The applications of hyperbaric oxygen therapy in emergency medicine

Abstract

Hyperbaric oxygen therapy involves the administration of oxygen in an environment where the ambient pressure has been increased. The ensuing hyperoxia and the elevated pressure have a number of beneficial clinical effects. Many of the clinical indications for hyperbaric oxygen therapy (HBOT) involve emergent conditions. It is therefore important for emergency physicians to be familiar with the applications of HBOT. Emergency physicians have become well represented in hyperbaric medicine. Currently, emergency physicians comprise approximately 15% of the membership of the Undersea and Hyperbaric Medical Society (UHMS). Along with internal medicine and anesthesiology/critical care medicine, emergency medicine is among the most heavily represented specialities in the UHMS (UHMS personal communication, February 1991). This is not surprising, considering the variety of emergent conditions that can be treated with HBOT. and the general attributes of an emergency physician: a broad general background, the ability to resuscitate unstable patients, and 24-hour in-house availability. The UHMS recognized the important association between Emergency Medicine and Hyperbaric Medicine when they convened a symposium entitled “Hyperbaric Oxygen in Emergency Medical Care” in 1983.’ This will not be a comprehensive review of hyperbaric medicine. Outstanding reviews of diving medicine and clinical hyperbaric medicine6-9 already have been written. This review will examine the relevance of HBO therapy to emergency medicine. It is necessary, however, to preface this review with a brief discussion of the background, the basic physics, and the physiology of HBOT.