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The Joys of HBO

The Joys of HBO. How I learned to love “PRESSURE”. “HAPPY” Patients. Unhappy Patients. Barotrauma (squeeze) Otic (ear) Pulmonary (lung) GI (colon) Dental (tooth) Sinus. Sighing is a marker for stress. Boyle’s Law. Pressure-Volume Relationship.

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The Joys of HBO

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  1. The Joys of HBO How I learned to love “PRESSURE” Comprehensive Healthcare Solutions

  2. “HAPPY” Patients Comprehensive Healthcare Solutions

  3. Unhappy Patients • Barotrauma (squeeze) • Otic (ear) • Pulmonary (lung) • GI (colon) • Dental (tooth) • Sinus Comprehensive Healthcare Solutions

  4. Sighing is a marker for stress Comprehensive Healthcare Solutions

  5. Boyle’s Law Comprehensive Healthcare Solutions

  6. Pressure-Volume Relationship Comprehensive Healthcare Solutions

  7. Is Boyle’s Law an issue for every pressure vessel? Comprehensive Healthcare Solutions

  8. Delta Sub Comprehensive Healthcare Solutions

  9. Unhappy Patients • Barotrauma (squeeze) • Ear (most common) • Pulmonary (most serious) • GI (colon) • Dental (tooth) • Sinus Comprehensive Healthcare Solutions

  10. Pulmonary Barotrauma • Tissue damage • Emphysema • Pneumothorax • Air embolism Comprehensive Healthcare Solutions

  11. Lung Anatomy Comprehensive Healthcare Solutions

  12. Mediastinal Shift Comprehensive Healthcare Solutions

  13. Tension Pneumothorax Comprehensive Healthcare Solutions

  14. Diagnosis • Chest pain ↑ • Blood Pressure ↓ • Respiratory Rate ↑ • Breath sounds ↓ • Bell Tympany ← • Hyper-resonance ← • Tracheal shift → Comprehensive Healthcare Solutions

  15. Chest Tube Comprehensive Healthcare Solutions

  16. Questions? Comprehensive Healthcare Solutions

  17. The Ear Under Pressure Comprehensive Healthcare Solutions

  18. Why Talk About Ears • Most frequent pressurerelated injury • Poor understanding ofequalization techniques • Ear damage (Barotrauma) is… *PREVENTABLE* Comprehensive Healthcare Solutions

  19. Pressure-Volume Relationship Comprehensive Healthcare Solutions

  20. Ear at Sea Level Comprehensive Healthcare Solutions

  21. Ear at 2.6 FSW Comprehensive Healthcare Solutions

  22. Locked Ear at 3.9 FSW Comprehensive Healthcare Solutions

  23. Forceful Valsalva Comprehensive Healthcare Solutions

  24. I HOPENOT! } The Present Strategy • How do we most often judge middle ear equalization ability? Test of pressure??? Patient query??? • “Reactive” instead of “Proactive” Comprehensive Healthcare Solutions

  25. Objectives • Recognize “Ear Fear” • Assess pressurization effortwith “Doc’s Technique” • Become proficient in 3 methodsof Middle Ear pressurization • Learn PROACTIVE intervention Comprehensive Healthcare Solutions

  26. What is “Ear Fear”? • Pressure is uncomfortable • Childhood pain -> adult fear • Retrograde tear duct inflation • Confusion over instructions Comprehensive Healthcare Solutions

  27. Assessing Equalization Effort • The Doc’s Technique: • Watch The Nose Inflate! • Palpate firmness of inflationand compare it to your own equalization effort • Watch for “Excessive Effort” Comprehensive Healthcare Solutions

  28. Otoscopy • Identify landmarks • Check mobility of the TM • Verify TM bulge withpresssurization of the middle ear Comprehensive Healthcare Solutions

  29. Normal Ear Comprehensive Healthcare Solutions

  30. Pneumatic Otoscopy Weird! Comprehensive Healthcare Solutions

  31. Bony Exostosis Comprehensive Healthcare Solutions

  32. Hemotympamum Comprehensive Healthcare Solutions

  33. Video Otoscopy Comprehensive Healthcare Solutions

  34. Pressurization Techniques • Valsalva Maneuver (1704) • Frenzel Maneuver (1932) • Lowry Technique (1950s) • Combination maneuver • Pressurize and swallow Comprehensive Healthcare Solutions

  35. Antonio Valsalva • Pinch nostrils closed • Increase pressure in chest • Cheeks tight, not puffed out • Should not be a prolonged effort • engorgement – venous return • never on ascent! Comprehensive Healthcare Solutions

  36. Herman Frenzel “Luftwaffe” • “The Throat Piston” • Close vocal cords • Pinch nostrils closed • Raise the back third of tongue • Feel “Adams Apple” elevate Comprehensive Healthcare Solutions

  37. Advantages • Does not adversely effect blood flow • Independent of respirations • Can be performed with mouth open • Easy to teach and practice “Bobbing Adams Apple” Comprehensive Healthcare Solutions

  38. Teaching TechniquesBazooka vs Otovent Comprehensive Healthcare Solutions

  39. So Many MethodsSo Little Time • Pressurization methods work best • “Eustachian Tube Awareness” • Combination methods work wellbut are harder to learn • Perform effective technique“Early and Often” Comprehensive Healthcare Solutions

  40. How Hard to Blow • Never “forceful” - just “ADEQUIT” • Never blow hard to relieve ear squeeze. Pressurization is a preventive maneuver • Never perform a Valsalva on ascent. Use swallow, yawn or jaw thrust Comprehensive Healthcare Solutions

  41. Doc’s Motto:Never give up…there is always a way In extreme cases consider PE tubes Comprehensive Healthcare Solutions

  42. Summary • Watch out for “Ear Fear” and the “Excessive Effort” sign • Watch the nose for proper inflation • Bob your Adams Apple • Verify ME pressurization prior to treatment by watching the TM bulge Comprehensive Healthcare Solutions

  43. Where to get more information • Doc’s Diving Medicine Homepage “divingdoc.com” Comprehensive Healthcare Solutions

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