the joys of hbo
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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. - PowerPoint PPT PresentationTRANSCRIPT
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Comprehensive Healthcare Solutions
How I learned to love “PRESSURE”
The Joys of HBO
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Comprehensive Healthcare Solutions
“HAPPY” Patients
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Comprehensive Healthcare Solutions
Unhappy Patients
Barotrauma (squeeze)Otic (ear)Pulmonary (lung)GI (colon)Dental (tooth)Sinus
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Sighing is a marker for stress
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Comprehensive Healthcare Solutions
Boyle’s Law
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Comprehensive Healthcare Solutions
Pressure-Volume Relationship
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Is Boyle’s Law an issue for every pressure vessel?
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Delta Sub
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Unhappy Patients
Barotrauma (squeeze)Ear (most common)Pulmonary (most serious)GI (colon)Dental (tooth)Sinus
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Pulmonary Barotrauma
Tissue damage
Emphysema
Pneumothorax
Air embolism
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Lung Anatomy
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Mediastinal Shift
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Tension Pneumothorax
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DiagnosisChest pain ↑Blood Pressure ↓Respiratory Rate ↑Breath sounds ↓Bell Tympany ←Hyper-resonance ←Tracheal shift →
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Chest Tube
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Questions?
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The Ear
Under Pressure
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Why Talk About Ears Most frequent pressurerelated injuryPoor understanding ofequalization techniquesEar damage (Barotrauma) is…
*PREVENTABLE*
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Comprehensive Healthcare Solutions
Pressure-Volume Relationship
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Ear at Sea Level
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Ear at 2.6 FSW
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Locked Ear at 3.9 FSW
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Forceful Valsalva
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The Present Strategy
How do we most often judge middle ear equalization ability?
Test of pressure???
Patient query???
“Reactive” instead of “Proactive”
I HOPENOT!
}
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Objectives
Recognize “Ear Fear”
Assess pressurization effortwith “Doc’s Technique”
Become proficient in 3 methodsof Middle Ear pressurization
Learn PROACTIVE intervention
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Comprehensive Healthcare Solutions
What is “Ear Fear”?
Pressure is uncomfortable
Childhood pain -> adult fear
Retrograde tear duct inflation
Confusion over instructions
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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”
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Otoscopy
Identify landmarks
Check mobility of the TM
Verify TM bulge withpresssurization of the middle ear
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Normal Ear
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Pneumatic Otoscopy
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Bony Exostosis
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Hemotympamum
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Video Otoscopy
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Pressurization Techniques
Valsalva Maneuver (1704)
Frenzel Maneuver (1932)
Lowry Technique (1950s)Combination maneuverPressurize and swallow
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Antonio Valsalva Pinch nostrils closed
Increase pressure in chest
Cheeks tight, not puffed out
Should not be a prolonged effortengorgement – venous returnnever on ascent!
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Herman Frenzel “Luftwaffe”
“The Throat Piston”
Close vocal cords
Pinch nostrils closed
Raise the back third of tongue
Feel “Adams Apple” elevate
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Advantages
Does not adversely effect blood flow
Independent of respirations
Can be performed with mouth open
Easy to teach and practice
“Bobbing Adams Apple”
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Teaching TechniquesBazooka vs Otovent
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So Many MethodsSo Little Time
Pressurization methods work best“Eustachian Tube Awareness”Combination methods work wellbut are harder to learnPerform effective technique“Early and Often”
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How Hard to BlowNever “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
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Doc’s Motto:
Never give up…there is always a way
In extreme cases consider PE tubes
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Summary
Watch out for “Ear Fear” and the “Excessive Effort” signWatch the nose for proper inflationBob your Adams AppleVerify ME pressurization prior to treatment by watching the TM bulge
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Where to get more information
Doc’s Diving Medicine Homepage
“divingdoc.com”