Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized chamber, raising the oxygen levels in tissues and blood. It can help heal wounds by promoting collagen synthesis, angiogenesis, and fighting infection through increased neutrophil oxygen radicals. While hypoxia triggers these healing processes, adequate oxygen is still needed for maturation. Hyperbaric oxygen therapy addresses this by significantly raising oxygen levels beyond what hemoglobin alone can provide through dissolved oxygen in plasma. This supports the full healing cascade from initiation to completion.
Hyperbaric oxygen therapy involves breathing 100% oxygen in a pressurized chamber and has several proposed mechanisms of action and indications. A review of the literature found:
1) Several randomized controlled trials and case studies provide evidence that HBOT can improve wound healing, graft survival, and reduce amputation rates for conditions like diabetic foot ulcers and crush injuries.
2) However, systematic reviews found the evidence inconclusive on its effectiveness for chronic wounds in general and its cost-effectiveness is unclear.
3) While HBOT shows promise for certain acute and chronic indications, more high-quality research is still needed to identify which patient subgroups are most likely to benefit.
portable hyperbaric
chamber, are used for
altitude sickness and
decompression illness
in remote areas.
This document discusses the history, basics, indications, contraindications, complications, and applications of hyperbaric oxygen therapy (HBOT). It begins with definitions and the initial discovery of HBOT in the 1600s. It then covers the physics and physiology behind how increased pressure and oxygen concentration improves oxygen delivery to tissues. Common indications for HBOT include carbon monoxide poisoning, decompression sickness, gas embolism, and infections like clostridial myonecrosis. Complications can include barotrauma, seizures from oxygen toxicity, and fire hazards. Applications of HBOT include wound
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen inside a pressurized chamber to increase oxygen delivery to tissues. HBOT works by increasing both oxygen pressure and concentration in the blood, allowing more oxygen to dissolve in plasma and reach tissues. This creates a stronger signal that stimulates wound healing and tissue repair. The primary FDA-approved uses of HBOT are for wound healing problems like decompression sickness and radiation injury, but it is also studied for conditions involving chronic hypoxia like cerebral palsy and stroke. While generally safe, risks include barotrauma and oxygen toxicity in some cases.
This document discusses a case of a 45-year-old male presenting with toe pain secondary to gout who had an IV placed with subsequent air embolism due to failure to flush the IV tubing. It prompts for the diagnosis and treatment. Air embolism would be the diagnosis, and treatment would involve placing the patient in left lateral decubitus position and administering 100% oxygen via non-rebreather mask to reduce the size of the air bubbles and support oxygenation. The document goes on to discuss various topics relating to hyperbaric oxygen therapy including its physics, physiology, indications, disadvantages, evidence for use in emergency medicine, and reimbursement issues.
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber above 1 atmosphere. HBOT increases the amount of oxygen dissolved in the blood plasma, allowing greater oxygen delivery to tissues. It has been used since the 17th century to treat various conditions and was established as a treatment for decompression sickness in the 1930s. HBOT works by increasing oxygen to tissues through hyperoxygenation and decreasing bubble size through increased pressure. It has multiple mechanisms of action including vasoconstriction, angiogenesis, and collagen formation.
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber above normal atmospheric pressure. This increases the amount of oxygen dissolved in the blood and tissues up to 15 times normal levels. The high oxygen levels and pressure have physiological effects that can help treat conditions like carbon monoxide poisoning, gas embolism, and non-healing wounds by promoting angiogenesis and fighting infection. HBOT is administered in multi-place or monoplace chambers and can cause potential side effects from higher pressure and oxygen levels if not done properly.
Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized chamber at greater than atmospheric pressure. HBOT works by increasing the amount of oxygen that dissolves in the blood plasma, which allows more oxygen to reach tissues. The increased oxygen levels stimulate various cellular functions that promote healing. HBOT has been used to treat conditions like non-healing wounds, radiation injuries, burns, carbon monoxide poisoning, and decompression sickness. While research shows HBOT may help with some conditions, further high-quality studies are still needed to establish its effectiveness for other proposed uses.
Deepu Mathews is an associate professor at Malabar Dental College & Research Centre in Kerala, India. The document discusses the history, use, and applications of hyperbaric oxygen therapy (HBOT). HBOT involves breathing pure oxygen in a pressurized chamber and has been used since the 17th century to treat conditions such as decompression sickness and gas gangrene. It works by increasing the amount of oxygen dissolved in the blood and tissues. The document reviews research on using HBOT as an adjunctive treatment for periodontal disease.
Hyperbaric oxygen therapy involves breathing 100% oxygen in a pressurized chamber and has several proposed mechanisms of action and indications. A review of the literature found:
1) Several randomized controlled trials and case studies provide evidence that HBOT can improve wound healing, graft survival, and reduce amputation rates for conditions like diabetic foot ulcers and crush injuries.
2) However, systematic reviews found the evidence inconclusive on its effectiveness for chronic wounds in general and its cost-effectiveness is unclear.
3) While HBOT shows promise for certain acute and chronic indications, more high-quality research is still needed to identify which patient subgroups are most likely to benefit.
portable hyperbaric
chamber, are used for
altitude sickness and
decompression illness
in remote areas.
This document discusses the history, basics, indications, contraindications, complications, and applications of hyperbaric oxygen therapy (HBOT). It begins with definitions and the initial discovery of HBOT in the 1600s. It then covers the physics and physiology behind how increased pressure and oxygen concentration improves oxygen delivery to tissues. Common indications for HBOT include carbon monoxide poisoning, decompression sickness, gas embolism, and infections like clostridial myonecrosis. Complications can include barotrauma, seizures from oxygen toxicity, and fire hazards. Applications of HBOT include wound
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen inside a pressurized chamber to increase oxygen delivery to tissues. HBOT works by increasing both oxygen pressure and concentration in the blood, allowing more oxygen to dissolve in plasma and reach tissues. This creates a stronger signal that stimulates wound healing and tissue repair. The primary FDA-approved uses of HBOT are for wound healing problems like decompression sickness and radiation injury, but it is also studied for conditions involving chronic hypoxia like cerebral palsy and stroke. While generally safe, risks include barotrauma and oxygen toxicity in some cases.
This document discusses a case of a 45-year-old male presenting with toe pain secondary to gout who had an IV placed with subsequent air embolism due to failure to flush the IV tubing. It prompts for the diagnosis and treatment. Air embolism would be the diagnosis, and treatment would involve placing the patient in left lateral decubitus position and administering 100% oxygen via non-rebreather mask to reduce the size of the air bubbles and support oxygenation. The document goes on to discuss various topics relating to hyperbaric oxygen therapy including its physics, physiology, indications, disadvantages, evidence for use in emergency medicine, and reimbursement issues.
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber above 1 atmosphere. HBOT increases the amount of oxygen dissolved in the blood plasma, allowing greater oxygen delivery to tissues. It has been used since the 17th century to treat various conditions and was established as a treatment for decompression sickness in the 1930s. HBOT works by increasing oxygen to tissues through hyperoxygenation and decreasing bubble size through increased pressure. It has multiple mechanisms of action including vasoconstriction, angiogenesis, and collagen formation.
Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen in a pressurized chamber above normal atmospheric pressure. This increases the amount of oxygen dissolved in the blood and tissues up to 15 times normal levels. The high oxygen levels and pressure have physiological effects that can help treat conditions like carbon monoxide poisoning, gas embolism, and non-healing wounds by promoting angiogenesis and fighting infection. HBOT is administered in multi-place or monoplace chambers and can cause potential side effects from higher pressure and oxygen levels if not done properly.
Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized chamber at greater than atmospheric pressure. HBOT works by increasing the amount of oxygen that dissolves in the blood plasma, which allows more oxygen to reach tissues. The increased oxygen levels stimulate various cellular functions that promote healing. HBOT has been used to treat conditions like non-healing wounds, radiation injuries, burns, carbon monoxide poisoning, and decompression sickness. While research shows HBOT may help with some conditions, further high-quality studies are still needed to establish its effectiveness for other proposed uses.
Deepu Mathews is an associate professor at Malabar Dental College & Research Centre in Kerala, India. The document discusses the history, use, and applications of hyperbaric oxygen therapy (HBOT). HBOT involves breathing pure oxygen in a pressurized chamber and has been used since the 17th century to treat conditions such as decompression sickness and gas gangrene. It works by increasing the amount of oxygen dissolved in the blood and tissues. The document reviews research on using HBOT as an adjunctive treatment for periodontal disease.
Obstetric shock is caused by circulatory inadequacy resulting in poor tissue perfusion and cellular hypoxia. There are four phases of general changes in shock - the first two are reversible with treatment, the third is possibly reversible, and the fourth is irreversible and involves multiple organ failure. Management of shock involves stopping bleeding, volume resuscitation, oxygen supplementation, antibiotics for infection, vasopressors, and treating underlying causes.
Shock its pathopysiology and managementSHAKIL JAWED
This document discusses shock, including definitions, types, causes, pathophysiology, diagnosis, and treatment. It defines shock as a state of low tissue perfusion from inadequate oxygen and glucose delivery. The main types of shock discussed are hypovolemic, cardiogenic, obstructive, distributive, and septic shock. Treatment involves identifying and treating the underlying cause, restoring circulating blood volume and tissue perfusion through fluid resuscitation, and providing vasopressor support if needed to maintain blood pressure. Goals of resuscitation are optimizing oxygen delivery while avoiding fluid overload.
Turbulent blood flow plays an essential localizing role in the development of...SHAPE Society
The study investigated the role of hemodynamic forces in localizing atherosclerotic lesions in hypercholesterolemic rats with abdominal aorta constriction. Doppler ultrasound showed turbulent blood flow downstream of the constriction with lower wall shear stress, while laminar flow and normal wall shear stress occurred upstream. Rats with constriction developed focally distributed atherosclerotic lesions downstream but only diffuse fatty streaks upstream. Immunohistochemistry also showed greater oxidative stress downstream. Thus, turbulent blood flow combined with hypercholesterolemia promotes localized plaque formation, showing hemodynamic forces prime the local vessel wall for lesion development.
1) The document discusses sepsis, its definitions, epidemiology, and current treatment guidelines which focus on early goal-directed therapy to optimize oxygen delivery through hemodynamic support.
2) It describes new findings that microcirculatory dysfunction, rather than just hemodynamics, is central to sepsis pathogenesis and impacts outcomes.
3) Future therapies may target preserving microcirculation through inhibiting factors like iNOS that cause vasodilation and shunting during sepsis.
Resuscitation of the patient with major traumaSamir Elkafrawy
This document provides guidance on triage procedures during mass casualty incidents or disasters. It outlines the Simple Triage and Rapid Treatment (START) method, which evaluates patients' respiratory, circulatory and neurological function to categorize them into one of four priority groups - Immediate, Delayed, Minor, or Dead. The document specifies that initial triage takes priority over emergency treatment, and is to be completed within 60 seconds. It provides details on triage procedures, tags, and transportation of patients based on triage categorization.
Burn Management is complex topic to learn and master during MS General Surgery courses.It is pet favorite questions during viva voice/practical exams.With this ppt it will help you to gain basic knowledge related to this Topic.If you like my work then do share your response by mailing me on officialdrrishi@outlook.com
This document provides an overview of cryosurgery. It discusses the history and development of cryosurgery using extreme cold, particularly liquid nitrogen, to destroy diseased tissue. The document outlines the cryosurgery procedure for conditions like prostate cancer, which involves inserting cryoprobes under ultrasound guidance to create ice balls to destroy the tumor. It explains how cryosurgery works through immediate and delayed cell destruction caused by rapid freezing and slow thawing. The document emphasizes the importance of using the lowest possible temperatures, rapid cooling and slow thawing to maximize the effectiveness of cryosurgery.
OXYGEN THERAPY is vast diversified topic.
in the slide share, we have tried to compile all detailed information in brief.
the slides are well versed and all information have been garnered from verified sources.
all recent guidelines, standard textbooks have been referred.
COURTESY- DEPARTMENT OF CRITICAL CARE MEDICINE,
ABVIMS & DR RML HOSPITAL, NEW DELHI.
This document provides a summary of key points regarding sepsis epidemiology, pathophysiology, diagnosis, and treatment. It discusses:
1) Sepsis is a leading cause of death in hospitals, with over 200,000 deaths per year in the US. Early goal directed therapy focusing on initial fluid resuscitation and hemodynamic support can reduce mortality.
2) The sepsis cascade involves a systemic inflammatory response that can progress to organ dysfunction and shock if not treated promptly. Global tissue hypoxia is a key indicator preceding multiple organ failure.
3) Early recognition and treatment is important, with antibiotics, fluid resuscitation, and hemodynamic support through vasopressors and inotropes if needed to
1. The alveolar-capillary unit is a complex structure that facilitates gas exchange through diffusion between alveoli and surrounding capillaries. It provides a thin barrier and large surface area for oxygen and carbon dioxide exchange.
2. Surfactant, produced by type II alveolar cells, reduces surface tension in alveoli to increase lung compliance and prevent collapse during expiration. It plays several roles including reducing work of breathing and stimulating the lung's immune system.
3. Gas exchange occurs through diffusion as blood passes through alveolar capillaries. Oxygen diffuses into the blood from alveoli while carbon dioxide diffuses out of the blood into alveoli based on partial pressure gradients
ED John Budd a 72yearold arrived in the emergency depa.pdfinfo878313
ED: John Budd, a 72-year-old, arrived in the emergency department unconscious, with stab
wounds to the upper right abdomen and lower right chest that were sustained in his home while
fighting off a burglar. The paramedics secured two large-bore intravenous catheters in his right
and left anticubital spaces and infused lactated Ringer's solution wide ope in both sites. An
endotracheal tube was inserted, and ventilation with resuscitation bag at 100% oxygen was
begun. Medical antishock trousers (MAST) were in place. Pressure dressings to both wounds
were secured. A 5-cm (2 inch) stab wound to his right lower chest and a 7.5-cm (3 inch) stab
wound to his upper right abdomen were inspected. Chest tubes were inserted into the upper-right
and lower-right midaxillary regions. Immediately, 500 ml of red drainage returned via the lower
chest tube. His heart rate was 125 bpm, and the monitor showed sinus tachycardia without ectopy.
His blood pressure was 70/50 mmHg. Inserting a Foley catheter resulted in drainage of 400 ml
clear, dark yellow urine. After infusion of more than 2000 ml of lactated Ringer's solution, Mr. Budd
was sent to surgery, still in a hypotensive state. Preoperative body weight was 74 kg (165 lb).
Surgical intervention: During surgery, a right thoracotomy and right abdominal laparotomy were
performed. The right chest wound was explored, and a lacerated intercostal artery was ligated.
Exploration of his upper-right abdominal wound revealed more extensive damage. The liver and
the duodenum were lacerated. Extensive hemorrhage and leaking of intestinal contents were
apparent after opening the peritoneum. Mr. Budd's injuries were repaired, the peritoneal cavity
was irrigated with antibiotic solution, and the incisional sump drains were placed in the duodenum.
During the 4-hour surgery, Mr. Budd received 6 U of blood and an additional 3 L of lactated
Ringer's solution. A pulmonary artery catheter and right radial arterial line were inserted.
ICU, Immediate Post-op: When Mr. Budd arrived in the surgical ICU, he was receiving ventilation
support. Ventilator settings were as follows:
Assit - mode Rate 12 FiO 60% Vt 800 ml
2
Vital signs and hemodynamic parameters immediately after surgery were:
o o
BP 92/52 HR 114 Resp 12 Temp 36.2 C (97.2 F) PAP 20/8 mmHg PCWP 6 mmHg CVP 4
2
mmHg CO 5L/min CI 2.9 L/min/m SVR 1040 dynes/sec/cm
Arterial blood gas values were normal. Except for a WBC of 13.6 and a hemoglobin of 10 g/dl, Mr.
Budd's other laboratory values were within normal limits.
ICU, PO Day1: Mr. Budd remained drowsy and received ventilatory support for 24 hours. His pain
was controlled by IV morphine sulfate. The nasogastric tube continued to drain large amounts of
green fluid, and an incisional duodenal sump tube drained large amounts of greenish brown fluid.
His chest and abdominal dressings remained dry. Breath sounds were diminished on the right side
but clear on the left. His chest tubes continued to drain small amounts of bloody fluid.
Acclimatization allows permanent residents at high altitudes to adjust to low oxygen levels through various compensatory mechanisms. These include increased pulmonary ventilation, higher red blood cell counts and hemoglobin concentration, decreased oxygen affinity of hemoglobin, and enhanced diffusion capacity. At the tissue level, capillarity increases and cellular changes improve oxygen utilization. Natives born at high altitude exhibit superior acclimatization through enhanced lung size, heart adaptations, and optimized oxygen delivery and transport. Failure to acclimatize can result in acute or chronic mountain sickness without appropriate ascent rates or remaining at altitude too long.
Transcutaneous blood gas monitoring is a noninvasive technique that measures partial pressure of oxygen (PtcO2) and carbon dioxide (PtcCO2) at the skin surface using heated electrodes. While an indirect measure of arterial blood gases, it allows for continuous monitoring and has applications in neonates, wound evaluation, and assessing tissue perfusion. Accuracy depends on factors like age, skin characteristics, temperature, and perfusion state. Arterial blood gases remain the gold standard for validation.
This document discusses various adjunctive treatments for acute respiratory distress syndrome (ARDS). It covers ventilatory strategies beyond lung protective ventilation including prone positioning, liquid ventilation, high frequency ventilation, and extracorporeal membrane oxygenation. It also discusses hemodynamic management including fluids and vasopressors. Selective pulmonary vasodilators, surfactant replacement therapy, anti-inflammatory strategies, antioxidants, and anticoagulants are mentioned as potential adjunct treatments for ARDS. Prone positioning is described in more detail as one strategy that can improve oxygenation in ARDS patients.
The document provides information on the physiology of the respiratory system, including the organs and their functions. It describes the process of respiration including ventilation, diffusion of gases, and gas transport in the blood. It also outlines steps for assessing the respiratory system, such as evaluating vital signs, breath sounds, and symptoms like cough, dyspnea, and chest pain.
Oxygen therapy involves administering oxygen at concentrations greater than in ambient air to treat hypoxia and reduce work of breathing and myocardial work. It can be delivered via low-flow nasal cannulas or high-flow face masks, hoods, and tents. Precautions must be taken when using oxygen to avoid drying tissues, hypoventilation, absorption atelectasis, oxygen toxicity, and fire hazards. Clinical assessment and arterial blood gases are used to monitor patients and determine appropriate oxygen concentrations and durations of therapy.
1) ARDS is characterized by hypoxemia, bilateral lung infiltrates, and respiratory failure not fully explained by cardiac failure. The Berlin definition classifies ARDS as mild, moderate, or severe based on oxygenation levels.
2) Management of ARDS focuses on treating underlying causes, preventing complications, and using ventilator strategies like low tidal volume ventilation to prevent ventilator-induced lung injury.
3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
1. The document discusses the physiology of inhalational anesthetic agents, including their history, potency measured by MAC values, factors affecting uptake and distribution, and theories of anesthetic action.
2. It provides background on the discovery and use of important agents as well as their blood:gas and tissue:blood partition coefficients which determine how rapidly they enter the blood and tissues.
3. The uptake and distribution of agents depends on alveolar ventilation, cardiac output, tissue blood flow and the arterial-tissue pressure gradient, with highly perfused tissues like the brain reaching equilibrium most rapidly.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Obstetric shock is caused by circulatory inadequacy resulting in poor tissue perfusion and cellular hypoxia. There are four phases of general changes in shock - the first two are reversible with treatment, the third is possibly reversible, and the fourth is irreversible and involves multiple organ failure. Management of shock involves stopping bleeding, volume resuscitation, oxygen supplementation, antibiotics for infection, vasopressors, and treating underlying causes.
Shock its pathopysiology and managementSHAKIL JAWED
This document discusses shock, including definitions, types, causes, pathophysiology, diagnosis, and treatment. It defines shock as a state of low tissue perfusion from inadequate oxygen and glucose delivery. The main types of shock discussed are hypovolemic, cardiogenic, obstructive, distributive, and septic shock. Treatment involves identifying and treating the underlying cause, restoring circulating blood volume and tissue perfusion through fluid resuscitation, and providing vasopressor support if needed to maintain blood pressure. Goals of resuscitation are optimizing oxygen delivery while avoiding fluid overload.
Turbulent blood flow plays an essential localizing role in the development of...SHAPE Society
The study investigated the role of hemodynamic forces in localizing atherosclerotic lesions in hypercholesterolemic rats with abdominal aorta constriction. Doppler ultrasound showed turbulent blood flow downstream of the constriction with lower wall shear stress, while laminar flow and normal wall shear stress occurred upstream. Rats with constriction developed focally distributed atherosclerotic lesions downstream but only diffuse fatty streaks upstream. Immunohistochemistry also showed greater oxidative stress downstream. Thus, turbulent blood flow combined with hypercholesterolemia promotes localized plaque formation, showing hemodynamic forces prime the local vessel wall for lesion development.
1) The document discusses sepsis, its definitions, epidemiology, and current treatment guidelines which focus on early goal-directed therapy to optimize oxygen delivery through hemodynamic support.
2) It describes new findings that microcirculatory dysfunction, rather than just hemodynamics, is central to sepsis pathogenesis and impacts outcomes.
3) Future therapies may target preserving microcirculation through inhibiting factors like iNOS that cause vasodilation and shunting during sepsis.
Resuscitation of the patient with major traumaSamir Elkafrawy
This document provides guidance on triage procedures during mass casualty incidents or disasters. It outlines the Simple Triage and Rapid Treatment (START) method, which evaluates patients' respiratory, circulatory and neurological function to categorize them into one of four priority groups - Immediate, Delayed, Minor, or Dead. The document specifies that initial triage takes priority over emergency treatment, and is to be completed within 60 seconds. It provides details on triage procedures, tags, and transportation of patients based on triage categorization.
Burn Management is complex topic to learn and master during MS General Surgery courses.It is pet favorite questions during viva voice/practical exams.With this ppt it will help you to gain basic knowledge related to this Topic.If you like my work then do share your response by mailing me on officialdrrishi@outlook.com
This document provides an overview of cryosurgery. It discusses the history and development of cryosurgery using extreme cold, particularly liquid nitrogen, to destroy diseased tissue. The document outlines the cryosurgery procedure for conditions like prostate cancer, which involves inserting cryoprobes under ultrasound guidance to create ice balls to destroy the tumor. It explains how cryosurgery works through immediate and delayed cell destruction caused by rapid freezing and slow thawing. The document emphasizes the importance of using the lowest possible temperatures, rapid cooling and slow thawing to maximize the effectiveness of cryosurgery.
OXYGEN THERAPY is vast diversified topic.
in the slide share, we have tried to compile all detailed information in brief.
the slides are well versed and all information have been garnered from verified sources.
all recent guidelines, standard textbooks have been referred.
COURTESY- DEPARTMENT OF CRITICAL CARE MEDICINE,
ABVIMS & DR RML HOSPITAL, NEW DELHI.
This document provides a summary of key points regarding sepsis epidemiology, pathophysiology, diagnosis, and treatment. It discusses:
1) Sepsis is a leading cause of death in hospitals, with over 200,000 deaths per year in the US. Early goal directed therapy focusing on initial fluid resuscitation and hemodynamic support can reduce mortality.
2) The sepsis cascade involves a systemic inflammatory response that can progress to organ dysfunction and shock if not treated promptly. Global tissue hypoxia is a key indicator preceding multiple organ failure.
3) Early recognition and treatment is important, with antibiotics, fluid resuscitation, and hemodynamic support through vasopressors and inotropes if needed to
1. The alveolar-capillary unit is a complex structure that facilitates gas exchange through diffusion between alveoli and surrounding capillaries. It provides a thin barrier and large surface area for oxygen and carbon dioxide exchange.
2. Surfactant, produced by type II alveolar cells, reduces surface tension in alveoli to increase lung compliance and prevent collapse during expiration. It plays several roles including reducing work of breathing and stimulating the lung's immune system.
3. Gas exchange occurs through diffusion as blood passes through alveolar capillaries. Oxygen diffuses into the blood from alveoli while carbon dioxide diffuses out of the blood into alveoli based on partial pressure gradients
ED John Budd a 72yearold arrived in the emergency depa.pdfinfo878313
ED: John Budd, a 72-year-old, arrived in the emergency department unconscious, with stab
wounds to the upper right abdomen and lower right chest that were sustained in his home while
fighting off a burglar. The paramedics secured two large-bore intravenous catheters in his right
and left anticubital spaces and infused lactated Ringer's solution wide ope in both sites. An
endotracheal tube was inserted, and ventilation with resuscitation bag at 100% oxygen was
begun. Medical antishock trousers (MAST) were in place. Pressure dressings to both wounds
were secured. A 5-cm (2 inch) stab wound to his right lower chest and a 7.5-cm (3 inch) stab
wound to his upper right abdomen were inspected. Chest tubes were inserted into the upper-right
and lower-right midaxillary regions. Immediately, 500 ml of red drainage returned via the lower
chest tube. His heart rate was 125 bpm, and the monitor showed sinus tachycardia without ectopy.
His blood pressure was 70/50 mmHg. Inserting a Foley catheter resulted in drainage of 400 ml
clear, dark yellow urine. After infusion of more than 2000 ml of lactated Ringer's solution, Mr. Budd
was sent to surgery, still in a hypotensive state. Preoperative body weight was 74 kg (165 lb).
Surgical intervention: During surgery, a right thoracotomy and right abdominal laparotomy were
performed. The right chest wound was explored, and a lacerated intercostal artery was ligated.
Exploration of his upper-right abdominal wound revealed more extensive damage. The liver and
the duodenum were lacerated. Extensive hemorrhage and leaking of intestinal contents were
apparent after opening the peritoneum. Mr. Budd's injuries were repaired, the peritoneal cavity
was irrigated with antibiotic solution, and the incisional sump drains were placed in the duodenum.
During the 4-hour surgery, Mr. Budd received 6 U of blood and an additional 3 L of lactated
Ringer's solution. A pulmonary artery catheter and right radial arterial line were inserted.
ICU, Immediate Post-op: When Mr. Budd arrived in the surgical ICU, he was receiving ventilation
support. Ventilator settings were as follows:
Assit - mode Rate 12 FiO 60% Vt 800 ml
2
Vital signs and hemodynamic parameters immediately after surgery were:
o o
BP 92/52 HR 114 Resp 12 Temp 36.2 C (97.2 F) PAP 20/8 mmHg PCWP 6 mmHg CVP 4
2
mmHg CO 5L/min CI 2.9 L/min/m SVR 1040 dynes/sec/cm
Arterial blood gas values were normal. Except for a WBC of 13.6 and a hemoglobin of 10 g/dl, Mr.
Budd's other laboratory values were within normal limits.
ICU, PO Day1: Mr. Budd remained drowsy and received ventilatory support for 24 hours. His pain
was controlled by IV morphine sulfate. The nasogastric tube continued to drain large amounts of
green fluid, and an incisional duodenal sump tube drained large amounts of greenish brown fluid.
His chest and abdominal dressings remained dry. Breath sounds were diminished on the right side
but clear on the left. His chest tubes continued to drain small amounts of bloody fluid.
Acclimatization allows permanent residents at high altitudes to adjust to low oxygen levels through various compensatory mechanisms. These include increased pulmonary ventilation, higher red blood cell counts and hemoglobin concentration, decreased oxygen affinity of hemoglobin, and enhanced diffusion capacity. At the tissue level, capillarity increases and cellular changes improve oxygen utilization. Natives born at high altitude exhibit superior acclimatization through enhanced lung size, heart adaptations, and optimized oxygen delivery and transport. Failure to acclimatize can result in acute or chronic mountain sickness without appropriate ascent rates or remaining at altitude too long.
Transcutaneous blood gas monitoring is a noninvasive technique that measures partial pressure of oxygen (PtcO2) and carbon dioxide (PtcCO2) at the skin surface using heated electrodes. While an indirect measure of arterial blood gases, it allows for continuous monitoring and has applications in neonates, wound evaluation, and assessing tissue perfusion. Accuracy depends on factors like age, skin characteristics, temperature, and perfusion state. Arterial blood gases remain the gold standard for validation.
This document discusses various adjunctive treatments for acute respiratory distress syndrome (ARDS). It covers ventilatory strategies beyond lung protective ventilation including prone positioning, liquid ventilation, high frequency ventilation, and extracorporeal membrane oxygenation. It also discusses hemodynamic management including fluids and vasopressors. Selective pulmonary vasodilators, surfactant replacement therapy, anti-inflammatory strategies, antioxidants, and anticoagulants are mentioned as potential adjunct treatments for ARDS. Prone positioning is described in more detail as one strategy that can improve oxygenation in ARDS patients.
The document provides information on the physiology of the respiratory system, including the organs and their functions. It describes the process of respiration including ventilation, diffusion of gases, and gas transport in the blood. It also outlines steps for assessing the respiratory system, such as evaluating vital signs, breath sounds, and symptoms like cough, dyspnea, and chest pain.
Oxygen therapy involves administering oxygen at concentrations greater than in ambient air to treat hypoxia and reduce work of breathing and myocardial work. It can be delivered via low-flow nasal cannulas or high-flow face masks, hoods, and tents. Precautions must be taken when using oxygen to avoid drying tissues, hypoventilation, absorption atelectasis, oxygen toxicity, and fire hazards. Clinical assessment and arterial blood gases are used to monitor patients and determine appropriate oxygen concentrations and durations of therapy.
1) ARDS is characterized by hypoxemia, bilateral lung infiltrates, and respiratory failure not fully explained by cardiac failure. The Berlin definition classifies ARDS as mild, moderate, or severe based on oxygenation levels.
2) Management of ARDS focuses on treating underlying causes, preventing complications, and using ventilator strategies like low tidal volume ventilation to prevent ventilator-induced lung injury.
3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
1. The document discusses the physiology of inhalational anesthetic agents, including their history, potency measured by MAC values, factors affecting uptake and distribution, and theories of anesthetic action.
2. It provides background on the discovery and use of important agents as well as their blood:gas and tissue:blood partition coefficients which determine how rapidly they enter the blood and tissues.
3. The uptake and distribution of agents depends on alveolar ventilation, cardiac output, tissue blood flow and the arterial-tissue pressure gradient, with highly perfused tissues like the brain reaching equilibrium most rapidly.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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4. Definition, History of Hyperbaric Oxygen therapy
Terminology and Indications and protocols
Process of Mediating the Healing of wounds
a.) Collagen synthesis
b.) Angiogenesis
Rationale for the Use of Oxygen in wounds
Antibacterial actions
Reperfusion Injury
Topical oxygenation
Complications of HBO therapy
5. Involves the inhalation of oxygen at partial
pressures meeting or exceeding 1.4 ATA.
---(Whelan,H.T. and Kindwall, E.P. 1999).
6. At its inception, lacked a scientific basis.
Precursors of modern hyperbaric oxygen simply
seemed like good ideas.
Henshaw 1662
Compressed air therapy resurfaced in the 19th
century in the European continent:
a.) Some of the devices could be pressurized to 2 ATA
(the pressure equivalent of a 33-foot column of sea
water)
b.) Capacity up to 10 occupants.
7. Fontaine (1879) and Corning (1891).
a.) Fabricated a mobile operating room on wheels,
b.) Pressurized in concert with the administration of
the anesthetic gas nitrous oxide.
Benefits of the hyperbaric surgical environment
a.) Reduction in the size of hernias
b.) Decreased cyanosis,
Corning,
a.) The first physician to administer spinal anesthetic
b.) Imported compressed air therapy into the United
States
c.) Pioneered electrical powering of compressors.
8. Cunningham,
Promoted hyperbaric therapy based on epidemiological
observations.
Individuals
A.) heart disease
B.) circulatory problems
Observations
1.) Fared less well than similarly stricken patients dwelling near sea
level.
2.) Patitents at altitude fared better when relocated to sea level.
Hypothesis:
PRESSURE WAS THE KEY
Elevation of pressure beyond that characteristic of sea level would
confer even greater benefit.
9. Case Report
A young colleague bear death from the flu apparently exhibited a
remarkable recovery in conjunction with hyperbaric therapy.
Early chambers
Created a large chamber measuring 88 feet in length with a 10-foot
diameter in Kansas City.
Treatment Protocols
No discrimination for clinical indications met by compressed air
therapy.
Further hypothesized
Ailments stemmed from infection with anaerobic bacteria.
Elevated partial pressures of oxygen would hinder anaerobic
bacteria,
Case report 2
Kidney patient underwent a nearly miraculous recovery while
under the care of Cunningham.
10. Results
Techniques of Cunningham were “miracles”,
The wealthy patient rewarded Cunningham by constructing
the largest hyperbaric chamber ever to have existed.
The giant sphere, “Steel Ball Hospital”
a.) Located in Cleveland, Ohio,
b.) Measured an impressive 6 stories in height and 64 feet in
diameter.
c.) Interestingly, the enormous chamber,
Could sustain pressures of 3 ATA (66 fsw),
Was lavishly appointed with carpeting, cafeterias, and a top-
floor smoking lounge
Cost 1,000,000 USD
11.
12. Results
Unable to gather data sufficient to support his
broad hypothesis concerning:
A.) Anaerobic bacteria in disease :
(e.g., hypertension, uremia, diabetes and cancer).
The AMA and Cleveland Medical Society in
1930 forcibly closed the hospital,
condemning it to scrap for use during World
War II.
13. Churchill-Davidson and colleagues (1955)
1.) Were the first to employ elevated
concentrations of oxygen,
2.) Became known as hyperbaric oxygen therapy.
3.) Oxygen was used in attempts to potentiate the
therapeutic effect of radiation in cancer
patients.
Boerema and associates (1956),
a.) Prolonged tolerance to a circulatory arrest
related to cardiac surgery.
14. Physical properties of gases under pressure,
At pressure greater than 1 atm.
Oxygen is essential in a variety of enzymatic,
biochemical, and physiologic interactions
a.) Promote normal cellular respiration and tissue
function.
b.) Collagen deposition and synthesis
c.) Angiogenesis and epithelization also are
oxygen dependent.
15. The mechanism
1.) Oxygen from air diffuses across the aveoli
From the high pressure in the alveoli (pO2 100 mmHg)
to lower pressure pulmonary capillaries (pO2 40
mmHg).
The pulmonary capillaries carry the deoxyhemoglobin
in the blood from the right ventricle to the lungs.
After oxygenation blood (carrying oxyhemoglobin)
moves into the pulmonary veins for return to the left
side of the heart to be pumped systemically.
16. Under normal conditions,
> 97.5% of 02 is carried in the bloodstream bound to
hemoglobin.
The remaining 2.5% is dissolved in plasma.
Each gram of hemoglobin combined with 1.34 cm3 of
oxygen.
> physiologic maximum.
> normal conditions, Sa02 hb = 97%, SV02 =70%.
The oxygen content can be calculated with the
following equation:
CaO2=(SaO2 x Hb x 1.34) + .003(PaO2)
> Increase Pa02 = increased dissolved 02 in the blood
17. At a constant temperature, the volume and
the pressure of a gas are inversely
proportional.
In other words…….
A gas will compress proportionately to the
amount of pressure exerted on it.
18. 1.) Decompression sickness,
2.) Carbon monoxide poisoning,
3) Gas embolism,
4.) Gas gangrene with positive culture for a clostridial species,
5.) Acute osteomyelitis refractory to standard medical
management,
6) Chronic non-healing (problem)
a.) Documented failure of an intensive wound management
program (minimum of 6 weeks)
b.) Failure of surgical management or documentation from a
surgeon of poor tissue oxygenation
19. 7.) Refractory bacterial infections,
8.) Acute traumatic ischemia in a salvageable area,
9.) Radiation necrosis (osteoradionecrosis and soft tissue
radiation necrosis)
10.) Acute cerebral edema
11.) Profound anemia with exceptional blood loss:
a.) only when blood transfusion is impossible or must be
delayed,
12.) Refractory mycoses,
13.) Acute cyanide poisoning,
20.
21. Medications like doxorubicin (adriamycin), bleomycin, disulfiram, cis-
platinum and mafemide acetate
Untreated pneumothorax
Pregnancy
Implanted pacemakers-electronic
Smoking
No air plane travel 24 hours after HBOT treatment.
Compressive brain or brainstem lesions e.g. unilateral or bilateral sub-
dural hematoma, intracranial hematoma.
Sickle Cell and Sickle Cell Trait.
22. Upper respiratory
infections/chronic
sinusitis
Seizure disorders
Emphysema with
CO2 retention
Acute asthma
High fevers
Claustrophobia
Otosclerosis
Congenital
spherocytosis
Viral infections such as
HIV or RSV
24. Chronic wounds
2 ATA for 90min 3-4 x weekly
Necrotizing infections
2 ATA for 90 min TID
CO Poisoning
3 ATA for 30 min
( ½ life of CO at 3 ATA pressure 23 min)
25.
26. The many forms of wounds
Contused (unbroken skin),
Incised (cut tissue),
Lacerated (torn skin),
Open (free outward opening),
Penetrating (affects underlying tissue)
Perforating (penetrating wound into viscous or
body cavity).
27. Problem wounds
Those failing to respond to the conventional
primary and adjunctive management within an
expected period of time.
Seen in individuals who do not have normal
patterns or rates of tissue repair.
a.) Numerous operations
b.) Prolonged hospitalizations.
c.) Most common in the lower extremities.
28. Chief pathological features of problem wounds
Chronic hypoperfusion and contamination.
Successful management = Identify etiology and potentially
complicating factors
a.) Advanced age,
b.) Nutritional deficits,
c.) Diabetes mellitus,
d.) Use of tobacco,
e.) Radiation damage,
f.) Hypoxia,
g.) Immunosuppression,
h.) Foreign bodies,
i.) Renal failure,
j.) cCancer
29. The injured blood vessels allows the wound space to be filled with plasma and red
blood cells.
The injured endothelium releases Factor III (thromboplastin), which accelerates the
clotting cascade.
Clotting factors throughout the plasma are activated, forming thrombin and fibrin.
The complement system activates and produces various chemoattractive
complement protein fragments.
Platelets, activated by exposed collagen and activated thrombin, release a number
of factors and cytokines.
To limit bleeding, traumatized vessels will constrict in response to inputs
a.) ANS
b.) PG’s released by the platelets.
The healthy vasculature proximal to the injury will dilate and leak plasma in
response to various inflammatory mediators such a histamine, kinins, and
serotonin,
30. Inflamatory process =
Hypoxic, acidodic and hyperlactate state
Neutrophils , fibroblasts, endothelial cells
a.) few mitochondria = rely on anaerobic glycolyis for ATP
Neutrophilic oxidants, will produce lactate
a.) Even if normal levels of 02 are present
b.) Induce an acidodic environment
The importance
ADPR SYS
a.) Post translational modification of many proteins
b.) Regulates transcription of collagen and VEGR
c.) Lactate in the wound reduce NAD+ to NADH
31. Importance of Hypoxia
Increases lactate within the wound environment,
This allows the synthesis of collage secondary to (redox)
mechanism
HOWEVER………..
Studies have proved that fibroblasts NEED 02
a.) Synthesize collagen
b.) Posttranslational modifications necessary for its cross-linking.
Take home message
Hypoxia acts as the triggering mechanisms for the repair-related
production of collagen,
Restoration of oxygenation is required to ensure that the collagen-
dependent processes of repair reach their successful conclusion
32.
33. Vasculogenesis,
> Primitive vascular network is established embryologically
from endothelial cells precursors called angioblasts.
Angiogenesis (i.e., neovascularization)
> Proceeds as preexisting vessels send out capillary buds
(sprouts) to create new vessels.
> Results the chronic inflammatory process and fibrosis.
> Redirection of vasculature seen during growth of tumors.
34.
35. Clark et al.(1976), injected autologous wound macrophages into rabbit
corneas to stimulate neovascularization and
Polverini et al.(1977), discovered that activated peritoneal macrophages
induced more vessel growth than non actviated macrophages in the
corneal angiogenesis assay.
Jensen et al. (1986), later demonstrated that acellular macrophage-
conditioned media alone was sufficient to cause angiogenesis, therefore
underscoring the role of the angiogenic factor.
Knighton et al. (Knighton, et al. 1983), for example, demonstrated that
media conditioned by macrophages grown at 15 mmHg pO2, supported
angiogenesis; media conditioned by macrophages grown at 38 mmHg or
76 mmHg did not.
IMPORTANCE:
Despite macrophages and vascular growth factors
a.) The most notable stimulator for angiogenesis is in fact hypoxia,
b.) Similar to initiation of the synthesis of collagen in response to injury.
36. 1.) BMJ 1998;317:1140-1143
Clinical review ABC of oxygen Hyperbaric oxygen therapy
2. ) Pediatr Emerg Care. Maintaining a high index of suspicion for carbon
monoxide poisoning is life saving. 2008 Mar;24(3):198.
3.) AANA J. Oxygen: the two-faced elixir of life. 2008 Feb;76(1):61-8.
4.). Singapore Med J. Hyperbaric oxygen therapy in the management of
diabetic lower limb wounds 2008 Feb;49(2):105-9.
5.) Undersea Hyperb Med. Hyperbaric oxygen pre-breathe modifies the
outcome of decompression sickness. 2006 Nov-Dec;33(6):407-17.
37.
38.
39. Angiogenesis and collagen synthesis and deposition
share common triggers,
Zabel et al.(1996).
Cultured macrophages in 0 or 15mM lactate and then
measured NAD+ and poly (ADP-ribose ) synthesis.
The cells incubated with lactate demonstrated a 40%
lower NAD+ level and therefore a 40% reduction in poly
adenosine diphosphoribose synthetase.
Constant et al. (1996)
Measured vascular endothelial growth factor in media
grown in normoxia, hypoxia, 15mM of lactate, or
hypoxia and elevated lactate in combination.
40. OVERALL:
1.) Hypoxia and lactate alone stimulate an
increase in VEGF
2.) Synthesis of collagen and the initiation of
angiogenesis proceed in relation to metabolic
demand, with hypoxia acting as the trigger.
3.) Maturation of collagen and the finalization of
angiogenesis require normal levels of oxygen.
41. I.E
Placing an oxygen-breathing individual in a hyperbaric
chamber:
a.) Raises arterial oxygen tensions 10 - 13 times
b.) The surplus oxygen carried by the arterial blood under
hyperbaric conditions will become available to
wounded tissue
c.) Promoting both the maturation/deposition of collagen
and angiogenesis and thus the closure of the wound.
*****Lactate (associated with hypoxia) is the greatest
trigger for stimulating fibroblasts and macrophages
to initiate the manufacture of collagen and induce
angiogenesis
43. More important line of defense against infection)
Seen in all wounds and contributes to tissue debris and
edema.
Neutrophils and macrophages enter the wound
environment,
a.) Neutrophils = primary defense
b.) Natural (or nonspecific) immunity,
> Neutrophils and macrophages + complement system
> Rapidly and independently of previous exposure to specific
microorganisms.
> The invading bacteria are opsinized by immunoglobins,
> Complement proteins bind to receptors found on
membranes of neutrophils, culminating in pathogenic
recognition by neutrophils and phagocytosis.
44. The respiratory burst first involves the
reduction of molecular oxygen (O2) to the
microcidal superoxide anion (O2 -) via the
NADPH oxidase system,
Superoxide dismutase catalyzes the
interaction of the two superoxide anions to
reform oxygen and hydrogen peroxide
(H2O2), another antibactericidal oxidant.
Myeloperoxidase, released by the
azurophilic granules of neutrophils,).
These halide oxygenation products are the
potent oxidants that attack the membrane
proteins of bacteria, (Hunt, T. 1988).
The production of oxygen radicals and
killing of pathogens via oxidation proceeds
in relation to the availability of oxygen in
the wound environment, (Park, M., 1999).
45. Oxygen is often ill-equipped to reach the wound
a.) Impaired vascular delivery.
b.) Further limiting the transport of oxygen to problem wounds
may be the necessarily limited oxygen-carrying capacity of
the blood.
Normal circumstances,
a.) The bulk of oxygen is delivered to tissue via hemoglobin with
plasma carrying a significantly smaller load of oxygen (in
solution).
b.) The concentration gradient may be too small to permit
immunologically sufficient quantities of oxygen to diffuse
from capillaries to the wound.
46. Under hyperbaric conditions,
a.) Situation changes favorably
b.) The breathing of 100% oxygen allows plasma to
transport a greatly elevated load of dissolved
oxygen
c.) Increases the total load of oxygen transported by
the blood
47. Increase the load of oxygen carried by the blood,
Concentration gradient of oxygen between the blood and the
hypoxic problem wound increases,
Promotes diffusion of the gas into its otherwise oxygen-poor
target.
Disruption of metabolism and proliferation of anaerobic
bacteria.
If cells of the immune system are able to access the wound,
A.) Oxygen-dependent attacks of the immune system on both
anaerobic and aerobic bacteria may increase,
B.) Thereby rendering the wound environment more amenable to
healing.
48. Ischemia,
Results from the functional constriction or actual
obstruction of the blood vessel).
High-energy trauma
Compartment syndrome,
Amputated body parts
peripheral vascular disease
RESULT = Some degree of microcirculatory failure and
hence necrosis
When reperfusion follows necrosis,
a.) There is further injury to the microvasculature,
b.) Leads to further cellular death,
c.) Large partially necrotized muscular areas being
particularly vulnerable to the pathological process.
49. The cytotoxic effects of
reperfusion
oxygen-derived free radicals,
A.) Highly unstable molecules
possessing an unpaired
electron in the outer shell.
B.) Hazardous to the
intracellular environment,
Sources:
A) Xanthine oxidase (XO),
which is located in the
microvascular endothelial
cells and
B) Neutrophils which destroy
damaged tissue and
invading bacteria
50. 1.) Ischemia= accumulation
hypoxanthine
2.) membrane-spanning pumps
fail,= increase in intracellular
levels of calcium.
3.) Activates proteases, allowing
the conversion of xanthine
dehydrogenase to XO.
4.) When reperfusion occurs, the
enzyme XO converts
hypoxanthine to xanthine and
the superoxide radical.
5.) hydroxy radical will emerge. .
( Aids neutrophils in the
production of the hydroxy
radical)
51. During reperfusion,
Increase in neutrophil adherence to the vascular
endothelium,
Reflects increasing numbers of neutrophils marginating
and extravasating into the surrounding tissues.
Results:
a.) Local vessels will eventually become ill defined.
neutrophils
Releases free radicals= endothelial damage
induce microcirculatory problems through adherence.
52. Speculations
One might predict that increased availability of
oxygen would:
a.) Promote free radical-mediated reperfusion injury.
b.) The increased oxygen-carrying capacity of plasma
under hyperbaric conditions,
Expect severe reperfusion in .
The production of free radicals would simply
escalate in concert with increased availability of
oxygen.
The reverse is actually the case.
53. The increase in microvascular flow helps increase tissue
survival and therefore decreases necrosis.
Decrease neutrophil adherence in the venules,
a.)Decreases, problems associated with neutrophilic
adhesions,
> increase free radicals which= tissue damage
The benefits of HBO on the ischemic tissue
Systemic
Inhalation of oxygen at a higher atmospheric pressure
Greater concentration of oxygen to circulate throughout
the entire body
A.) Suppress of systemic neutrophils.
B.) Increase in superoxide dismutase, which is a free
radical scavenger. Zamboni ( 1992),
54. Currently available evidence indicates:
That systemically (rather than locally)
augmented levels of oxygen
mitigate the destructive
consequences of free radicals in
ischemic tissue undergoing
reperfusion.
55. Increases in oxygen tension in a chronic wound in
may permit and promote a cascade of events
culminating in the full healing of otherwise
nonhealing tissue.
Means by which oxygen tensions are increased in
such a fashion involves the inspiration of 100%
oxygen under substantially elevated ambient
pressures.
Henrys Law, allows oxygen to diffuse readily from
capillaries to otherwise inaccessible insufficiently
vascularized tissue, thereby initiating oxygen-
dependent cascades related to healing.
61. The rational for the topical approach is simple:
Some investigators believe that topical oxygen
dissolves in sufficient quantity
a.) Exert bactericidal and angiogenic effects,
Marketed aggressively by companies such as
GWR Medical, Hyperbaric solutions Inc.,
Sandia-Numotech partnership, which was
established in 1998 to create home-use topical oxygen
applicators.
62. The device
The devices employed in the topical application of
oxygen typically consist of a compartment to encase
the affected portion of the body.
When connected to a regulated flow of oxygen
from commercially available tanks, the
compartment is intended to provide the wound
with a therapeutic oxygen-rich external
environment,
The compartments (commonly called canopies) that
enclose the wound may be box-like or function as
disposable plastic bags
63. Acute or chronic wounds such as skin ulceration
a.) Diabetes,
b.) venous stasis,
c.) Post surgical infection,
d.) Decubitus ulcers (pressure ulcers),
e.) Skin grafts,
f.) Frost bites,
g.) Amputations,
h.) Grangrenous lesions,
i.) Burns
Contraindications:
1.) Inadquate perfusion to support healing,
2.) Wounds completely covered with eschar,
3.) Wounds with fistulae or deep sinus tracts where the end cannot be
probed,
4.) Wounds covered with petroleum based dressing,
5.) non-compliant patients.
64. Medical history,
Allergies,
Current medications,
Psychological status (to predict compliance),
Nutritional status,
Wound description.
***NO ABI’s, NO AGRAM, NO MRA
65. Debridement of the wound with removal of thick eschar.
Culturing of the wound to detect pseudomonas (pseudomonas grows
in an oxygen-enriched environment).
If pseudomonas is detected, 1% acetic acid is applied with a gauze
dressing, which remains in place during exposure to topical oxygen.
All creams, ointments, and lotions must be removed as well as all
dressings (except when wounds are positive for pseudomonas) before
oxygen is applied topically.
8. Treatment will cease if improvement does not occur within 28 d
66. Applied for either 90 minutes (twice per day) or during a
single session lasting 180 minutes.
The lesion should be covered with a moist environmental
dressing following each treatment.
Before and after each treatment, the topical oxygen canopy
must be cleaned with antiseptic. A culture of the appliance
must be taken periodically to make prevent contamination
of wounds by the apparatus.
This protocol will not be followed and treatment will not be
administered in the patient has acute thrombophlebitis or if
there is minimal blood supply to the lesion.
67. Inability to complete collagen synthesis and
angiogenesis
Inability to produce a bactericidal effect
Inability to prevent reperfusion injury
68. Henry’s Law is relevant to the reversal of hypoxia associated with the
administration of hyperbaric oxygen.
Delivery with HBO increase arterial oxygen tensions by 6 volumes
percent,
Solubility of 02 plasma increases greatly as a function of pressure.
Importance =
1.) Systemic elevations of oxygen tensions depend on the combination of
substantially elevated pressure (e.g., 2.4 ATA) and pulmonary delivery of
the gas.
2.) A patient is undergoing topical oxygenation of a wound continues to
breathe air at ambient pressure.
Henry’s Law dictates that,
A.) Even if adequate blood flow and hematocrit are maintained,
plasma at the level of the wound will not suspend significantly more
oxygen.
69. NO elevated load of oxygen in plasma,
One can readily predict the failure of
a.) Oxygen-dependent maturation of collagen
b.) Angiogensis
Henry’s Law predicts
a.) Topical oxygenation does not elevate the load of
dissolved oxygen available to problematically
wounded ischemic tissue,
Problem wounds will remain as problems, even in
the face of aggressive topical oxygen therapy.
70. Hyperbaric oxygen may exert bactericidal effects
A.) Anaerobic species as demonstrated Hill et al, (1972)
(hyperbaric oxygenation and Clostridium species of bacteria).
B.) Enhance the ability of the immune system to kill even aerobic
bacteria, (Ollodart, 1966).
Topical Oxygenation
a.) Look at the HBO literature
b.) Oxygen delivered systemically at partial pressures lower than 1.4
ATA does not fulfill the criteria of bacteriostatic agents
(i.e., agents that suppress the growth and proliferation of bacteria;
(Park, M., 1999).
71. Park et al. (1999) reported
1.) Local environmental conditions permits the
proliferation of Pseudomonas aeruginosa.
2.) Topical oxygen does not augment the capacity of the
immune system
Topical Oxygenation enthusiasts
1.) Apparently aware (but perhaps unconcerned) by the
notable contradiction,
2.) Recommend , application of acetic acid when
problems wounds are Pseudomonas-positive,
Acetic Acid:
1.) Adjunctive topical acetic acid may act as an irritant
72. Mechanism of HBO
1.) Bactericidal effects of HBO YOU NEED free radicals by cells
of the immune system.
2.) THEREFORE, topical oxygen therapy would need to
augment free radicals.
3.) BUT, therapeutic free radical production is systemically
rather than locally medicated.
Conclude:
Basic premise upon which topical oxygen therapy is built is
false.
73. Hyperbaric oxygen exerts its beneficial effects through
systemic rather than local actions.
1.) Zamboni et. al, (Zamboni, 1999). rendered the hindlimb
of rabbits ischemic for 8 hours, after which the flow of
blood was restored.
2.) Functional tests of the reperfused muscle revealed
beneficial effects of hyperbaric oxygen,
3.) Suggests that systemic factors contributed positively to
the recovery of function following reperfusion.
4.) Conducted in Humans
74. Topical oxygen
1.) What is the mechanism???? diminishing
reperfusion injury.
2.) Another assumption =
a.) Pure oxygen on a wound pure oxygen at
marginally elevated pressures would deliver
oxygen to the body at a rate similar to the lungs
receiving a load of pure oxygen at pressures
commonly in excess of 2 ATA.
75. Topical oxygen is non systemic
1.) Unable to have the beneficial suppression on
neutrophils which play a significant role in
reperfusion injury ( Zamboni et al)
2.) May play a detrimental role in conditions in
which ischemia is present
76. Basis of Evidence
1.) Heng MCY: Topical Hyperbaric Therapy for Problem Skin
Wounds. J Dermatol Surg.Oct 1975: 1:3:55-58
2.) Heng MCY, Kloss SG: Endothelial Cell Toxicity in Leg Ulcers
Treated with Topical Hyperbaric Oxygen. AM J Dermatopathol
1986; 8:403-410
3.) Leslie CA, Sapico FL, Ginunas VJ, Adkins RH: Randomized
Controlled Trial of Topical Hyperbaric Oxygen for Treatment of
Diabetic Foot Ulcers. Diabetes Care Feb 1988 11:2: 111-115.
Investigators reported tendencies for healing to decelerate in the
presence of topical
77.
78. Potential for oxygen to exert (potentially damaging)
effects in healthy tissue located far from the wound.
Increase availability of cytotoxic free radicals.
Therapeutically beneficial effects of hyperbaric oxygen
are achieved through the production of free radicals
(e.g., immune system-guided antibacterial effects).
Toxic effects of hyperbaric oxygen well documented
(Kindwall, E., 1999).
A.) central nervous system,
B.) lungs,
C.) eyes,
79. 1.) Dependent on the partial pressure of oxygen (Whelan et. al, 1999).
2.) central oxygen toxicity is a clinical concern at partial pressures of
oxygen greater than 2.0 ATA.
Manifestations
1.) Behavioral
2.) Dramatic seizures on EEG.
a.) overt signs (e.g., autonomic, affective, cognitive, or motor)
b.) Signs may be subtle or even absent,
c.) Progression between initial signs of central oxygen toxicity and
seizures may be rapid.
80. When?
1.) Partial pressures as low as 0.5 ATA
Symptoms
a.) Substernal burning,
b.) Chest tightness,
c.) Cough, and dyspnea,
d.) Likely reversible with the cessation of hyperbaric oxygen
therapy.
e.) IF not stopped = adult respiratory distress syndrome.
(Kobzik,1999).
Cases of irreversible pulmonary dysfunction have NOT
followed single-treatment hyperbaric oxygen protocols
such as those deployed by the United States Navy.
81. Diabetic and Elderly patients.
1.) Secondary to lenticular changes,
2.) Progressive myopia:
a.) Partial pressures of oxygen between 2.0 and 2.4 ATA
b.) Recurrent treatments lasting at least 90 minutes.
c.) 20 - 40% will experience visual changes.
The condition is reversible, typically resolving during
six treatment-free weeks.
82. This condition is a rarity in the chamber,
Most arrythmias usually improve within HBO
Incidence < 0.2% ( Kindwall)
Case Report
1.) Individual suffered 30 cardiac arrests during the 48
hours he was treated during a research study.
2.) 28 of his 30 cardiac arrests occurred at the surface
The protocol
Multiplace
> CPR can be immediatley initiated.
Monoplace
>The patient must be removed from the chamber in
order to initiate cardiopulmonary resuscitation.
83. > This condition is a life threatening event
> If patien is decompressed it will increase as # ATA’s increase.
Signs of a pneumothorax
SOB
Chest pain,
Tracheal deviation to the side of the collapsed lung
Absence of breath sounds on the affected side.
Pathognomonic Test
If the patients respiratory distress worsens on decompression and
improves immediately on recompression one can diagnose a
pneumothorax.
Treatment:
The patient shoould be held at pressure until a management team can
be assembled, ( surgeon, anesthesiologist etc).
The patient is then brought quickly to the surface
A needle is place into the affected side to relieve pressure.
84. 1.) Patients may be fitted with clear plastic hoods.
2.) Audio/visual entertainment systems may be
incorporated to add comforting distractions.
3.) Often fabricated from clear materials
4.) Afford visual contact between the patient and
the external Environment
85. 1.) HBO therapy follows Physiological Principles and the Laws
of physics
2.) HBO is Currently indicated for 13 diseases and supported
by the literature
3.) Various “Fringe Therapy” based off of HBO
4.) Evidence includes testimonial and case reports
5.) THBO is a misnomer, that does not follow basic tenets of
certain physiological principles and laws
6.) THBO, is a therapy that physicians should be aware of and
not utilize
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systematic review of the effectiveness of interventions to enhance the healing of chronic
ulcers of the foot in diabetes . Diabet Metab Res Rev 2008 ; 24 ( Suppl 1): 119 – 144.
Whereas the systematic review of the International
Working Group that considered HBO accepted
that there was some evidence to support its use, it
is clear that more data are required from larger
controlled trials not only to confirm efficacy but
also to clarify which wounds might best benefit
from this expensive treatment
89.
90. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
91. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
92. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
93. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
94. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
95. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
96. Bollero D, et al. THE ROLE OF NEGATIVE PRESSURE WOUND THERAPY IN THE
SPECTRUM OF WOUND HEALING. Ostomy Wound Management. 2010;56(5 Suppl):1–18.
97. A number of growth factors and other agents
designed to modify abnormalities of the
biochemistry of the wound bed or surrounding
tissues have been described, but there is still no
consensus as their place in day - to - day
clinical practice. One example is platelet -
derived growth factor (PDGF) which is
available for clinical use in a number of
countries.
Jeffcoate WJ , Lipsky BA , Berendt AR , Cavanagh PR , Bus SA , Peters EJ , et al . Unresolved
issues in the management of ulcers of the foot in diabetes . Diabet Med 2008 ; 25 : 1380 – 1389 .
98. Whereas there is some support for their use for
randomized clinical studies, their expense
together with the fact that most neuropathic
ulcers can be healed with appropriate
offloading, have limited their use.
Unfortunately, PDGF together with other
topically applied agents such as epidermal
growth factor do not have sufficient robust
data to support their day - to - day use in
routine clinical practice.
Wieman TJ , Smiell JM , Yachin S . Efficacy and safety of a topical gel formulation of
recombinant human platelet - derived growth factor - BB (Becaplermin) in patients with chronic
neuropathic diabetic foot ulcers. Diabetes Care 1998 ; 21 : 822 – 827 .
99.
100. Similar to other treatments in this group of
adjunctive therapies although there is some
evidence to support the use of bioengineered
skin substitutes in non - infected neuropathic
ulcers, its use of somewhat restricted by cost. A
systematic review on this topic concluded that
the trials assessed were of questionable quality
and until high quality studies were performed,
recommendations for the use of these skin
substitutes could not be Made.
Blozik E , Scherer M . Skin replacement therapies for diabetic foot ulcers: systematic review
and meta - analysis . Diabetes Care 2008; 31 : 693 – 694 .