Emergency Medicine

HYPERBARIC OXYGEN TREATMENT (HBOT) SERVICE

The Department of Emergency Medicine directs the UK Hospital HBOT Service. The treatment facility is located adjacent to the Emergency Department. Dr Charles Eckerline is the medical director and, along with the other Emergency Medicine faculty, supervises patient treatment. LaDawn Reynolds is the full-time hyperbaric technician and provides weekday scheduled patient treatments. Glenda Hale, Debbie Sublett, and Jerry Sherrow provide after-hours hyperbaric technician coverage for emergency treatments.

The HBOT service uses a Sechrist monoplace chamber capable of pressures to 3.0 ATA (atmospheres absolute or 66 psi). The chamber has the capability of cardiac rhythm monitoring, intravenous infusions, mechanical ventilation, and air breaks for patients undergoing treatment. The service provides scheduled treatments Monday through Friday, between 8:00 am and 4:00 pm. Emergency treatments are provided on an on-call basis. Currently, the program provides over 500 treatments per year.

The HBOT service follows the approved uses of hyperbaric treatment as developed by the Undersea and Hyperbaric Medical Society and the approved indications for hyperbaric treatment as established by Medicare. In these conditions, there is clinical evidence of benefit with HBOT. These conditions are:

1. Acute carbon monoxide intoxication
2. Decompression illness (dysbarism)
3. Air or gas embolism
4. Gas gangrene (clostridial myonecrosis)
5. Acute traumatic peripheral ischemia
6. Crush injuries and repair of severed limbs
7. Progressive necrotizing infections (necrotizing fasciitis)
8. Acute peripheral arterial insufficiency / exceptional blood loss
9. Treatment of compromised skin flaps and grafts
10. Chronic refractory osteomyelitis
11. Osteoradionecrosis
12. Enhancement of healing in selected problem wounds
13. Soft tissue radionecrosis
14. Radiation cystitis
15. Cyanide poisoning
16. Intracranial abcess

It is the policy of the UK Hospital HBOT service that only patients with an accepted or approved indication will be treated. Treatment of patients for other reasons will only be done using an IRB approved research protocol.

The majority of scheduled patients treated by the UK HBOT service have either osteoradionecrosis or soft tissue radionecrosis and typically undergo 30 to 40 treatments over 6 to 8 weeks. Emergency patients are generally severe carbon monoxide intoxication and undergo 1 to 2 treatments. Most treatments last 90 to 120 minutes and utilize pressures of 2.0 to 2.5 ATA.

Absolute contraindications to HBOT include:

1. Untreated pneumothorax
2. Recent doxorubicin administration (within one week)
3. Daily disulfiram treatment
4. Current cis-plantinum therapy
5. Current mafenide therapy

Relative contraindications to HBOT include:

1. Current sinusitis
2. Seizure disorder
3. Emphysema with CO2 retention
4. History of spontaneous pneumothorax
5. History of surgery for otosclerosis
6. History of optic neuritis

To refer a patient for potential HBOT:

1. Routine referral for scheduled outpatients: call the department office at 859-323-5908 and request a HBOT consultation.
2. Emergency referrals: call UKMDs at 859-257-6845 and ask for the Emergency Department Attending.