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Hyperbaric O2 & Prehospital Care

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by

Howard Chen

on 15 December 2014

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Transcript of Hyperbaric O2 & Prehospital Care

100% Oxygen at pressures higher than atmospheric pressure

Administration requires a hard-sided Hyperbaric Oxygen Chamber
What is Hyperbaric Oxygen?
Hyperbaric Oxygen & Prehospital Care
Signs and Symptoms of Carbon Monoxide Poisoning
Co-oximetry Warning Levels
Non-smokers - COHb > 3%
Smokers - COHb > 10%
DCS Type 1
Musculoskeletal
localized joint pain - elbow, shoulder, knee, hip
Cutaneous
Upper body pruritis, mottled skin
Lymphatic
chest and torso lymphadenopathy
Hydration - IV fluids

100% O2 by Non-Rebreather or Intubation

81 mg ASA PO

Left Lateral Decubitus and Mild Trendelenberg positioning

Transporation to nearest emergency facility

Hyperbaric Oxygen Therapy, especially in type II DCS
Transport to nearest emergency facility for evaluation and treatment

If need for HBOT is suspected, notify emergency facility, who will contact us.

Urgent, but Non-Emergent transfer to Renown Hyperbaric Oxygen Therapy from emergency facility

Ground transfer preferred in DCS, due to reduced pressure during air transport worsening nitrogen bubble size
Transportation
Renown Center for Advanced Medicine B
1500 E. 2nd St, Suite 104, Reno, NV 89502
Carbon Monoxide (CO) is an odorless, tasteless, colorless gas, which is a byproduct of incomplete combustion
Carbon Monoxide Poisoning
First recognized in 1843 among tunnel workers working in compressed air environments
For qualifying patients, for either CO poisoning or DCS, the optimum transport time to a Hyperbaric Facility is within 6 hours
Decompression Sickness
(DCS)
Logistical Details:
Hyperbaric Oxygen
Renown Hyperbaric Oxygen Therapy
Signs and Symptoms of DCS
Prehospital Management of DCS
Prehospital Management
The CO molecule attaches to the Red Blood Cell 240x stronger than the oxygen molecule

O2 under hyperbaric pressures displaces the CO molecule from the red blood cell.
In the emergent prehospital Setting, Hyperbaric Oxygen is useful in the treatment of Carbon Monoxide Poisoning and Decompression Sickness (DCS)
Mild to Moderate Poisoning:
Headache, dizziness, nausea

Severe Poisoning:
Altered mental status, seizures, loss of consciousness
EKG changes (ischemia, ventricular arrhythmias)
lactic acidosis

Long Term Effects
Myocardial injury
Delayed Neurological Sequelae
Increased Mortality
Exposure to Carbon Monoxide increases during the winter months due to incorrectly vented heating systems and space heaters.
Mental Status Evaluation
100% O2 by Non-Rebreather or Intubation
12 lead EKG
Transport to nearest emergency facility
SCENE SAFETY
Ambient CO Monitor if available
HBOT Used for COHb>25%, altered neurological status, metabolic acidosis, end organ ischemia

Half life of CO at Room Air is 300 minutes, at 100% O2 via NRB = 90 minutes, and under hyperbaric O2 Conditions = 30 minutes
Renown Hyperbaric Oxygen
Howard Chen, MD

24/7 Contact
Tary Varnum, Director of Operations 775-313-8504
Resources
Poison Control Center: 800-222-1222
Divers Alert Network: diversalertnetwork.org
919-684-9111
Patients will generally require one hyperbaric treatment, but may require more, dependent on treatment response
Each of our Hyperbaric Chambers accept one patient at a time - .ie monoplace chambers
In pressurized environments, body tissues become loaded with nitrogen, which may lead to bubble formation upon surfacing
Bubbles may lodge in multiple body tissues, causing discomfort and dysfunction in various organs of the body
Risk factors: Male,increasing age,cold water,exertion, inexperienced divers, air travel < 12 hours after diving
DCS Type 2
Neurological
paresthesia, weakness, memory loss, ataxia, visual disturbances, mental change
Pulmonary
Chest Pain, Wheezing, dyspnea, "chokes"
Symptoms generally develop within 1 hour, but may be up to 12 hours
Once inhaled, the high pressure of oxygen increases the O2 carrying capacity of the blood up to 6x
High O2 Pressure displaces Carbon Monoxide from Red Blood Cells
High Pressure environment shrinks nitrogen bubbles in Decompression Sickness

Not all Hyperbaric Facilities accept emergent cases such as CO poisoning or DCS
A multiplace chamber is located at Travis AFB
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