Northern Nevada Hyperbarics Presentation


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A presentation containing information about Hyperbaric Oxygen Therapy & its benefits.

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Northern Nevada Hyperbarics Presentation

  1. 1. Northern Nevada Hyperbarics, Inc. Serving the Community for over 10 Years <ul><li>(775) 826-2084 </li></ul><ul><li>Center for Advanced Medicine - B 1500 E. Second St., Ste. 104 </li></ul>
  2. 2. What is HBOT? <ul><li>100% oxygen in an enclosed chamber at higher-than-atmospheric pressure where oxygen dissolves in arterial plasma in increased amounts---up to 10 to 15 fold increase. </li></ul><ul><li>Typical course consists of 30 or more treatments done daily for six weeks. </li></ul>
  3. 3. Some Basics <ul><li>HBOT has been used in chronic wounds for about 40 years. </li></ul><ul><li>100% oxygen is delivered to a chamber under high pressure (2 to 2.4 ATA) for 90 minutes </li></ul><ul><li>Typical HBOT treatment course consists of 30 or more treatments daily—M-F </li></ul><ul><li>Administering oxygen to hypoxic tissue shown to activate fibroblast proliferation, down-regulate inflammatory responses, cytokines, up-regulate growth factors – all proxies for wound healing. </li></ul>
  4. 4. Our State-of-the-Art Facility
  5. 5. 5 Sechrist Monoplace Chambers Safe & Secure Oxygen Farm
  6. 6. Courteous & Professional Staff Janet Albright, MD, FACS Medical Director Richard Flyer, MS Clinic Director And Staff of Certified Hyperbaric Technologists
  7. 7. Clinical Hyperbaric Oxygen Therapy Clinical HyperbaricOxygen Therapy <ul><li>Scheduled Indications </li></ul><ul><li>Non-Healing Diabetic and problem Wounds </li></ul><ul><li>Radiation soft tissue necrosis, cystitis, and proctitis. </li></ul><ul><li>Osteoradionecrosis </li></ul><ul><li>Osteomyelitis </li></ul><ul><li>Emergency Indications </li></ul><ul><li>Acute Traumatic Ischemia </li></ul><ul><li>Crush Injuries and </li></ul><ul><li>Compartment Syndrome </li></ul><ul><li>Carbon Monoxide Poisoning </li></ul><ul><li>Gas Gangrene </li></ul><ul><li>Surgical Infections </li></ul><ul><li>Failed Flaps and Grafts </li></ul><ul><li>Diving Injuries </li></ul>
  8. 8. Primary Mechanisms <ul><li>Hyper---oxygenation </li></ul><ul><li>Vasoconstriction—reduce inflammation </li></ul><ul><li>Microbiological effects </li></ul><ul><li>Activate fibroblast and collagen synthesis </li></ul>
  9. 9. Secondary Mechanisms <ul><li>Angiogenesis </li></ul><ul><li>Osteogenesis </li></ul><ul><li>WBC Oxidative Killing </li></ul><ul><li>Cell wall permeation </li></ul>
  10. 10. Cumulative Effects
  11. 11. Vascular Density in Response to Hyperbaric O2 Response to 20 x 1ATA 100% O2 Response to 20 x 2.4ATA 100% O2 8 x increase in vascular density
  12. 12. Vascular Density Increase No HBO Start HBO 18 Tx 24 Tx
  13. 13. Diabetic Wound w/ Recalcitrant Osteomyelitis <ul><ul><li>Pre-Hyperbaric </li></ul></ul><ul><ul><li>Partial Wound Closure </li></ul></ul><ul><ul><li>20 HBO2 TX---4 Weeks </li></ul></ul><ul><ul><li>Complication Resolved </li></ul></ul><ul><ul><li>Full Healing </li></ul></ul><ul><ul><li>35 HBO2 TX </li></ul></ul><ul><ul><li>7 Weeks </li></ul></ul>78 Y.O Male/ 2 Wks Resection Bone / Continued Drainage
  14. 14. Problem Wound w/ Skin Graft Failure <ul><li>u </li></ul>After 25 Tx---5 Weeks---beefy, red, healthy granulation tissue Split thickness graft placed--- 100% take 58 Y.O. Female / Diabetic / 6mo. Non-healing / 1 Failed Graft
  15. 15. Tissue Necrosis in Diabetic Foot <ul><li>After 15 Tx—2 Week </li></ul><ul><li>Granulation tissue </li></ul>Required incision, drainage, and debridement After 20 Tx---3 Week After 30 Tx---4 Week 69 Y.O. Diabetic Female / with Exposed Tendon
  16. 16. Non-Healing Post Amputation Initial Visit After 10 Tx After 16 Tx After 34 Tx 46 Year-Old Diabetic Male
  17. 17. Achilles Tendon Repair Site After 10 tx’s After 25 tx’s
  18. 18. Problem Wound Non-healing suture line 3 months post Healing after 25 HBO TX Medial View Non Healing Transmetatarsal Amputation
  19. 19. Left Mandibular Osteoradionecrosis Initial Visit - Bone Exposed Tx 12 - 2 Weeks Tx 25 - 5 Weeks Tx 39 - 8 Weeks New skin over bone 45 Y.O. Male / Radical Neck Dissection / Radiation / Exposed Bone
  20. 20. Radiation Soft Tissue Necrosis After 8 Tx—2 Weeks After 36 Tx---7 Weeks After 18 Tx---4 Weeks 52 Year-Old Male w/ Post-Radical Neck Reconstruction Wound Dehiscence & Flap Compromise
  21. 21. Radiation Necrosis w/ Incision Dehiscence 12 TX 21 TX 36 TX Three weeks post tx 51 Year-Old Female w/ Neck Dissection
  22. 22. Soft Tissue Radiation Necrosis 40 Y.O. Male post T-cell Lymphoma—Rt. hand Initial Visit Tx 7---1 Week Tx 24---5 Weeks Tx 50---10 Weeks No need for graft
  23. 23. Graft Placement Post-Radiation Necrosis 2 Months Post-Surgery After 20x HBOTs 10 Days After Spilt Thickness Graft
  24. 24. Crush Injury <ul><li>decreased perfusion or hypoxia </li></ul><ul><li>» HBO at </li></ul>11 Weeks after Surgery---Full Range of Motion 3 Tx in first 24hrs. Then total of 20 over a period of 4 weeks. Avulsion of the Palmar Skin
  25. 25. Traumatic Ischemia of a Replanted Leg <ul><li>Microvascular reattachment of nerves and arteries </li></ul>3 days after surgery—and 6 Tx, Then 4 more Tx over 3 days After 12 weeks, sensate leg--- can walk and run with the aid of brace. 4 Year-Old Mid-Calf Amputation from Lawnmower
  26. 26. Healing Compromised Flap of Tibia Fracture <ul><li>Necrosis and </li></ul><ul><li>breakdown of </li></ul><ul><li>tissue over plate </li></ul><ul><li>and bone </li></ul>After 10 Tx--- 1 Week---compromised portion of flap is now viable After 20 Tx---3 Week— 100% flap survival 54 Year-Old Male w/ Tibia Fracture and Internal Fixation
  27. 27. Failed Flap - Left Dorsal Foot Tx 1 Tx 30---5 Weeks Tx 18---3 Weeks Tx 12---2 Weeks Follow-Up 3 Weeks Final Follow-Up 50 Year-Old Female w/ Degloving Accident
  28. 28. Healing Burns A C B D A) 12 hrs after injury B) 24 hrs & 2x HBOTs C) 24 hrs & 2x HBOTs D) Shortly before discharge 23 YO Female w/ Facial Burns From Flaming Gasoline
  29. 29. Failed Flap – Right Knee Tx 9—Two Weeks Tx 16---3 Weeks Initial Visit 62 Y.O. Female w/ Failed Flap Post Total Knee eplacement
  30. 30. Lip Reimplantation Re-attached wound looked ischemic and swollen. Patient started hyperbarics and antibiotics. After 10Tx Follow-up: Happy Smile 10 Year-Old Female w/ Full Thickness Lesion From a Dog Bite
  31. 31. Side Effects of HBOT <ul><ul><li>Claustrophobia / Confinement Anxiety </li></ul></ul><ul><ul><li>Barotrauma </li></ul></ul><ul><ul><li>Reversible Myopia </li></ul></ul>
  32. 32. Contraindications <ul><li>Absolute: </li></ul><ul><li>Untreated Pneumothorax </li></ul><ul><li>Cis-Platin; Doxorubicin; Disulfiram </li></ul><ul><li>Relative: </li></ul><ul><li>Emphysema with CO 2 Retension </li></ul><ul><li>Emphysema w/ Air Trapping </li></ul><ul><li>Pulmonary Lesion in CXR </li></ul><ul><li>Uncontrolled High Fever </li></ul><ul><li>Claustrophobia </li></ul><ul><li>Seizure Disorder </li></ul><ul><li>Malignant Disease </li></ul>
  33. 33. Insurance <ul><li>Contracts / Agreements with: </li></ul><ul><li>HHP </li></ul><ul><li>Senior Care Plus </li></ul><ul><li>Blue Cross </li></ul><ul><li>Aetna </li></ul><ul><li>CIGNA </li></ul><ul><li>Senior Dimensions </li></ul><ul><li>Universal Health Network </li></ul><ul><li>Principal Financial </li></ul><ul><li>Nevada Preferred Professionals </li></ul><ul><li>Humana </li></ul><ul><li>Regence Blue Cross Blue Shield </li></ul><ul><li>Wellcare </li></ul><ul><li>Tri-Care </li></ul><ul><li>Medicare and Medicaid (through our partnership with Renown Health) </li></ul>
  34. 34. How To Consult or Refer <ul><li>Call us 24/7 at (775) 826-2084 </li></ul><ul><li>or Visit Us at </li></ul><ul><li> </li></ul><ul><li>We do most pre-authorizations for you! </li></ul>