for Emergency Room Personnel Daphne W. Denham, MD FACS FACCWS - - PowerPoint PPT Presentation

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for Emergency Room Personnel Daphne W. Denham, MD FACS FACCWS - - PowerPoint PPT Presentation

Jan 09, 2024 221 likes •905 views

Hyperbaric Oxygen for Emergency Room Personnel Daphne W. Denham, MD FACS FACCWS Healing with Hyperbarics of North Dakota What Is It? How Does It Work? Hyperbaric Who Can Benefit? FDA approved Indications Oxygen

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Hyperbaric Oxygen for Emergency Room Personnel

Daphne W. Denham, MD FACS FACCWS Healing with Hyperbarics of North Dakota

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Hyperbaric Oxygen

  • What Is It?
  • How Does It Work?
  • Who Can Benefit?

– FDA approved Indications

  • Extras

– Non-FDA approved

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I am Biased!

  • I own two hyperbaric clinics

– Northbrook, IL November 2015 – Fargo, ND July 2018

  • We have multiple different studies
  • My goal: Standard of Care after Injury
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Full Disclosure

I got some images off of the internet without prior approval Because these talks are boring… without pictures

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What is hyperbaric

  • xygen?
  • Breathing 100% oxygen
  • Increased atmospheric

pressure

  • 1.5 ATA – 3 ATA
  • Medical grade

chambers

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What it is not?

Soft Chamber = face mask of 100% oxygen

http://www.hbomdga.com/hyperbaricvsmildhyperbaricther

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What is involved with a treatment?

  • A patient goes into the

chamber

  • He/she can watch

TV/sleep

  • If you aren’t born with

it, it doesn’t go in

  • No
  • Paper
  • Make-up
  • Bling
  • Electronics
  • Etc.

Pacemakers, AICDs, implants all need to be approved

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Risks: Minimal really

  • FIRE!
  • Wear our 100%

cotton

  • Ear drum rupture
  • Like flying on an

airplane

  • We communicate

and stop if necessary

  • Low blood sugar
  • Diabetics
  • Cardiac and pulmonary
  • Not an issue with

athletes

  • We do a medical

clearance

HBO is one of the safest procedures/devices Over 1,000 tx given a day in USA Pneumothorax!!

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Take a deep breath

What bodily process does not need oxygen?

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Gradient Gradient O2 Diffusion Through Normal Tissue Fluid (Capillary to Cell)

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What happens when RBCs can’t get to the tissue?

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Or RBCs get there too slowly for tissue O2 demands?

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Welcome to the ER

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Indications

14 FDA, Many Internationally

FDA Approved Insurance Covers

1. Air/gas embolism 2. CO poisoning 3. Gas gangrene 4. Crush Injury (compartment syndrome) 5. Decompression sickness 6. Arterial Insufficiency 7. Severe anemia 8. Intracranial abscess 9. Necrotizing infections 10. Osteomyelitis 11. Radiation tissue damage 12. Skin grafts/flaps 13. Thermal burns (frostbite) 14. Sudden hearing loss

Internationally Accepted Insurance Does Not Cover

  • Strokes/cranial trauma/concussion
  • Poor healing fractures
  • Peripheral nerve injury
  • Viral encephalitis
  • Cerebral palsy
  • Heart disease
  • Myocarditis
  • Vertigo
  • Spinal cord injury
  • Ulcerative colitis
  • Hepatitis
  • Psoriasis
  • Malignant tumors
  • Multiple sclerosis
  • Sports Injuries
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700-1200% more oxygen

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What does it do?

Primary

  • Hyper-oxygenates tissues

Increase tissue levels of

  • xygen by 700-1200%

Secondary

  • Decreases edema
  • Decreases reperfusion

injury

  • Angiogenesis
  • Increases circulating stem

cells

  • Increases circulating growth

factors

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All cells are within the diffusion gradient (range) of a blood vessel

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After an injury, cells swell. Vessels occlude. Cell necrosis can occur.

Necrotic cell Ischemic cell Damaged blood vessel

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With hyperbaric oxygen, tissues have much higher levels of

  • xygen due to increased diffusion.

Necrotic cell Ischemic cell Damaged blood vessel

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Hyperbaric Oxygen

Oxygen gets to ischemic tissue, decreases edema, restores some circulation

247 m 64 m

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What does it do?

Primary

  • Hyper-oxygenates tissues

Increase tissue levels of

  • xygen by 700-1200%

Secondary

  • Decreases edema
  • Decreases reperfusion injury
  • Angiogenesis
  • Increases circulating stem cells
  • Increases circulating growth

factors

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Normal Situation Blood Inflow Blood Outflow

Filtration = Reabsorption

Interstitial Fluid Balance

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Trauma or Injury Increased Inflow from Vasodilation Inflow Outflow

Filtration > Reabsorption

Swelling

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Decreased Inflow

with Hyperbaric Oxygen (vasoconstriction)

Inflow Outflow Filtration < Reabsorption 20-30% Reduction in Swelling

With improved tissue oxygenation

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  • Decreases edema
  • Decreases reperfusion

injury (inflammation)

  • Angiogenesis
  • Increases circulating stem cells
  • Increases circulating growth

factors

What does it do?

Primary

  • Hyperoxygenates tissues
  • Increase tissue levels of
  • xygen by 700-1200%

Secondary

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SLIDE 27

Prevents Neutrophil Adhesion

less swelling/inflammation

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  • Decreased edema
  • Decreases reperfusion

injury Angiogenesis Increases circulating stem cells Increases circulating growth factors

What does it do?

Primary

  • Hyperoxygenates tissues
  • Increase tissue levels of
  • xygen by 700-1200%

Secondary

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Necrotic cell Ischemic cell Damaged blood vessel

Over time, new vessels grow into the tissue, if needed (Important for the older injuries)

Stem Cell

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HBO

  • Hyperoxygenates tissue
  • Reduces swelling
  • Turns off inflammation
  • Increases stem cells and

growth factors

  • Turns on angiogenesis
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Indications

14 FDA, Many Internationally

FDA Approved Insurance Covers

1. Air/gas embolism 2. CO poisoning 3. Gas gangrene 4. Crush Injury (compartment syndrome) 5. Decompression sickness 6. Arterial Insufficiency 7. Severe anemia 8. Intracranial abscess 9. Necrotizing infections 10. Osteomyelitis 11. Radiation tissue damage 12. Skin grafts/flaps 13. Thermal burns (frostbite) 14. Sudden hearing loss

Internationally Accepted Insurance Does Not Cover

  • Strokes/cranial trauma/concussion
  • Poor healing fractures
  • Peripheral nerve injury
  • Viral encephalitis
  • Cerebral palsy
  • Heart disease
  • Myocarditis
  • Vertigo
  • Spinal cord injury
  • Ulcerative colitis
  • Hepatitis
  • Psoriasis
  • Malignant tumors
  • Multiple sclerosis
  • Sports Injuries
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https://www.cathlabdigest.com/article/Coronary-Artery-Air-Embolism-What-Look-Out-How-Treat-It

Air or Gas Embolism

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https://orlandohyperbarics.com/carbon-monoxide-poisoning-and-hyperbaric-therapy/

CO Poisoning

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CO Poisoning

But even low levels CO and/or repeated CO exposure has been shown to cause long-term neurologic issues

Inflammation

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Gas Gangrene

Clostridium perfringens Anaerobic bacteria Tissue oxygen pressures > 60 mmHg stop alpha toxin production Still need OR debridement and antibiotics

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Compartment syndrome

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Traumatic Brain Injury Skull---Compartment Syndrome?

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TREAT a Concussion

In 2019, “REST” Is the best we’ve got?

We are taking an aggressive TREAT a Concussion approach Average less 4 tx (acute) No long term consequences Fewer repeat concussion

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Indications

14 FDA

Air/gas embolism CO poisoning Crush Injury (compartment syndrome) Decompression sickness Arterial Insufficiency Severe anemia Gas gangrene Intracranial abscess Necrotizing infections Osteomyelitis Skin grafts/flaps Radiation tissue damage Thermal burns (frostbite)

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Bone (ligaments, tendons) poorly vascularized

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Flaps: Ankle replacement

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Flaps: Ankle replacement

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10,15,20,35,40,55mmHg = 10-20 mm Hg 50,50,90,120-350 mmHg

During HBO at 2.4 ATA

230 mmHg

Baseline at 1.0 ATA

5,25,35,55,55 mmHg

After 18 HBO treatments

= 10-20 mm Hg After 24 HBO treatments, oxygen gradients are reduced 30,40,55,55,55 mmHg

Delayed Radiation Injury

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Frostbite 10 day follow up

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Frostbite: After 1 tx no pain

Dying tissue to pink HBO works

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Extra

So much more HBO can do

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Recent Review Article

http://www.bestpub.com/images/WCHM_Online/WCHM_Winter_2016.pdf

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Concussion

  • Brain requires high
  • xygen and glucose

levels

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Diffuse brain vascular changes

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Case 1

  • 16 year old lacrosse player took

a “shot to the head”

  • Stopped practice immediately
  • Within an hour “head was really

bothering him, just didn’t feel right.”

  • Wore his sunglasses to

pediatrician the next morning

  • Headache 7 of 10
  • Mental fogginess
  • AP History test—could not study
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Case 1

Treated him Friday midday (less 48 hours) I was out of town over the weekend Treated Monday morning—symptoms resolved, he was able to study

Monday afternoon Tuesday morning (didn’t need it really)

4 total treatments

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Case 1

Post-injury day 7 had studied for 8 hours

  • Post-injury Day 8

Took AP History test Test 12:00 pm-4:30 pm

“Left the test feeling good”

NO HEADACHE Able to concentrate

PASSED

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2 weeks after injury

  • Played the entire playoff game
  • No headache, no return of symptoms
  • His mom sent me a photo of him

drenched with sweat, smiling!

(Not this photo)

Now 2 years out and no additional concussion

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TREAT a Concussion

  • Over 250 acute
  • Defined as less than 7

days from injury

  • Average < 4 treatments
  • No “new” normal
  • Acute on Chronic

– Worse injury – More treatments

  • Chronic

– Some respond quickly

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32 year old Veteran

  • Multiple suicide attempts
  • Kept the entire house

dark

  • After 10 treatments

(recommendation 40)

– All shades were up – He was up and fixing his children’s lunches before school.

More than 40 pills in a single day

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Neurons require high energy

to function as neurons

Concept of “idling” neurons

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Advantages of Private HBO Centers

  • Private HBO Centers

– Cheaper than hospitals – Will treat “non-FDA approved”

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There is so much more……

  • Hyperbaric oxygen

therapy

– Pure Oxygen – Increased pressure

  • 3 things

– Oxygenate tissue (heal) – Decrease swelling – Turn off inflammation

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Indications

14 FDA, Many Internationally

FDA Approved Insurance Covers

1. Air/gas embolism 2. CO poisoning 3. Gas gangrene 4. Crush Injury (compartment syndrome) 5. Decompression sickness 6. Arterial Insufficiency 7. Severe anemia 8. Intracranial abscess 9. Necrotizing infections 10. Osteomyelitis 11. Radiation tissue damage 12. Skin grafts/flaps 13. Thermal burns (frostbite) 14. Sudden hearing loss

Internationally Accepted Insurance Does Not Cover

  • Strokes/cranial trauma/concussion
  • Poor healing fractures
  • Peripheral nerve injury
  • Viral encephalitis
  • Cerebral palsy
  • Heart disease
  • Myocarditis
  • Vertigo
  • Spinal cord injury
  • Ulcerative colitis
  • Hepatitis
  • Psoriasis
  • Malignant tumors
  • Multiple sclerosis
  • Sports Injuries