvant HBOT as well as drug therapy (e.g. hypertonic saline, mannitol) for TBI.
© RKLyman, LLC. All Rights Reserved.