Patient instruction for Treatment with oxygen at high atmospheric pressures (Hyperbaric Oxygen Therapy HBOT) 1) Introduction
Hyperbaric oxygen therapy (HBOT) involves the intermittent inhalation of 100 per cent oxygen in chambers
pressurized above one atmosphere absolute. The treatment duration and number of sessions required depend on the reason for HBOT. Effectiveness of HBOT HBOT is safe and effective and according to the UHMS (Undersea and Hyperbaric Medical Society) and can be given for the following indications :
1. Air or gas embolism 2. Carbon monoxide poisoning 3. Carbon monoxide poisoning complicated by cyanide poisoning 4. Clostridal myositis and myonecrosis (gas gangrene) 5. Crush injury, compartment syndrome, and other acute traumatic ischemias 6. Decompression sickness 7. Enhancement of healing in selected problem wounds 8. Consequences of Diabetes such as diabetic foot, diabetic retinopathy, diabetic nephropathy 9. Exceptional blood loss (anemia) 10. Intracranial abscess 11. Necrotizing soft tissue infections (necrotizing fasciitis) 12. Osteomyelitis (refractory) 13. Delayed radiation injury (soft tissue and bony necrosis) 14. Skin grafts and flaps (compromised) 15. Thermal burns
Counteract the condition of hypoxia, resulting from various causes such as disorders of the lung or breathing,
blood loss, shock, inhalation of smoke in large quantities.
Also the toxic gas carbon monoxide. The effect on the contraction of blood vessels, is useful in the treatment of swelling of tissues caused by
trauma, swelling of the brain and various wounds, etc.
Enhanced white blood cell removal will improve reduction of bacterial infection. stimulate muscle cells to be able to heal wounds faster.
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Stimulate the creation of new capillaries, improving blood supply in gangrene from diabetes mellitus, arterial
stenosis, ulcers caused by chemotherapy and radiation.
Resistance to infection. Inhibit the growth of many types of germs, bacteria and fungi (Anaerobic organisms)
Stimulate stem cells in the bloodstream to help repair the injured tissue.
Duration of treatment Each treatment duration can vary from one to two hours, although most treatments are in excess of 90 minutes, for a variable number of sessions, depending on type of diseases and conditions. Safety and restrictions Patients treated with HBOT to adjust the air pressure. Existing balance in the body and some external conditions such as respiratory tract infections can cause sinus and ear pressure. Necessary check up before treatment with HBOT for patients with lung disease or lung injury to avoid get stuck, or out of the air bag. (Pneumothorax). Lung X-ray examination should be performed before HBOT treatment. 2) Alternatives 3) Risk, Contraindications and side effects of treatment with HBOT HBOT is a relatively safe method for approved medical treatments. Complications can be reduced if pressures within the hyperbaric chamber remain below three times the normal atmospheric pressure and sessions last no longer than 2 hours. Milder problems associated with HBOT include claustrophobia, fatigue, and headache. More serious complications include myopia (short-sightedness) that can last for weeks or months, sinus damage, ruptured middle ear, and lung damage. A complication called oxygen toxicity can result in seizures, fluid in the lungs, and even respiratory failure. Patients at high risk of oxygen toxicity may be given “air breaks” during which they breathe ordinary air rather than pure oxygen for short periods during treatment. People with severe congestive heart failure may have their symptoms worsened by HBOT. Patients with certain types of lung disease may be at higher risk of collapsed lung during HBOT. Pregnant women should be treated with HBOT only in serious situations where there are no other options. Hyperbaric oxygen chambers can also be a fire hazard: fires or explosions in hyperbaric chambers have caused about 80 deaths worldwide. PI-HBO-01 REV.0 (01/06/11) F/M-XXX-XXX-000 2/1 Hongyuk Utis Rd, Muang District, PHUKET,THAILAND 83000 Tel. 076-254425-30 Fax. 076- 254430 Contact Center Tel.1719 Pages 2/ 4
Contraindications The only absolute contraindication to hyperbaric oxygen therapy is untreated pneumothorax. Patients should not undergo HBO therapy if they are taking or have recently taken the following drugs: Doxorubicin (Adriamycin) – A chemotherapeutic drug. Cisplatin – Also a chemotherapeutic drug. Disulfiram (Antabuse) – Used in the treatment of alcoholism. Mafenide acetate (Sulfamylon) – Suppresses bacterial infections in burn wounds The following are relative contraindications -- meaning that special consideration must be made by specialist physicians before HBO treatments begin: Upper respiratory infections – These conditions can make it difficult for the patient to clear their ears, which can result in what is termed sinus squeeze. High fevers – In most cases the fever should be lowered before HBO treatment begins. Emphysema with CO2 retention – This condition can lead to pneumothorax during HBO treatment. History of thoracic (chest) surgery – This is rarely a problem and usually not considered a contraindication. However, there is concern that air may be trapped in lesions that were created by surgical scar ing. These conditions need to be evaluated prior to considering HBO therapy. Malignant disease: Cancers thrive in blood rich environments but may be suppressed by high oxygen levels. HBO treatment of individuals who have cancer presents a problem, since HBO both increases blood flow via angiogenesis and also raises oxygen levels. Taking an anti-angiogenic supplement may provide a solution. A study by Feldemier, et al. and recent NIH funded study on Stem Cells by Thom, et al., indicate that HBO is actually beneficial in producing stem/progenitor cells and the malignant process is not accelerated. Middle ear barotrauma (MEBT) is always a consideration in treating both children and adults in a hyperbaric environment, but most children currently being treated with HBOT are being pressurized to 1.3 ATA, which reduces the risks of side effects. Adverse effect of HBOT Symptoms of oxygen poisoning can occur when the atmospheric pressure is higher than 3 atmospheres. Patients can convulse similar to an epileptic seizure. It can be prevented by lowering atmospheric pressure to under 3 atmospheres. Injuries from high-pressure are rare. Common side effect of HBOT is deafness or sinus pain. PI-HBO-01 REV.0 (01/06/11) F/M-XXX-XXX-000 2/1 Hongyuk Utis Rd, Muang District, PHUKET,THAILAND 83000 Tel. 076-254425-30 Fax. 076- 254430 Contact Center Tel.1719 Pages 3/ 4
Qualified medical staff Studies have shown benefits of using HBOT, but it needs supervision by qualified medical staff and specialized nurses. 4) Before and after treatment Wounds should be cleaned and covered. Patients with colds, fever, fatigue, diar hea or other symptoms of allergies, and/or history of chest or lung abnormality should inform the medical staff before treatment. Dentures should be removed before the procedure. Should know how to adjust the pressure in the inner ear (Valsalva Maneuver). Do not smoke at least four hours prior before treatment. You can eat normally before coming to receive treatment, but avoid carbonated drinks or alcohol. Take medication as prescribed. (If you take medication such as Disulfiram (Antabuse), Doxorubicin (Adriamycin), Cis- Platinum and Mefenide Acetate (Sulfamylon) please inform the medical staff. Wear clothes provide by the hospital (clean cotton clothes). Do not wear any synthetic fabrics. In cases patients with Diabetes Mellitus, the sugar levels should be checked, and preferably be greater than 150 mg / dl. Limits are between 120 mg / dl and 300 mg / dl (depending on medical advice). Do not use powder, oil, cosmetics, perfume lotion, or any kind of spray containing oil or Vaseline. Do not wear stockings or socks, from nylon and a source of static electricity. Do not wear metal jewelry such as watches, glasses, contact lenses and hearing aids. Do not bring any fuel material that may cause fire. After the HBOT you should rest. You should not travel by plane within 72 hours after treatment. PI-HBO-01 REV.0 (01/06/11) F/M-XXX-XXX-000 2/1 Hongyuk Utis Rd, Muang District, PHUKET,THAILAND 83000 Tel. 076-254425-30 Fax. 076- 254430 Contact Center Tel.1719 Pages 4/ 4
Ley 191/1964, de 24 de diciembre, de asociacionesEs el derecho de asociación uno de los naturales del hombre que el positivo no puedemenoscabar y aun viene obligado a proteger, ya que al propio Estado interesa sumantenimiento y difusión como fenómeno social e instrumento de sus fines, forjados no sólopor la concurrencia de individuos, sino de asociaciones que necesariamente han de formarparte
Encuentro de la Defensa Pública Penal de la Provincia de Buenos Aires Mar del Plata, octubre de 2011 Datos: Eduardo Néstor Cirille. Defensor UFD-Descentralizada Saladillo-Departamento Judicial de La Plata. Area temática: penal Resumen: En el Código Procesal Penal se verifican inconsistencias normativas que afectan la sustentabilidad del sistema acusatorio. Se propicia superar