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Hyperbaric Oxygen Therapy, Emergency Medicine

Trevonne M. Thompson Reviewed 06/2017
 


Basics

Description

  • Administration of 100% oxygen at >1 atm (typically 2–3 atm)

  • Mechanisms of action:

    • Increases oxygen availability at the cellular level:

      • Breathing 100% oxygen at 3 atm supplies enough ...

Diagnosis

Signs and Symptoms

Indications for hyperbaric oxygen therapy: 
  • Arterial gas embolism

  • Decompression sickness

  • Carbon monoxide toxicity

  • Soft tissue infections:

    • Clostridial myonecrosis

    • Necrotizing fasc...

Treatment

Initial Stabilization/Therapy

  • Manage ABCs

  • Establish IV access.

  • 100% oxygen

  • Cardiac monitor (when appropriate)

Ed Treatment/Procedures

  • Determine need for hyperbaric oxygen therapy.

  • Fill any devices ...

Follow-Up

Disposition

Admission Criteria

  • Arterial gas embolism

  • Decompression sickness

  • Significant carbon monoxide toxicity

Discharge Criteria

Stable patient with resolved symptoms 

Issues for Referral

  • May nee...

Pearls and Pitfalls

  • Fill any devices with balloons (Foley catheters, endotracheal tubes) with fluid to avoid rupture during therapy.

  • Check for occult pneumothorax.

Additional Reading

  • Buckley  NA, Juurlink  DN, Isbister  G, et al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev.  2011;(4):CD002041.

  • Guzman,  JA. Carbon monoxide ...

Codes

ICD9

  • 958.0 Air embolism

  • 986 Toxic effect of carbon monoxide

  • 993.3 Caisson disease

ICD10

  • T58.94XA Toxic effect of carb monx from unsp source, undet, init

  • T70.3XXA Caisson disease [decompression sicknes...

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