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Primary Hyperbaric Training

Training / Dates

Faculty

Palmetto Health Richland Educational Programs

Course Information and Registration

Accreditation Statements

Educational Programs

National Baromedical Services provides both Primary and Advanced hyperbaric medicine training programs. Courses are taught on the campus of Palmetto Health Richland/University of South Carolina School of Medicine, in Columbia, South Carolina.

Over the past two decades, we have evolved into the busiest such training center, with more than 6,000 course attendees. Approximately 400 physicians, nurses, technologists and other allied health care professionals visit Columbia each year, from throughout the United States and from overseas. Our courses are accredited by the:

  • American Council of Continuing Medical Education, via the Education Committee of the Undersea and Hyperbaric Medical Society
  • National Board of Diving and Hyperbaric Medical Technology
  • American Association of Respiratory Care
  • South Carolina Nurses Association

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Selected Curriculum Topics

Physical Aspects of Hyperbaric Medicine

The clinical utilization of alterations in atmospheric pressure dictate that the practitioner comprehend both the beneficial and potentially hazardous aspects of this esoteric environment. Applicable gas laws and their role in hyperbaric medicine will be reviewed.

Mechanisms of Action

Under increased atmosphere pressure, oxygen becomes a potent and dose dependent drug. Six beneficial effects have been identified: hyperoxygenation, vasoconstriction, superoxide radical formation, pressure/volume related effects, neovascularization and antagonism of leukocyte induced reperfusion injury. The scientific elucidation of these mechanisms and their clinical relevance are discussed.

Patient Care

Special emphasis will be placed upon the preparation of the patient for hyperbaric oxygen therapy. The typical emergent referral involves a patient who is incubated, ventilator dependent, with peripheral and central vascular access lines and the possibility of a chest tube. Each of these aspects, as they relate to relative patient isolation and alterations in atmospheric pressure, will be discussed and practiced. Risk factors for hyperbaric oxygen exposure will be clarified and the management of patient complications reviewed in detail.

Oxygen Toxicity

As a gaseous drug, large doses of oxygen can produce undesirable side effects and drug interactions. The central nervous system and lungs are two most commonly effected organs and their response to hyperbaric oxygen will be reviewed in depth. Special emphasis will be placed on the recognition and management of CNS oxygen toxicity.

Monoplace Chamber Operations

Through a cohesive series of clinical training sessions, the prospective hyperbaric team member will learn and participate in all aspects of the monoplace hyperbaric chamber delivery system.  Standard operational protocols will be augmented with ancillary equipment demonstrations and a detailed review of emergency procedures.

Contraindications and Side Effects

Pre-exposure evaluation of risk factors centers around the prevention of pulmonary barotrauma of ascent and the development of a central nervous system oxygen intolerance secondary to high inspired oxygen pressures. The risk-benefit ratio will be discussed, and in the context of the ull range of patient states.

Non-pulmonary Barotrauma

Boyle’s law dictates that the volume of a gas is inversely proportional to the pressure exerted upon it.  Specifically, the clinical ramifications of this simple principle as it relates to gas bearing anatomy will be discussed. The effects of pressure changes in the middle ear will be examined in detail, and the technical considerations of needle myringotomy will be detailed.

Carbon Monoxide Poisoning/Smoke Inhalation
-cyanide poisoning

Carbon monoxide is the most common cause of poisoning in the U.S. In its subtle form the diagnosis is easily missed. A new appreciation for the phenomenon of clinical relapse following conventional oxygen therapy and the potential for long term sequelae has reshaped our understanding of this toxic gas. Current concepts in the pathophysiology of the disease are explored and will include the role of hyperbaric oxygen therapy in pregnancy.

Decompression Sickness

This occupational disease of divers, aviators and tunnel workers is no longer limited in presentation to coastal regions and military institutions. Decompression sickness can result from exposure to any body of water deeper than 30 feet. With more divers flying to and from their dive sites, the potential for illness must be considered, regardless of geographic location. Differential diagnosis, on-site management, evacuation protocols and definitive therapy will be discussed, as will the capabilities of the monoplace chamber.

Cerebral Arterial Gas Embolism

A major life-threatening event, cerebral arterial gas embolization can occur during decompression (in divers and aviators), traumatically in penetrating chest injuries and, most commonly, in the clinical setting secondary to invasive diagnostic, monitoring,  or therapeutic procedures. Presentation, differential diagnosis and management guidelines will be reviewed.

Crush Injuries/Compartment Syndrome
— other acute ischemias

In an earlier report, it was found that when hyperbaric oxygen therapy was used to arrest the progression of a skeletal compartment syndrome, the cost of management was one-fourth that of surgically treated compartment syndromes. While not proposed in severe cases, the use of HBO in compartment syndrome in selected cases is based on its ability to down-regulate leukocyte eceptor sites, decrease tissue edema, hyperoxygenate tissue and overcome diffusion barriers. Evidence for its role in the management of crush injuries is reviewed in detail.

Gas Gangrene
(clostridial and nonclostridial)
— necrotizing soft tissue infections

Anaerobic infections are among the most challenging infectious disease problems. Optimum management in many instances mandates a combined therapeutic regimen using antibiotics and surgery in combination with hyperbaric oxygen. There is a growing body of evidence to indicate that HBO provides a number of benefits, which include detoxification of the patient, enhanced white cell activity,  a synergistic enhancement of selected antibiotics, and improved wound healing.

Acute Thermal Burns

The therapy of burns is directed a minimizing edema, preserving marginally viable tissue, enhancing host defenses and promoting wound closure. Adjunctive hyperbaric oxygen can attack all of these problems directly through a combination of mechanisms. Basic research, controlled clinical studies and cost impact will be reviewed.

Radiation Tissue Damage

It was the consensus of the 1990 National Cancer Institute Conference on Oral Complications of Cancer Therapies that HBO is a standard of care, in conjunction with surgery as indicated, for osteoradionecrosis of the mandible. Further, HBO was recommended in a prophylactic capacity prior to surgical procedures within the irradiated field, in high risk patients. Evidence of a benefit of HBO in soft tissue radiation injury will be included during this presentation.

Selected Problem Wounds; Diabetic Wound Healing
— preparation and preservation of skin grafts and flaps

While not indicated for the support of adequately perfused tissue, hyperbaric oxygen can play an important adjunctive role where hypoxia or decreased microcirculatory flow complicates wound healing. In the compromised host setting, HBO can restore a favorable cellular milieu in which the wound repair process and host antibiotic mechanisms are enhanced. The role of HBO in diabetic foot lesions will be emphasized.

Transcutaneous Oximetry

Drawing upon the orthopedic and vascular surgery literature, a number of indicators have served to both predict outcome from various procedures and determine the degree of severity in vascular disease. One particular aspect, tissue oxygen tension , as measured trancutaneously, has been introduced into the hyperbaric oxygen setting as a indicator of the ability to reverse local hypoxia. An algorithmic screening and case-management protocol will be introduced.

Case Presentations

Interesting clinical problems and case illustrations will be presented. Cases have been selected which will emphasize key management principles.

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Faculty

  • Dick Clarke, CHT, President, National Baromedical Services
  • D. Lindsie Cone, MD, Corporate Medical Director, NBS
  • Stacy Handley, BSN, ACHRN, CWCN, CHT Vice President, NBS
  • J. Jeffrey Brown, MD, FACS, General Surgery
  • Harold Friedman, MD, FACS, Plastic and Reconstructive Surgery
  • Thomas Norris, MD, FAAFP, Family and Geriatric Medicine
  • Gregory Grabowski, MD, Orthopedic Surgery
  • Solomon Wesley Ross, MD, Opthalmology
  • Tamar Wagner, RN, CHT, National Baromedical Services

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2012 Primary Training in Hyperbaric Medicine

  • May 7 - 11
  • June 11 - 15
  • August 13 - 17
  • October 15 - 19
  • December 3 - 7

2013 Primary Training in Hyperbaric Medicine

  • January 21 - 25
  • March 4 - 8
  • April 22-26
  • June 3 - 7
  • July 29 - August 2
  • September 9 - 13
  • October 21 - 25
  • December 9 - 13

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Accreditation Statements

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Undersea & Hyperbaric Medical Society (UHMS) and National Baromedical Services, Inc. The UHMS is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statements

Physicians:

  • 40 AMA PRA Category 1 Credits - The Undersea and Hyperbaric Medical Society designates this educational activity for a maximum of 40 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses:

  • 40 Contact Hours

    This continuing nursing education activity was approved by the South Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

    Approval valid through April 28, 2013.

Hyperbaric Technologists:

  • 40 Category A hours — National Board of Diving and Hyperbaric Medical Technology

Respiratory Therapists:

  • 40 Continuing Respiratory Care Education Credits — American Association for Respiratory Care

Full Disclosure Statement

All faculty members and planners participating in continuing medical education activities sponsored by National Baromedical Services, Inc. are expected to disclose to the participants any relevant financial relationships with commercial interests. Full disclosure of faculty and planner relevant financial relationships will be made at the activity.

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