HBOT Safety/Review Questions #6
You are treating a female spayed canine with marked azotemia and pyelonephritis. Urine culture by cystocentesis has revealed an organism susceptible only to gentamycin, which is being given IV.
You want to support GFR at all times. You are employing adjuvant HBOT, so you have the patient on intravenous fluids during her sessions. The patient was initially very depressed and moved about very little during her sessions.
She has progressively become much brighter and more active . Today during her HBOT session she was moving about her module, and she pulled her IV extension off where it inserts into the inside of the "pass through port" on the chamber door. The IV set on the outside of the door pops off, and oxygen begins escaping through the IV " pass through port" on the door.
Is this an emergency situation?
What actions should you take?
ANSWER: This is not an emergency situation. You should first insert a sterile catheter plug into the IV "pass through port" on the chamber door, and thus stop the flow of oxygen out of the chamber. (See image.)
You may then consult with the attending doctor and ask if it is appropriate to gradually end this HBOT session with a standard, slow decompresion over 10-15 minutes, then flush and reconnect the intravenous line connections and begin a new, abbreviated session to make up for the time remaining in the shortened session; or the doctor may decide to simply end this particular session and wait until the next scheduled HBOT session for this individual patient.
Elevation of the pO2 of ischemic tissue (by adjuvant HBOT) optimizes the antimicrobial activity of aminoglycosides such as gentamycin by facilitating transport of the drug through the cell membranes of bacteria (Reference , Kindwall and Whelan, Hyperbaric Medical Practice, Best Publishing, Second Edition Revised, 2004, page 224).
Which of the following drugs may increase the potential for oxygen toxicity induced seizures in the hyperbaric chamber?
enrofloxacin
penicillin
furosemide
prednisolone
ANSWER: 4. prednisone
Glucocorticoids such as prednisolone, prednisone, dexamethasone, triamcinolone, depomedrol, or methylprednisone may hasten the onset or increase the potential for oxygen induced seizures. Eleations in adrenocortical hormones in naturally occurring hyperadrenocorticism also decrease oxygen tolerance (Reference Kindwall and Whelan, Hyperbaric Medicine Practice, 2004, Best, page 76, and Jain, KK, Textbook of Hyperbaric Medicine, 5th Edition, Hogrefe, page 52).