Hyperbaric Oxygen Therapy

GENERAL NOTES
 What is hyperbaric? Wound care…?
 Not just divers!
 Late soft tissue radiation injury : essneitally complications of
radiotherapy
 Necrotising Infections (ie fournieres)
 What is Hyperbaric? 100% oxygen under pressure
 Pressure and the Human Body : pascal, boyle, henry’s laws
 Boyles law : essentially as you get deeper the volume contained is
bigger but breathing gas is constant. Reason this is important is if
when you’re coming back up to the surface and you don’t breathe
out it can cause Pulmonary Barotrauma
o Consequences : haemoptysis, pneumptorax,
pneumomediastinum
o BUT THE BIG TICKET IS : arterial gas embolism
o So how does hyperbaric medicine come in? Basically can fix
AGE if catch it early enough
 Henry’s Law (think soda streams) : basically the nitrogen part of your
gas dissolves into tissue because of pressure effect “The Bends” or
decompression sickness
o It’s very generalised on the lower side (think hangover) –
fatigue, achy pain etc
o The reason it’s called the BENDS – used to build
bridges/tunnels to build foundations need t put tube in water
and pressurise so you can build on it. Had all these workers
down in the waters and they were dying quite quickly (bubble
load). Essentially bubbles causing infarction backs would
eventually go and they were all stooped over (BENDS).
Nowadays bends is mostly shoulder, hip and knee pain –
 bubbles going up through bone and causing infarction 
avascular necrosis.
o Hyperbaric essentially removes gas and compressed bubbles –
but key is again EARLY ENOUGH
 Now lets go outside of diving….
 Hyperbaric oxygen : restoring oxygenation in ischaemic tissue – need
to have a good macrovascular supply (level of capillary bed is the
key)
 The oxygen cascade of breathing air (in air 150mmg  in tissue
50mmHg)
 So diabetic feet : peripheral vascular induced wounds
o TCOM assessment “ testing partial pressure fo oxygen in tissue
o In chamber if it rises – can be promising
o So once have oxygen (takes about 4 weeks) then can start kick
starting capillary bed
 Carbon Monoxide Poisoning
 Necrotising Fasciitis
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KEY POINTS
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QUESTIONS
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ACTION
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RESOURCES

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