Hyperbaric Oxygen Therapy Module II CRC 432 Subacute Cardiorespiratory Care Problem-Based Learning.
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Transcript of Hyperbaric Oxygen Therapy Module II CRC 432 Subacute Cardiorespiratory Care Problem-Based Learning.
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Hyperbaric Oxygen TherapyModule II
CRC 432 Subacute Cardiorespiratory
CareProblem-Based Learning
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HBO OUTLINE
• Definitions• History• Altitude/descent• Gas laws• Physiological effects of HBO
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Hyperbaric Oxygen Therapy
• Therapeutic oxygen at pressures greater than 1 atm
• Unit expressing HBO pressure = ata• Ata = atmospheric pressure absolute• 1 ata = 1 atmosphere (atm), or 760
torr• HBO general pressure range = 2 to 3
ata
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Hyperbaric Oxygen Therapy
• Pressure:pressure = force/area
• Force:force = mass x
acceleration
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Hyperbaric Oxygen Therapy
• Ambient pressure = surrounding pressure on land, or under water.
• Atmospheric pressure = surrounding pressure caused by the weight of air.
• Water pressure = surrounding pressure caused by weight of water.
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Hyperbaric Oxygen Therapy
• Barometric pressure = measure of atmospheric pressure
• Barometric pressure = atmospheric pressure
• When surrounded by air: atmospheric pressure = ambient pressure = barometric pressure
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Hyperbaric Oxygen Therapy
• When surrounded by water: atmospheric pressure = water pressure = ambient pressure
• CAUTION!!! Don’t confuse: atmospheric pressure & atmosphere as unit
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Hyperbaric Oxygen Therapy
• Atmospheric pressure can be ANY value:
1 atm (sea level)½ atm (8,000 feet
elevation)3 atm (hyperbaric
chamber)
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Hyperbaric Oxygen Therapy
ABSOLUTE PRESSURE vs. GAUGE PRESSURE
• 33 ft sea water = 1 atm• Gauges set sea level pressure at 0 • At 33 ft depth, gauge indicates 1 atm• Absolute pressure = 2 atm
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Hyperbaric Oxygen Therapy
• Standard atmospheric pressure: average sea level pressure
• 14.7 psi• 1034 cm H2O• 101.3 kPa• 760 mm Hg (torr)• 33 ft H2O• 29.9 in Hg
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Hyperbaric Oxygen Therapy
• First sealed chamber called Domicilium built in 1662
• Chamber held compressed air (21% O2)
• Treated various ailments: scurvy, arthritis, inflammation, rickets
• Likely too little compression to benefit patients
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Hyperbaric Oxygen Therapy• Beddoes is known as the “Father of
Respiratory Therapy”• Thomas Beddoes founded the “Pneumatic
Institute in Bristol,” England 1780• Patients inhaled different gases to treat
their diseases
• Pneumatic laboratory enriched with O2 treated chronic conditions
• Father of English poet Thomas Lovell Beddoes
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Hyperbaric Oxygen Therapy
• J. Priestly discovered O2 in England 1776
• Antoinne Lavoisier of France shares O2 discovery
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Hyperbaric Oxygen Therapy
GAS LAWSAir under hyperbaric conditions obeys
the same gas laws as air in the atmosphere.
Boyle’s law (1627 – 1691)Dalton’s law (1766 – 1844)Henry’s law (1774 – 1790)
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Hyperbaric Oxygen Therapy
Boyles’s law
• When mass & T are K, V & P inverse.K = V x PK = 2V x ½PK = ½V x 2 P
• If P increases, V decreases, & vice versa.
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Hyperbaric Oxygen Therapy
Boyle’s law• When mass & T are K, D & P direct.
K = D/P• Consider container open at one end
holding 1 L at 1 atm.• At 2 atm, V by ½, & D doubles.• At 3 atm, V by ⅓, & D triples.
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Hyperbaric Oxygen Therapy
Boyle’s law
• During HBO, density in lungs increases.
• Deep scuba diving: density of air increases, & breathing becomes more difficult.
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Hyperbaric Oxygen Therapy
Dalton’s law
• PT = pressure exerted by gas equals the sum of all the Pgas of the constituent gases.
PT = P1 + P2 + P3 = . . . Pn
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Hyperbaric Oxygen Therapy
Dalton’s law To calculate the partial pressure of
a gas in a mixture of gases:
Pgas = Fgas (PT – PH2O)
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Hyperbaric Oxygen TherapyDalton’s law
TRUE or FALSEThe sum of the partial pressures of all the gases in a gas mixture can never exceed the total pressure of the gas mixture.
? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
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Hyperbaric Oxygen Therapy
Dalton’s law
TRUE!!!
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Hyperbaric Oxygen TherapyDalton’s law
TRUE or FALSEAs air pressure increases (hyperbarism) or decreases (altitude), the partial pressures exerted by the constituent gases increases or decreases, as well.
???????????????????????????????????????
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Hyperbaric Oxygen Therapy
Dalton’s law
TRUE!!!
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Hyperbaric Oxygen Therapy
Dalton’s law TRUE or FALSE
When room air is compressed in a hyperbaric chamber, the percentage of the individual gases in the mixture is the same.
???????????????????????????????????????
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Dalton’s law
TRUE!!!
Hyperbaric Oxygen Therapy
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Hyperbaric Oxygen TherapyDalton’s law• Lower partial pressures at altitude reflect
presence of less O2 & N2 molecules per volume compared to sea level.
• Summit at Mt. Everest (29,000 ft): 21% O2, 78% N2, 1% other
• # of O2 & N2 molecules per volume of air only 1/3 that at sea level.
• PO2 & PN2 only 1/3 that at sea level
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Hyperbaric Oxygen Therapy
Henry’s lawAmount of gas that dissolves in a liquid at a given temperature is a function of the partial pressure of the gas in contact with the liquid, and the solubility of the gas in that particular liquid.
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Hyperbaric Oxygen Therapy
Henry’s law
SIMPLIFIED: As the partial pressure of a gas above the surface of a liquid increases, more of that gas will dissolve into that liquid.
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Hyperbaric Oxygen Therapy
Henry’s & Dalton’s laws
When ambient pressure decreases (altitude), the partial pressures of O2 & N2 in the body fall, and fewer O2 & N2 molecules dissolve into the blood.
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Hyperbaric Oxygen Therapy
Henry’s & Dalton’s laws
When ambient pressure increases (hyperbarism), the partial pressures of O2 & N2 in the body increase, and more O2 & N2 molecules dissolve into the blood.
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Hyperbaric Oxygen Therapy
Physiologic Effects• Hyperoxygenation
– Increases volume of O2 in plasma
– 10 to 13 x greater than normal
– Elevated O2 levels purge toxins & CO from the body
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Hyperbaric Oxygen Therapy
Physiologic Effects• Hyperoxygenation
– At sea level while breathing room air plasma O2 concentration is 0.3 vol%
100 torr x 0.003 vol%/torr = 0.3 vol%
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Hyperbaric Oxygen Therapy
Physiologic Effects• Hyperoxygenation
– At sea level while breathing room air plasma O2 concentration is 0.3 vol%
100 torr x 0.003 vol%/torr = 0.3 vol%
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Hyperbaric Oxygen Therapy
Physiologic Effects• HyperoxygenationAlveolar Air Equation:
R
OF0.1OFPaCO)PP(OFOP 2
222T22
IIOHIAP O F O (P P ) P aC O F O
1 .0 F O
RA I H O I
I2 2 T 2 2 2
2
P O F O (P P ) P aC O F O
1 .0 F O
RA I H O I
I2 2 T 2 2 2
2
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Hyperbaric Oxygen Therapy
Physiologic Effects• Hyperoxygenation
HBO patient breathing FIO2 0.4@ 2.5 atm
P O 0 .4 (1 ,9 0 0 to rr 4 7 to rr) 4 0 to rr 0 .4 1 .0 0 .4
0 .8A 2
P O 0 .4 (1 ,9 0 0 to rr 4 7 to rr) 4 0 to rr 0 .4
1 .0 0 .4
0 .8A 2
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Hyperbaric Oxygen Therapy
Hyperoxygenation
PAO2 = 1,807 torr 1,807 torr x 0.003 vol%/torr = 5.4 vol%
PAO2 = 0.4 (1,900 torr – 47 torr) – 40 torr(1.15)
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Hyperbaric Oxygen Therapy
Normal a-v difference = 5.0 vol%
Arterial Blood
PaO2 100 torr
SaO2 97.5%
[Hb] 15 g%
Mixed Venous Blood
PvO2 46 torr
SvO2 73%
[Hb] 15 g%
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Hyperbaric Oxygen Therapy
CaO2 = (1.34)(15) (0.975) + 100(0.003)
= 19.6 vol%
CvO2 = (1.34)(15)(0.73) + 46(0.003 vol%.torr)
= 14.6 vol%
CaO2 – CvO2 = a-v diff = 5.0 vol%
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Hyperbaric Oxygen Therapy
PHYSIOLOGIC EFFECTS• Hyperoxygenation
– HBO increases dissolved oxygen in the plasma
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Hyperbaric Oxygen Therapy
Physiologic Effects• Direct Pressure
– Shrinks gas bubbles (Boyle’s law) to expedite reabsorption of gases
– Good for decompression sickness (DCS – aka: “the bends”)
– Good for air/gas embolism
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Hyperbaric Oxygen Therapy
Physiologic Effects• Vasoconstriction
– Reduces blood flow
– No significant reduction in tissue O2nation
– Benefits crushing type injuries– Benefits thermal burns
– O2 directly enters interstitial fluid promoting healing
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Hyperbaric Oxygen Therapy
Physiologic Effects• Bactericidal/Bacteriostatic
– Halts spread of toxins– Enhances killing of bacteria– Stimulates production of neutrophils
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Hyperbaric Oxygen Therapy
Physiologic Effects• Angiogenesis/Neovascularization
– Promote growth of new blood vessels– Promote collagen formation to
support new blood vessels
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Hyperbaric Oxygen Therapy
• Atmospheric pressure caused by weight of gas molecules in contact with earth’s surface
• Atmospheric pressure exerted on a surface of water
• Pressure decreases with altitude• Denver, CO at 5,280 ft elevation; 1
atm = 630 torr
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Hyperbaric Oxygen Therapy• Water more dense than air• 33 ft sea water = 1 atm (760 torr)• Pressure at any depth = hydrostatic
pressures + atm pressure• Depth of 33 ft of H2O = 2 atm, or 2 ata• At 33 ft H2O, 2,112 lbs over each ft2 of
body (33 ft x 64 lbs/ft3 = 2,112 lbs/ft2)• 66 ft H2O = 3 ata
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Hyperbaric Oxygen Therapy
• Indications – CHRONIC– Nonhealing wounds– Refractory osteomyelitis– Radiation necrosis
www.uhms.org/indications/indications.htm
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Hyperbaric Oxygen Therapy
• Hazards– Fire: 50 deaths worldwide in 20 years
(1997)• Most common FATAL complication• Only 100% cotton fabrics in chambers• No alcohol/petroleum products• No sprays, makeup, deodorant
– Barotrauma• Ear/sinus trauma• Tympanic membrane rupture• pneumothorax
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Hyperbaric Oxygen Therapy
• Hazards– O2 Toxicity
•CNS toxicity (twitching, seizures, convulsions)
•Pulmonary toxicity (leaky A/C membrane)
– Other•Sudden decompression•Reversible visual changes•Claustrophobia
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Hyperbaric Oxygen Therapy
• Hyperbaric Chambers– Monoplace transparent Plexiglas
cylinder– One patient– No mask– No electric equipment inside– 100% oxygen– Less expensive than multi-place
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Hyperbaric Oxygen Therapy
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Hyperbaric Oxygen Therapy
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Hyperbaric Oxygen Therapy
multiplacehyperchamber.jpg
• Multi-place chambers– large tanks able to accommodate 2 – 14
people– achieve pressures up to 6 atm– have a chamber lock entry system that allows
medical personnel to pass through without altering the pressure of the inner chamber
– allows patients to be directly cared for by staff– filled with compressed air; patients breathe
100% oxygen through facemask, head hood, or endotracheal tube.
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Hyperbaric Oxygen Therapy
img_header.jpg
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multiplacehyperchamber.jpg
Hyperbaric Oxygen Therapy
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COHb% SYMPTOMS
≤ 10% Usually none
10-20% Mild headache, dyspnea
20-30% Throbbing headache, impaired concentration
30-40% Severe headache, impaired thinking
40-50% Confusion, lethargy , syncope
50-60% Respiratory failure, seizures
60-70% Coma, convulsions, depressed cardiac & respiratory function
≥ 70% Coma, rapidly fatal