Hyperbaric oxygen therapy (HBOT) is usually very well tolerated. The clear acrylic wall of the chamber allows the patient to see around the room, reducing the sensation of claustrophobia. Most chambers are fitted with speakers so that patients can listen to music or watch their favorite movie or TV show. From time to time, it does, however, become necessary to ascend your patient prior to completion of their dive.
Some common situations where you may want to consider terminating your patient’s dive include:
· Claustrophobia/confinement anxiety: gentle reassurance and a calming voice on the intercom can often assuage a patient’s anxiety. Pre-dive anti-anxiolytics may help, including agents such as benzodiazepines. Never force a patient to stay at depth if they request to come up.
· Inability to clear the ears: Avoid barotrauma. Gently “bouncing the patient” (slowly descending, ascending, descending) and using safe clearing techniques may alleviate the issue. Never force the dive. Pre-dive decongestants may be helpful. Pressure-equalization tubes are occasionally inserted by an ear, nose, and throat specialist if the indication for HBOT is urgent
· Hypoglycemia: most wound care centers do not use in-chamber glucose monitoring. If your patient is diabetic and informs you that he or she feels lightheaded, dizzy, shaky, or has tingling, you may decide to bring the patient up. Pre- and post-dive blood glucoses should always be performed and patterns analyzed. Blood glucoses may tend to drop after the initial several dives. Patients can be given glucose tablets to bring in the chamber with them.
· Any symptom concerning for a serious cardiopulmonary issue: shortness of breath, chest pain, palpitations
· Need to void: even with a pre-dive trip to the bathroom, patients on diuretics or with gastrointestinal distress may need to ascend. Urinals and incontinence briefs can be alternatives to avoid frequent dive terminations. Always ensure that anything sent into the chamber with the patient is approved by your hyperbaric safety director.
Patient comfort and safety should always be a priority during HBOT treatments. Pre- and post- dive checklists and good communication between the patient and the technician, and the technician and the physician (or supervising healthcare provider) are key to helping the dive go smoothly.