UHMS Accredits Hyperbaric Medicine at Park Ridge Health, Hendersonville, North Carolina

The advanced wound care program at Park Ridge Health, in Hendersonville, North Carolina, has received accreditation from the Undersea and Hyperbaric Medical Society (UHMS). The hospital-based center operates two monoplace chambers. Learn more about facility accreditation in our UHMS profile and on the UHMS website.

New on HyperbaricLink: Hyperbaric Oxygen for Cyanide Poisoning

Today we have added cyanide poisoning to our Diseases and Conditions section. Cyanide, like carbon monoxide (CO), binds to hemoglobin in red blood cells and blocks their capacity to carry oxygen to cells and tissues. Hyperbaric oxygen therapy (HBOT) is indicated for the emergency treatment of carbon monoxide poisoning complicated by cyanide poisoning after smoke inhalation. Hyperbaric oxygen is also an adjunctive therapy for pure cyanide poisoning in patients who do not respond to cyanide antidotes. From our commentary:

The emergency treatment of smoke inhalation offers perhaps the single best reason for the healthcare community to demand 24/7 access to hyperbaric chambers across the US. Cyanide, carbon monoxide, inhaled particulates, and thermal injuries together require speedy action to save the lives of firefighters and other fire victims. The clinical evidence for HBOT may not be as strong for nonfire cyanide poisoning as for nonfire carbon monoxide poisoning, but the benefits of oxygen are well established. As [Medscape] puts it: “Oxygen and sodium thiosulfate are the most widely accepted cyanide antidotes…. The mechanism of action of oxygen as a cyanide antidote is unclear, but it potentiates the effect of other antidotes. When used in the setting of smoke inhalation, it is also therapeutic for CO poisoning. Thus, high concentrations of oxygen should be promptly delivered.” Ongoing surveillance projects and prospective trials may bolster the clinical case for HBOT in the routine treatment of smoke inhalation. 

Cyanide is a rapidly acting and deadly chemical. Smelling of bitter almonds or entirely odorless, cyanide may take the form of a colorless gas, a liquid, or a crystal powder. Many plants, foods, and microbes produce harmless cyanides, and for decades cyanides have been used safely in manufacturing. Cigarette smoke contains traces of cyanide. Cyanide has also been used as an agent of chemical warfare and domestic terrorism. Our selection for Further Reading provides an insightful account of the still-unsolved 1982 Chicago Tylenol murders.

UHMS Accredits Hyperbaric Medicine at Davis Hospital and Medical Center, Layton, Utah

The hyperbaric and wound center at Davis Hospital and Medical Center, in Layton, Utah, has received accreditation from the Undersea and Hyperbaric Medical Society (UHMS). The outpatient facility is located on the hospital campus in the Robert Bitner Medical Office Building. Learn more about facility accreditation in our UHMS profile and on the UHMS website.

[Photo: Davis Hospital and Medical Center website]

UHMS Accredits Hyperbaric Medicine at Christus St Vincent, Santa Fe, New Mexico

Wound care and hyperbaric oxygen therapy at Christus St Vincent Regional Medical Center, in Santa Fe, New Mexico, has received accreditation from the Undersea and Hyperbaric Medical Society (UHMS). The hospital-based program operates two monoplace chambers. Learn more about facility accreditation in our UHMS profile and on the UHMS website.

[Photo: Christus St Vincent website]

Update: Hyperbaric Oxygen Therapy for Carbon Monoxide (CO) Poisoning

Today we have upgraded and expanded our carbon monoxide (CO) poisoning page. Carbon monoxide is the most common cause of injury and death by poisoning, both accidental and intentional (suicide). Inhaling even small amounts of CO can be fatal. Serious neurological effects may be delayed days or weeks after acute poisoning.

Supplemental oxygen, at normal or hyperbaric pressures, is the primary treatment for carbon monoxide poisoning. Hyperbaric oxygen therapy (HBOT) dissolves additional oxygen in the blood plasma and has been shown to block all known cellular mechanisms of CO toxicity. HBOT is also FDA cleared and UHMS approved to treat smoke inhalation in firefighters and other fire victims who suffer carbon monoxide poisoning complicated by cyanide poisoning. 

CO poisoning remains an active area of HBOT clinical research. From our new commentary:

Every year CO poisoning accounts for some 50,000 emergency room visits and kills about 450 Americans by accidental exposure alone. US fire departments respond to seven nonfire CO incidents every hour [NFPA, 2005]. For more than 50 years emergency physicians have been increasing their use of hyperbaric oxygen to treat acute carbon monoxide poisoning, yet access to emergency-ready hyperbaric chambers remains a public health crisis in the US today. Since 2008 the UHMS has participated in the CDC national surveillance system for carbon monoxide poisoning. Findings from nearly 2,000 cases at 87 hyperbaric facilities in 39 states are just now emerging for careful analysis and publication. These data will make a welcome addition to the medical literature, which currently lacks the strongest evidence, from randomized controlled trials (RCTs), to support the routine use of hyperbaric oxygen for acute CO poisoning [Cochrane Collaboration, 2011]. 

Regular readers of this blog know this topic is dear to our hearts. Once again, we do not consider it unreasonable for the US healthcare community to demand access to an emergency-ready and professionally staffed hyperbaric chamber in every hospital. Yet we're eager to see new evidence in the months and years ahead to support or challenge our views of HBOT for carbon monoxide poisoning and other trauma indications.

Hyperbaric Oxygen for Bodies in Exceptional Circumstances

We very much enjoyed the article "Extreme Endurance" in the Guardian earlier this month, about the development of new medical treatments for people exploring the rarefied air of Everest and the zero gravity of space. You will find HBOT about halfway down the page:

Hyperbaric oxygen therapy (HBOT) is the medical administration of 100% oxygen at higher than atmospheric pressures. The treatment, which dates back to the 1660s, was popular across Europe in the 19th century but saw a downturn as medicine became more evidence-based. Its use to treat decompression sickness suffered by divers and tunnel workers took off again during the 20th century. Since then, HBOT's effectiveness in treating a number of other conditions has been demonstrated.

At normal atmospheric pressure, oxygen is mainly transported around the body via the oxygen-biding properties of haemoglobin in red blood cells, with very little carried by the blood plasma. At higher pressures, plasma is able to transport more oxygen. The treatment fights infections by creating a hostile environment for bacteria that thrive and cause infection in the absence of oxygen. There is also evidence to suggest HBOT increases the activity of bone marrow stem cells.

Certainly it has been shown to be effective in the treatment of carbon monoxide toxicity, bone and bladder damage caused by radiation, poorly healing wounds, gas gangrene and severe anaemia. Benefits have been suggested for more than 100 conditions including autism, senile dementia and impotence. However, many such claims have rested on small, uncontrolled studies, which may have been susceptible to placebo effects.

These few well-researched paragraphs pertain more to space travelers than to mountain climbers. Regular visitors may have noticed we're saving a spot for acute mountain sickness (AMS) on our running list of diseases and conditions treated with hyperbaric oxygen therapy. Here's the odd case of an approved indication exclusively reserved for mild HBOT. In fact the inflatable bag chamber was invented by mountain climbers, and AMS remains the only FDA-cleared indication for its clinical use.


[Illustration: Brett Ryder, The Guardian]

Decompression Sickness: More Major Coverage on HBOT for Lobsters Divers of the Miskito Coast

Add to our September 10 story the following dramatic and beautiful new footage from NBC Rock Center. Along the Caribbean coast off Nicaragua and Honduras, the Miskito people face the constant risk of decompression sickness, or the bends, in their deep-sea pursuit of the coveted spiny lobster. The divers are poorly trained and equipped. Dr Elmer Mejía struggles to provide basic care, including hyperbaric oxygen therapy, which he sometimes worries may only compound the problem:

We feel very pleased when they improve very quickly at the chamber, but sometimes we are kind of scared because if they improve so quick, so fast, they will think the hyperbaric chamber makes miracles. So they will go back again diving and the next time can be the last time.

Read more at NYDailyNews.com.

Hennepin County Medical Center (HCMC) Installs New Hyperbaric Chamber

We are gratified to report progress according to schedule on the chamber replacement project at Hennepin County Medical Center, Minneapolis, Minnesota. With the new chamber HCMC will almost double its capacity, from 12 to 23 patients, and relocate hyperbaric medicine from an offsite facility to the Medical Center proper.

The video below shows both the new "giant white box" hung on a gantry and the old 1964 multiplace chamber. Our company profile of Fink Engineering includes exterior and interior photos to give you a better idea of the triple-lock rectangular design.

For over two years we have been following HCMC's fight for survival and funding as our way of asking: Why doesn't every Level 1 trauma center in America provide 24/7 access to a hyperbaric chamber?

CRAO: Fast Intervention with Hyperbaric Oxygen Helps Save Student's Eyesight

Here's the kind of story we'd like to read more often, about a timely referral to a hyperbaric oxygen treatment center to prevent blindness due to central retinal artery occlusion (CRAO). University of Delaware student Alyssa Tait was fortunate to receive quick attention in a medical community familiar enough with HBOT to make the right connection in time. Most impressive of all is the initiative medical directors  took to reach out, free up a chamber at Christiana Care Wound Care Center in Wilmington, and get Tait the treatment she so urgently needed.

Central retinal artery occlusion is a blockage in one of the small arteries that supply blood to the retina of the eye. People with CRAO experience sudden blindness, blurring, or partial loss of vision. The vascular event is usually brief and painless, but retinal damage and impaired vision may be permanent. Proper treatment in the first 24 hours is critical. Better if hyperbaric oxygen can be administered within 2-12 hours of symptom onset.

Tait's story is heartwarming and encouraging. Now if only the word about HBOT, one of the few treatments proven effective for CRAO, would spread among more ophthalmologists and emergency physicians.

Read the full account in Christiana Care News.

[Photo: Christiana Care News, Barbara McCullough and her daughter Alyssa Tait]

Hyperbaric Centers on High Alert for Carbon Monoxide (CO) Poisoning

Warnings about the risk of carbon monoxide poisoning have begun to spread in the news media as the mercury drops and the snow flies in the West, the Midwest, and the Northeast. Hyperbaric oxygen treatment centers have featured prominently this week and last. Read "The Nebraska Medical Center Urges Caution with Carbon Monoxide" in the Journal-Democrat (Syracuse, Nebraska) and click the play button, below, to watch "Hospital sees spike in CO poisonings" from New8 (Hartford, Connecticut). You'll find both Hartford Hospital and Nebraska Medical Center in our treatment center directory.

Hospital sees spike in CO poisonings: wtnh.com