Hyperbarics and Wound Care

[tdane1284]

I am an experienced PA that recently accepted a job offer for a hyperbaric and wound care clinic. Can anyone give me some advice as to how I can prepare myself to manage wound care/hyperbaric patients? I am looking for the best reading material for this as well. So far I have been reading uptodate which has been good so far. TIA!

[Acebecker]

Been in wound care for 3 years.  Highly recommend YouTube videos of wound debridements to help get you up to speed on what stays and what goes.  I really like the Undersea and Hyperbaric Medicine Society website for CE resources. 

 

Understand vascular workups - what is most appropriate and when.  Get ABIs on all lower extremity wounds (or TBIs if the ankle is the site of the wound).  This will give you a qualitative assessment of whether or not there is blood flow sufficient to heal the wound.  If ABI shows a low ratio, I like segmental arterial pressure ultrasound with flow velocities (if you can find someone who will do it) to give you the quantitative information about how bad the obstruction is and where it is.  Make friends with an interventional radiologist who can do stents for you. 

 

Make friends with orthopedists who will do bone biopsies and debridements for you (some centers restrict non-surgeons from doing these procedures and I really don't want to do them anyway). 

 

Always get tissue for culture - this is the gold standard in infectious disease.  In osteomyelitis, that means bone.  Another thing about osteomyelitis is that if you don't cut out the infected bone, the wound will never heal. 

 

The old adage holds true - if the wound is wet, make it dry; if it's dry, make it wet.  Know what primary dressing does what and when to use which. 

 

Every wound more than 2 wks old has at the very least bacterial contaminant so requires some sort of antimicrobial agent to keep the little bugs at bay.  If it's topical ABx, use them sparingly.  If antiseptics, get to know a couple that you like and get comfortable with them. 

 

As far as books - there are a bunch out there.  I attended a conference put on by Healogics to get my foot in the door.  Built up from there.  I have more resources, just not in this office - I'll get some references for you. 

[sk732]

UHMS is a good resource to get involved with and membership isn't expensive.  Just remember that HBO is both useful and also potentially dangerous...though I seem to recall the usual treatment tables are at 60fsw and usually an hour at a time, 15 or 20 min on 5 off sort of thing.  Be aware of O2 toxicity symptoms/syndromes if you're monitoring the "dive" and how to deal with potential barotraumas.

 

SK

[Acebecker]

UHMS is a good resource to get involved with and membership isn't expensive.  Just remember that HBO is both useful and also potentially dangerous...though I seem to recall the usual treatment tables are at 60fsw and usually an hour at a time, 15 or 20 min on 5 off sort of thing.  Be aware of O2 toxicity symptoms/syndromes if you're monitoring the "dive" and how to deal with potential barotraumas.

 

SK

Our dive table is typically 50fsw (2.5 atmospheres), 90 minutes bottom time with 2x 5 minute air breaks for most patients.  Those at high risk for CNS toxicity and seizures we'll do 2.0 atmospheres for 90 minutes and no air breaks

 

Going by the navy dive tables, 50fsw for 90 minutes should actually not require any air break.  We add them in just for a layer of safety. 

 

CNS toxicity is the most common adverse event, but occurs in less than 1% of HBO treatments at 2.5ATA. 

[sk732]

Interesting - worth getting out of bed :-D...when I used to do Trials of Pressure for query DCS, we'd do 20 min on, 5 off x 2 at 60fsw.  I've seen one CNS O2 hit on a non-rebreather apparatus and one pulmonary...Canadian Navy tables were slightly different, will have to dig them out (haven't been in a chamber in about 6 years now).  Mind you, most of our treatment tables were for diving badness - DCS or AGE, so they'd be in there minimum of 6 hours, which isn't fun.  I always hated being on pure O2 from doing hypobaric chamber runs for aviation stuff - Oxygen Ear really sucks at 0300 hrs when it wakes you up.  A buddy of mine was doing a Table 6 on someone with aviation bends when they seized in the chamber...there's video lying around somewhere of it.  The things we did for an extra $13/day, lol.

 

SK