Overview of Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
When a limb gets injured, it can cause a condition known as acute traumatic peripheral ischemia. This happens when the tissues in the injured area don’t get enough oxygen due to swelling (also known as edema). The injury can vary from minor to severe and may involve damage to major blood vessels and nerves. In severe cases, amputation may be necessary. Sometimes, the blood vessels need to be repaired and reattached for the limb to heal properly.
This injury can be caused by events such as physical crush injury or burn. Apart from affecting the blood vessels, the tissue damage can also result in more swelling, which in turn means less oxygen supply to the tissues, causing even more swelling. This can start a harmful cycle that can lead to a condition called compartment syndrome. Compartment syndrome tends to affect areas in the muscles that can’t stretch well to accommodate the swelling, and it’s a medical emergency that requires surgery to save the limb. Certain types of severe injuries called “threatened flaps” are also a type of acute traumatic peripheral ischemia, in which a treatment called hyperbaric oxygen has been noted to improve the oxygen supply.
However, surgery and hyperbaric oxygen therapy should not be viewed as rival treatments but as complementary. They can be used together to give the patient the best chance of recovery. In fact, using hyperbaric oxygen therapy to treat acute traumatic peripheral ischemia is an approved method by the Undersea and Hyperbaric Medical Society and the Centers for Medicare and Medicaid Services. These organizations recommend that in cases of severe injuries like crush injuries where limbs might have been severed and surgically reattached, doctors can supplement traditional treatments with hyperbaric oxygen therapy, especially when the patient’s limb function or even life are at risk.
Anatomy and Physiology of Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
When a limb suffers a sudden injury, it often disrupts the blood vessels, causing bleeding into surrounding tissues. As clots start to form and blood flow stagnates, the affected cells aren’t able to receive enough oxygen or meet their usual energy needs. This can result in a troublesome accumulation of fluid inside these cells. This excess fluid, or “edema”, can increase pressure in the area, disrupt oxygen flow even more, and cause more cells to die.
Once blood starts flowing to the area again, more damage can actually occur. This is because the inner layer of the blood vessels may be harmed, causing more fluid to leak out and create edema. This is also matched with a restricted blood flow due to white blood cells (neutrophils) sticking to the damaged vessel wall.
Hyperbaric oxygen therapy can be very helpful in resolving these issues. This treatment works by reducing blood flow by about 20% to the injured area, which sounds counterintuitive but it actually lessens the fluid accumulation. Even with reduced blood flow, the oxygen amount in the remaining blood is greatly increased, resulting in more oxygen overall being delivered to the affected tissue. The overall effect is a decrease in edema and better oxygen supply. In addition, hyperbaric oxygen therapy also reduces the stickiness of neutrophils to the damaged blood vessels, which aids in reducing further injury when blood flow is reestablished.
Why do People Need Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
In emergency situations, such as severe injuries needing repair of blood vessels or fixing broken bones, immediate surgical care is a priority. Only after these urgent measures, doctors might recommend a treatment known as hyperbaric oxygen therapy. This involves breathing pure oxygen in a pressurized room or tube. This type of therapy can be particularly useful in less urgent situations as it helps the surgeon distinguish between healthy and damaged tissue. This can help minimize the amount of tissue that needs to be removed and reduce the chances of needing an amputation.
But not everyone needs hyperbaric oxygen therapy. The decision to use this treatment, and how often it’s used, depends on many factors. These include the type of injury, how severe the injury is, and also the overall health of the patient. Doctors usually consider things like the patient’s age, whether they smoke, the use of certain medications like steroids, ability to walk, and their heart and kidney health when making this decision.
For consistency and better decision-making, doctors often use established systems like the Gustillo system, which grades the severity of bone injuries. The addition of a grading system for the patient’s overall health condition, can help tailor the treatment to each individual patient.
Another crucial aspect of patient care is reviewing the effectiveness of the hyperbaric oxygen treatments once a certain number have been performed. This helps doctors adjust the treatment plan if needed. This review is typically done by both the surgery team and the team responsible for the hyperbaric treatment.
When a Person Should Avoid Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
In simple terms, acute traumatic peripheral ischemia is a severe condition where blood flow to the limbs is blocked due to a severe injury. Hyperbaric oxygen therapy, which involves breathing in pure oxygen in a pressurized room or tube, can help treat this. However, if giving this treatment would delay emergency surgeries like reopening the blocked blood vessels (revascularization) or a procedure to relieve pressure on muscles (established compartment syndrome), it should not be used. Similarly, if the patient has a severe condition like tension pneumothorax, where air gets into the space between the lung and the chest wall causing the lung to collapse, then hyperbaric oxygen therapy should also not be used.
Equipment used for Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
Hyperbaric oxygenation is a medical treatment where you breathe in pure oxygen in a pressurized room or tube. This treatment has several benefits for the body. There are two types of devices that can help you receive this treatment: mono-place chambers and multi-place chambers.
A mono-place chamber is a clear, tube-shaped device that can hold one person at a time. It’s made from transparent acrylic with a metal door at one end for you to enter and exit. Inside this chamber, pure oxygen is used to increase the pressure while you breathe in the oxygen around you. Some mono-place chambers also have a special mask that provides air during specific instances called ‘air breaks’. Not only that, but these chambers can also be equipped with devices like ventilators, infusion pumps, and monitors to provide high-quality care. They are usually small enough to fit into a standard hospital room and can connect directly to the hospital’s oxygen and air supply.
On the other hand, multi-place chambers are made from steel with small acrylic windows. They are large enough to accommodate anywhere from two to over twenty people at a time. Inside the multi-place chamber, air is used to create the pressure while you breathe in oxygen via a well-fitted mask or a special hood that seals around your neck. If needed, these chambers also allow you to breathe in the air inside the chamber during air breaks. These chambers tend to be much larger, often part of big facilities equipped with large air and oxygen storage tanks.
Both types of chambers need to be built and set up according to specific safety guidelines. In the U.S, these guidelines are provided by the NFPA 99 (National Fire Protection Association). It’s also recommended that facilities offering hyperbaric oxygen treatments are accredited by professional organizations like the Undersea and Hyperbaric Medical Society.
During the treatment, a device called a transcutaneous oximeter may be used. This device measures the amount of oxygen in your tissues when you’re breathing normal room air, and also during the hyperbaric treatment. Research shows that if the level of oxygen in your tissues exceeds 200 mm Hg (millimeters of mercury) during treatment, there is a strong chance (88%) that the therapy will help you heal.
Who is needed to perform Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment?
In single-person hyperbaric chambers, there needs to be one specially trained worker outside who runs and watches over up to two hyperbaric treatments at the same time. This worker must always be present outside the chambers whilst they’re in use. For larger chambers that can fit more than one person, you need trained workers both inside and outside. Workers inside the chamber breathe the same air like the one inside the chamber and this can put them at risk of decompression sickness, which is a condition that can occur in scuba divers when they come up too quickly.
Precautions and procedures should be in place to reduce this risk. An operator outside the chamber controls the pressure and keeps constant communication with the person inside.
There should be a safety director whose job is to make sure everything runs smoothly and safely in the hyperbaric facility. A doctor with training in hyperbaric medicine gives and supervises the pressure, time, and type of gas used during the treatments. This doctor also checks on the patients before and after their treatments. There are also trained healthcare workers specializing in hyperbaric medicine who help to take care of any wounds, give patients any needed medication, and teach them about the process.
Preparing for Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
To reduce the risk of fire in a hyperbaric (high-pressure) environment, certain safety measures must be taken. People inside such environments must wear cotton-blend clothes. They should also avoid anything oily and alcohol, and they absolutely cannot bring anything that could start a fire. On rare occasions, when a patient has trouble balancing the pressure in their ears during pressure changes, they may need to have small tubes called myringotomy tubes placed in their ears.
Based on the nature of the patient’s injury, some preparations may be needed before entering the hyperbaric chamber, like changing bandages or cleaning the wound. If the patient needs to be monitored during the treatment, special sensors will be connected through safe connectors in the chamber’s walls. Medicines or infusions, if required, must be prepared with special equipment. It’s critical for the main surgical team and the team that oversees the hyperbaric treatment to maintain good communication to ensure the patient’s safety and treatment effectiveness.
How is Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment performed
A specialist in hyperbaric medicine will advise on how long a patient needs to be treated, what pressure should be used, and what type of breathing gas will be administered. They will also organize the timeline for the treatment, especially when multiple patients are being scheduled simultaneously. For a common condition like sudden reduced blood flow to the limbs, the treatment usually involves applying pressure equivalent to 2 atmospheres for 2 hours or 2.4 atmospheres for 90 minutes.
The treatment timeline (referred to as ‘treatments table’) varies depending on the type of injury. For example, if we want to prevent damage caused by sudden return of blood supply to tissues, a single treatment session might be enough. Severe injuries like crush injuries might require a more intensive approach, with up to 8 treatment sessions over several days. This could look like three times a day for two days, twice a day for another two days, and once a day for the next two days.
If the patient is at risk of developing ‘compartment syndrome’ a condition where pressure within the muscles builds up to dangerous levels, three treatment sessions are recommended. Two treatment sessions on the first day, and one on the subsequent day. Explicitly any established compartment syndrome will need a surgical procedure called a fasciotomy to relieve the pressure. However, hyperbaric oxygen therapy can still play an important role after surgery, particularly in dealing with residual problems such as inadequate tissue oxygenation, substantial swelling, or nerve damage. In this case, the patient might receive treatment twice a day for up to a week.
Possible Complications of Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment
Hyperbaric oxygen treatment is generally easy to tolerate. However, some patients may struggle to adjust their ear pressure during the process, which can cause discomfort or damage to the ears. This is usually addressed with nose sprays for congestion, but rarely, a doctor specializing in ear, nose, and throat issues might have to place small tubes in the ears to help.
Lung injury from this treatment is very uncommon, but if a patient starts to feel chest pain when they are in the process of coming to normal pressure level, it might indicate possible slight lung damage. Side effects related to too much oxygen in the lungs and brain usually don’t happen because of the short length of time this type of treatment is given for severe injuries with poor blood flow. But, it’s still possible.
What Else Should I Know About Acute Traumatic Ischemia Hyperbaric Evaluation and Treatment?
Acute traumatic peripheral ischemia is a severe condition where the blood flow to your limbs is suddenly blocked, often by an injury, causing severe damage or even loss of the limb. This scenario can negatively impact both physical functionality and overall quality of life. Moreover, the cost of treating an amputation, including rehabilitation, and loss of work productivity can outweigh the cost of saving and reconstructing the limb.
Hyperbaric oxygen therapy, a treatment that involves breathing pure oxygen in a pressurized room or tube, can help in this regard. This therapy helps interrupt the damaging cycle of swelling, limited blood supply, and low oxygen levels in the tissues, caused by the blockage, and can also reduce the harmful effects of an injury that’s followed by the restoration of blood flow. However, this treatment method isn’t commonly thought of as a quick response treatment but is mostly remembered for reducing the severity of late complications following the initial injury. Therefore, it’s important to note that the early application of hyperbaric oxygen therapy can help prevent substantial tissue loss, which would otherwise occur due to delayed treatment. It’s also worth noting that the cost of this therapy adds only about 10% to the overall cost of limb salvage and reconstruction.