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Rx Pad

Improving the Health of Your Clinical Practice
May
02

Hyperbaric Emergency Procedures

Hyperbaric-Emergency-Procedures

Hyperbaric emergency procedures usually address a variety of problems ranging from mechanical malfunction to medical complications—important events that do not seem to share a common trait but cover a wide range of situations. Such a variable group of events must be discussed in a broad context. This chapter will discuss emergency pro- cedures within the framework of the entire hyperbaric safety program. In this broader context, events that may or may not be emergencies belong together. That is why this dis- cussion will replace the term “emergency procedure” with the term “contingency plan.”

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Apr
26

I. Measure: Best Practice for Wound Assessment

Wound Care Measure Best Practice for Wound Assessment

A consensus document by Keast et al. reviewed clinically useful wound measurement approaches. This evidence-based document provided an overview of principles and practice regarding chronic wound assessment in a simple mnemonic format. The text articulated effective management of a nonhealing wound based upon:

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Apr
19

Introduction to Wound Assessment

Wound-Care-Wednesday-Introduction to Wound Assessment

Various theories have been proposed to explain why some wounds become chronic and non-healing. Although the complete answer is not yet available, a great deal has been learned in recent years that sheds light on this phenomenon.

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Apr
11

Management of Critically Ill Patients in the Monoplace Hyperbaric Chamber (Part 2)

Management of Critically Ill Patients in the Monoplace Hyperbaric Chamber (Part 2)

APPROACH TO THE CRITICALLY ILL PATIENT

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Apr
05

Management of Critically Ill Patients in the Monoplace Hyperbaric Chamber (Part 1)

Management of Critically Ill Patients in the Monoplace Hyperbaric Chamber

In the past several years, there has been rapid growth in the number of clinical hyperbaric facilities, due in part to the availability of the monoplace, or single-person, hyperbaric chamber and the proliferation of outpatient wound care centers. Monoplace chambers are relatively inexpensive, require fewer personnel, and require less space to operate and maintain than multiplace (walk-in) chambers. Another advantage of the monoplace over the multiplace chamber is that attendants need not enter the hyperbaric chamber with the patient. However, some hyperbaric physicians express concerns about treating unstable or critically ill patients in the monoplace chamber, because of the lack of “hands-on” care during hyperbaric exposure, the lack of suitable equipment for optimal patient care, and the limitations of treatment pressures to 3 atmospheres absolute pressure (ATA). We have found that with a well-trained staff and the availability of appropriate equipment, critically ill patients can be treated safely in the monoplace chamber. We, and others, have presented monoplace chamber use in critically ill patients. Anyone who anticipates treating critically ill patients in a monoplace chamber should be familiar with this work.

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Mar
27

INTERVENTIONS TO INCREASE BLOOD FLOW AND OXYGEN DELIVERY TO WOUNDS

INTERVENTIONS TO INCREASE BLOOD FLOW AND OXYGEN DELIVERY TO WOUNDS

Adequate wound perfusion and its delivery of oxygen to the healing tissues is fundamental to wound healing as just explained. Revascularization invariably is the first intervention considered to achieve this goal. Hyperbaric oxygen all too often is not considered in the management. In addition, other interventions can improve perfusion-oxygenation. These include edema reduction, improvement in cardiac function through medical management, and enhanced blood rheology using pharmacological methods. In contrast to the other four treatment strategies where typically a single technique is utilized, the methods to improve the perfusion-oxygenation strategy are complimentary, and typically two or more techniques are employed simultaneously.

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Mar
20

OXYGEN REQUIREMENTS FOR WOUND HEALING AND INFECTION CONTROL (PART 2)

OXYGEN REQUIREMENTS FOR WOUND HEALING AND INFECTION CONTROL (PART 2)

The second source of information regarding perfusion-oxygen needs for wound healing arises from indirect information . It is obvious that markedly increased blood flow and oxygen availability are required to heal a wound and control infection.(19) Perfusion and oxygen requirements are minimal for noncritical tissues that do not have wounds or infections because they are in a steady-state, resting status. An example of this would be the feet of the patient with advanced peripheral artery disease. If a relatively minor wound occurs in one foot, healing may not occur, and a lower limb amputation becomes necessary. In contrast, in the opposite limb that does not have a wound, but perfusion is equally poor, the foot is not immediately at risk for an amputation.

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Mar
16

The Fire Triangle and the Special Role of Oxygen

The Fire Triangle and the Special Role of Oxygen

In general, fire prevention is described in terms of the Fire Triangle model. For a fire to occur, a fuel, an oxidizer, and an ignition source must be present. Fire prevention in a hyperbaric chamber must account for an increase in the oxygen component of the atmosphere in terms of both oxygen fraction and partial pressure. The resultant increase in oxygen renders what might be inactive fuels and ignition sources in a “normal” air environment active, which increases the risk of a fire.

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Mar
09

OXYGEN REQUIREMENTS FOR WOUND HEALING AND INFECTION CONTROL (Part 1)

OXYGEN REQUIREMENTS FOR WOUND HEALING AND INFECTION CONTROL

Wound oxygenation is an essential strategy for the management of wounds regardless of their severity. Fortunately, in most wound healing situations, autoregulatory mechanisms ensure that oxygen is adequate to meet metabolic requirements. When not adequate, wound healing may be impeded or even totally interrupted, infection may not be controlled, and tissues may die, leading to limb amputations . Wound oxygenation is a function of perfusion. This part of the three-part series discusses oxygen requirements for wound healing and control of infection and methods (and their rationale) for augmenting wound perfusion-oxygenation and introduces the subject of hyperbaric oxygen (HBO2) as a tactic for mitigating hypoxia in wounds in particular and in other conditions where HBO2 is useful in general.

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Mar
07

Hyperbaric Chamber Safety Systems

Hyperbaric Chamber Safety Systems

Safety in a hyperbaric chamber begins with design and specifications that are incorporated in construction codes such as the ASME Boiler and Pressure Vessel Code. ASME and related codes establish minimum standards for materials utilized in the construction of a chamber and how those materials are fabricated.2 Subcodes address specific requirements for pressure vessels intended for human occupancy and the viewports utilized in the chamber.3 ASME codes focus on maintenance of the structural integrity of the chamber during routine operations as well as providing safety components such as pressure relief valves to reduce the potential for catastrophic failure of the chamber in the event of overpressure resulting from fire or other mishap. A chamber will undergo inspection, testing, and be stamped to indicate that it has been manufactured in compliance with the applicable pressure vessel code. In many locales, only stamped pressure vessels are allowed to be utilized.

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