Hyperbaric medicine

Background

  • Initial use of compressed air for treatment of "Caissons disease" which was forms of Decompression sickness seen in the use of Caissons in the 1800s.[1]
  • Further research was performed in 1930s-1940s through the Navy.
  • 1986 the Undersea Medicine Society became the Undersea and Hyperbaric Medicine Society
  • 2000 UHM became a board certified through ABEM, there are currently

Physiology

  • For every 10m (33ft) submerged in water, atmospheres absolute (ATA) increases by 1.
    • At a depth of 30m (99ft), you would be at 4 ATA.
  • Hyperbaric Oxygen Therapy (HBOT) utilizes pressure and oxygen to saturate hemoglobin, bot more significantly, blood plasma itself, to provide enough oxygen to meet metabolic demands under various circumstances that may limit hgb oxygen carrying capacity or access.[2]
  • Vasoconstriction
    • Maintains oxygenation through increased O2 gradient and plasma saturation, but decreases edema from capillary filtration.
  • Antibacterial
    • Directly harmful to anaerobic orgasnisms
    • May increase neutrophil efficacy
  • Angiogenesis
  • Prevention of reperfusion injury

Diving Physiology

  • Pascals Law applies to the diving body (without air filled areas such as lungs) states that the pressure applied to any part of the enclosed liquid will be transmitted equally in all directions through the liquid.
  • Boyles Law applies to the diving body's air filled areas such as lungs, sinuses, middle ear, and states that the volume and pressure of a gas at a given temperature are inversely related.
    • At 2 ATA (10m/33ft) a given gas would be 1/2 it's volume, at 3 ATA (20m/66ft) it would be 1/3 it's volume and so on.

Indications

Carbon monoxide toxicity

Types of Hyperbaric Chambers

  • Monoplace chamber
    • Majority of chambers in US, intended for use on a single person.
  • Multiplace chamber
    • Allows for treatment of multiple patients simultaneously, with the possibility of an attendant in chamber.
  • Portable recompression chambers
    • For altitude illness, are often lightweight, portable, when descent is not possible.
    • Sturdier portable chambers are sometimes used by Navy, Coastguard, or commercial diving ventures.

Complications


Disposition


See Also

References

  1. Van Hoesen, K. (2017). Hyperbaric Medicine. In P. S. Auerbach, T. A. Cushing, & N. S. Harris (Authors), Auerbach's wilderness medicine (pp. 1619-1635). Philadelphia, PA, PA: Elsevier.
  2. Van Hoesen, K. (2017). Hyperbaric Medicine. In P. S. Auerbach, T. A. Cushing, & N. S. Harris (Authors), Auerbach's wilderness medicine (pp. 1619-1635). Philadelphia, PA, PA: Elsevier.
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