Hyperbaric nursing

Hyperbaric nursing is a nursing specialty involved in the care of patients receiving hyperbaric oxygen therapy. The National Board of Diving and Hyperbaric Medical Technology offers certification in hyperbaric nursing as a Certified Hyperbaric Registered Nurse (CHRN).^[1] The professional nursing organization for hyperbaric nursing is the Baromedical Nurses Association.^[2][3]

Hyperbaric nurses are responsible for administering hyperbaric oxygen therapy to patients and supervising them throughout the treatment. These nurses must work under a supervising physician trained in hyperbarics who is available during the treatment in case of emergency. Hyperbaric nurses either join the patient inside the multiplace hyperbaric oxygen chamber or operate the machine from outside of the monoplace hyperbaric oxygen chamber, monitoring for adverse reactions to the treatment.^[4] Patients can experience adverse reactions to the hyperbaric oxygen therapy such as oxygen toxicity, hypoglycemia, anxiety, otic barotrauma, or pneumothorax.^[4][5][6] The nurse must know how to handle each adverse event appropriately.^[5] The most common adverse effect is otic barotrauma, trauma to the inner ear due to pressure not being released on descent.^[4] Since hyperbaric oxygen therapy is usually administered daily for a set number of treatments, adverse effects must be prevented in order for the patient to receive all prescribed treatments.^[4] The hyperbaric nurse will collaborate with the patient's physician to determine if hyperbaric oxygen therapy is the right treatment. The nurse must know all approved indications that warrant hyperbaric oxygen therapy treatments, along with contraindications to the treatment.^[4]

History

The use of hyperbaric medical therapy was first documented back in 1662 when a British physician came up with the "domicilium," which was a pressurized airtight chamber operated with bellows to increase pressure. This innovative approach actually came before some fundamental discoveries in gas physics, such as Boyle's Law and the discovery of oxygen. Moving into the late 19th century, researchers like Paul Bert and J Lorrain Smith started diving into the physiological effects of pressurized air, which eventually led to the establishment of the principles of hyperbaric medicine. There were some significant advancements that followed, including Fontaine's creation of the first mobile hyperbaric operating theater in 1877, as well as Dr. JL Corning's pioneering work on hyperbaric chambers and treatment feasibility in the late 19th and early 20th centuries. World War II brought about further developments, especially in treating decompression sickness among Navy divers, with the introduction of pressurized oxygen therapy in the 1930s by Behnke and Shaw. And let's not forget the groundbreaking studies, like Dr. Ite Boerema's "Life Without Blood" in 1959, which really showcased the potential of hyperbaric oxygen therapy in sustaining life, paving the way for ongoing research and application in modern medicine.

Physics

In hyperbaric nursing, it's crucial to grasp the physics of light, sound, buoyancy, and thermal dynamics to ensure that patients receive safe and effective care. When underwater, light gets weaker as it's absorbed and scattered, giving that familiar blue tinge in underwater settings. Meanwhile, refraction can play tricks on our eyes, altering how we perceive size and distance. Hearing where sounds are coming from can be tricky due to the faster speed of sound in water and how it fades, making communication and situational awareness more challenging. Buoyancy, following Archimedes' principle, determines whether something floats, sinks, or stays neutral underwater, and factors like density affect the balance. When it comes to temperature, wearing wetsuits or drysuits is crucial for preventing divers from getting dangerously cold, especially on deep or chilly dives, where they might need protective gear and warmed breathing gas to avoid losing heat. Understanding these physical principles helps hyperbaric nurses prioritize patient safety and comfort in underwater settings.

Function

Hyperbaric oxygen therapy (HBOT) involves breathing in pure oxygen at increased air pressure, typically between 2 and 3 times higher than normal. For some conditions, even higher pressures may be needed. Scientists have studied HBOT extensively, using principles from gas laws to understand how it works. It's crucial to have a good grasp of the 14 approved conditions for hyperbaric medical therapy because HBOT has a wide range of medical uses. These conditions cover everything from decompression sickness and carbon monoxide poisoning to thermal burns and necrotizing fasciitis. HBOT works in several ways to provide therapeutic effects. First off, it shrinks gas bubbles in the blood and helps dissolve gas, which is crucial for conditions like decompression sickness and air embolism. Breathing 100% oxygen under pressure also helps create favorable gradients, making it easier to get rid of unwanted gasses and allowing oxygen to reach tissues with low oxygen levels. This is important for treating conditions such as carbon monoxide poisoning and ischemic injuries. Moreover, HBOT boosts the blood's ability to carry oxygen by increasing the concentration of oxygen in the plasma, ensuring that tissues receive more oxygen than they would through normal blood flow. This multi-pronged approach highlights how effective HBOT is in treating a wide range of medical conditions by using the basic principles of gas physics.

Areas of Focus

So, hyperbaric oxygen therapy (HBOT) and diving are pretty common all over, but they do come with some risks. One common issue is middle ear barotrauma (MEBT), which happens when the gas volume changes, following Boyle’s law. It might need techniques to equalize pressure or adjustments in treatment depth. Dental implants can become less stable with repeated exposure to hyperbaric environments. If someone has untreated pneumothorax, they shouldn't do HBOT because of the risk of tension pneumothorax during decompression. Oxygen toxicity can happen when there's too much oxygen pressure, so it's important to manage it carefully, like by reducing oxygen exposure or changing the treatment depth. And, of course, it's super important to take precautions against chamber explosions, like making sure there are no combustible materials around and that patients follow safety protocols, including removing makeup and preventing static discharge.

References

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