Patient Protection

Question 0

What is bleomycin?

Answer 0

• Medications
o Bleomycin – antineoplastic and an antibiotic
• Makes a patient more oxygen sensitive
• Increases the risk of pulmonary oxygen toxicity
• NO HBO EVER, EVER, EVER

Question 1

What is absolute contraindication to HBO

Answer 1

Absolute contraindications to placing patients in chamber
o Untreated pneumothorax
• Risk a tension pnuemothorax

Question 2

Considerations for doxorubicin/andriamycin

Answer 2

o Doxorubicin/andriamycin – chemo agent
• Can cause cardiac toxicity?
• Must wait 2 to 3 days after last dose prior to starting HBO

Question 3

Considerations for Antabuse

Answer 3

o Disulfram/antabuse – alcohol deterrent​
• Stops superoxide domutase production
• Stop the drug for daily tx

Question 4

Considerations for cisplatinum

Answer 4

o Cisplatin/Cis-platinum – chemo agent

• Impairs wound healing

Question 5

Considerations for sulfamylon

Answer 5

o Mafenide acetate/sulfamylon – burn ointment​
• Promotes CO2 buildup, which causes peripheral vasodilation
• Remove the ointment and replace with silver sulfadiazine - silvadene

Question 6

Former absolute contraindications

Answer 6

• Former absolute contraindications
o Known malignancy
• ? if it promotes tumor growth
• Research has disproved this theory
o Pregnancy
• Retrolental fibroplesia – eye problem in newborns –? If it was related to HBO
• Premature closure of ductus arterious?
• Russian study disproved both of these theories
o Implanted pacemaker
• Reports that it can cause accelerated pacing
• MUST check with manufacturer prior to putting patient in chamber

Question 7

Considerations for URI

Answer 7

• Relative contraindications
o URI and chronic sinusitis
• Can cause difficulty in equalizing pressure
• Premedicate or withhold treatments, or place tubes

Question 8

Seizure disorder

Answer 8

Relative contraindication
? if it makes patients more prone to seizures
• Give additional meds (benzodiazepines) or more frequent air breaks

Question 9

High fever

Answer 9

Relative contraindication
Predispose patient to oxygen toxicity
• Premedicate with acetaminophen

Question 10

Emphysema or COPD with CO2 retention

Answer 10

Relative contraindication
? if it knocks out the respiratory drive
• With sever COPD the respiratory drives changes and is based on low oxygen levels
• The theory is that the elevated oxygen levels will reduce the drive of COPD patients and make them stop breathing.
• Must balance risk vs benefits

Question 11

Hx of spontaneous pneumothorax

Answer 11

History of spontaneous pneumothorax
• Absolute contraindication for scuba divers
• Have equipment ready to manage the situation (chest tube, etc.)

Question 12

Hx of surgery for otosclerosis

Answer 12

o History of surgery for otoscleoris
• Surgical immobilization of a spongy stapes bone
• Send these patients back to ENT for PE tubes

Question 13

Hx of infection

Answer 13

• ? if it will exacerbate the infection

* Studies show it is not a problem in HIV, AIDS, shingles, or herpes

Question 14

Hx of thoracic surgery

Answer 14

o History or thoracic surgery
• Not really a contraindication
• Need to be aware of potential for pneumothorax

Question 15

Hx of optic neuritis

Answer 15

o History of optic neuritis – inflammation of optic nerve
• Might accelerate blindness
• Easy to dismiss the symptoms due to the common lens changes associated with HBO
• Presyopia (far sightedness) should get better
• Myopia (near sightedness) should get worse
• Refer to ophthalmologist for monitoring

Question 16

Hx congenital spherocytosis

Answer 16

Fragile red blood cells that can burst in increased oxygen

• Rare but it can occur, be prepared to manage complications of anemia