Review Question - QID 2826

The presence of a crush injury to an extremity is an indication for hyperbaric oxygen (HBO) therapy. The remainder of the options listed are contraindications to hyperbaric oxygen treatment.

Hyperbaric oxygen therapy potentially can provide enhanced oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma. The idea behind HBO is to provide enhanced oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma.

Greensmith et al provide a review of HBO therapy and discuss the relative and absolute contraindications and indications for this treatment. They report in patients with crush injury or early compartment syndrome, hyperbaric oxygen therapy may reduce the penumbra of cells at risk for delayed necrosis and secondary ischemia. They report that both animal studies and prospective human clinical trials suggest the benefits of such therapy.

Buettner et al found that based on clinical evidence and cost analysis, medical institutions that treat open fractures and crush injuries are justified in incorporating HBO theray as a standard of care.

Illustration A shows an example of a hyperbaric oxygen(HBO) chamber.

Incorrect Answers:
Answer 2: COPD is a contraindication to hyperbaric oxygen treatment due to the possible presence of air trapping or bleb formation, which could place the patient at risk of pneumothorax.
Answer 3: History of bleomycin treatment is a contraindication to hyperbaric oxygen treatment because supplemental oxygen may cause life threatening pneumonitis.
Answer 4: Presence of a pneumothorax is a contraindication as hyperbaric oxygen treatment may cause a gas embolism, tension pneumothorax, or pneumomediastinum.
Answer 5: Presence of an insulin pump is a contraindication to hyperbaric oxygen treatment because malfunction or deformation of the device may occur under pressure.