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This 5th Edition of Hyperbaric Medicine Practice, captained by Dr. Harry T. Whelan, is the most robust and monumental information source for undersea and hyperbaric medicine to date. Split into two volumes due to its size and detail, this 5th edition boasts six new chapters. With the help of 70 contributors from all over the world, Hyperbaric Medicine Practice has become the go-to authority for both studying and practicing hyperbaric medicine professionals.

HYPERBARIC MEDICINE & WOUND CARE TRAININGS
The 2025 January through March training courses are filling up quickly for wound care certification basic training, basic training in hyperbaric medicine, hyperbaric safety director training, and clinic business trainings. 

Join us for in-person training for:

Have you ever attended one of our Introduction to Hyperbaric Medicine courses? Last week we had the pleasure of learning from Dr. Michael White, MD, UHM, MMM, CWS who taught Day 2 of the 4-day program.

There are 3 chances left in 2024 to earn your CEU's with us, or complete your trainings in hyperbaric medicine, clinic business, and/or hyperbaric safety . . .

Have you ever attended one of our Introduction to Hyperbaric Medicine courses? Last week we had the pleasure of learning from Dr. Larry Chase, MD, UHM, CWSP who kicked off Day 1 of the 4-day program.

The Use of Drugs Under Pressure

A hyperbaric and hyperoxic environment creates numerous considerations for the use of drug therapies within it. First, the physical stress of hyperbaria impacts drug storage and has implications on which containers are most appropriate for use. Second, physiologic changes to the body from hyperbaria and hyperoxia may lead to pharmacokinetic changes in drug disposition. Lastly, hyperbaric oxygen acting as a drug can interact and enhance or ameliorate the physiologic effect of a drug.

Hyperbaric Facility Safety Creating the Contingency Plan

Analysis of hazards and risk assessment allows us to understand the true nature of the potential incident we are attempting to manage. This is an important first step in designing a contingency plan. There are several other important considerations that affect the design of the plan. Realizing the potential damage or injury helps us to identify appropriate staff responses. These responses should minimize the impact of the incident. It is important to consider what personnel are available to help (e.g., additional staff members, code team, and emergency responders) and how these individuals are capable of participating in the plan. Designing contingency plans with available personnel in mind drives minimum facility staffing decisions. It is also important to consider what equipment is available (e.g., personal protection, patient transportation, fire-fighting, and crash cart). All the considerations discussed above are likely to vary among different hyperbaric facilities.

Current knowledge indicates that there are multiple mechanisms of action of hyperbaric oxygen therapy in CO poisoning. Based on the law of mass action, elevated partial pressures of O2 will accelerate the rate of CO dissociation from hemoglobin. Thus, COHb half-life can be decreased from approximately 5 .5 hours when breathing air and to approximately 20 minutes when breathing O2 at 3 ATA. Indeed, this was the reasoning behind the first clinical implementation of hyperbaric oxygen therapy for CO poisoning. As the COHb level is not associated with clinical risk, it is hard to accept that a more rapid dissociation of CO from hemoglobin could be the central factor for the benefit of hyperbaric oxygen . A fraction of the acute mortality from CO is due to hypoxia, however, and prompt removal of CO from hemoglobin will be of benefit . HBO2 also promotes normalization of tissue hypoxia. CO binds to cytochrome oxidase, particularly when the COHb level exceeds 40% to 50% . Brown and Piantadosi demonstrated that hyperbaric oxygen at 3 ATA markedly accelerates the dissociation of CO from cytochrome oxidase. Furthermore, it was shown that HBO2 completely reversed brain mitochondrial electron transport chain inhibition by CO. Hyperbaric oxygen also has effects related to the cascade of vascular injury triggered by CO poisoning. Hyperbaric oxygen was found to be effective for preventing brain oxidative injury through increased heme oxygenase and upregulation of antioxidants. The mechanism appears to be associated with denaturation of a membrane-associated guanylate cyclase that plays a role in coordinating the elevated affinity of beta 2 integrins expressed on the cell surface. Given that vascular changes are prominent in clinical CO poisoning, it is feasible that neurological sequelae in patients may involve a perivascular injury mediated by leukocyte sequestration and activation. Moreover, HBO2 reduces neuronal apoptosis and necrosis, and it also mobilizes stem cells via a nitric oxide–dependent mechanism. Hence, timely administration of hyperbaric oxygen may ameliorate the cascade leading to brain injury via multiple mechanisms.