Hyperbaric nurses are responsible for administering hyperbaric oxygen therapy to patients and supervising them throughout the treatment. These nurses must work under a supervising physician trained in hyperbarics who is available during the treatment in case of emergency. Hyperbaric nurses either join the patient inside the multiplace hyperbaric oxygen chamber or operate the machine from outside of the monoplace hyperbaric oxygen chamber, monitoring for adverse reactions to the treatment.[4] Patients can experience adverse reactions to the hyperbaric oxygen therapy such as oxygen toxicity, hypoglycemia, anxiety, barotrauma, or pneumothorax.[4][5][6] The nurse must know how to handle each adverse event appropriately.[5] The most common adverse effect is otic barotrauma, trauma to the inner ear due to pressure not being released on descent.[4] Since hyperbaric oxygentherapy is usually administered daily for a set number of treatments, adverse effects must be prevented in order for the patient to receive all prescribed treatments.[4] The hyperbaric nurse will collaborate with the patient's physician to determine if hyperbaric oxygen therapy is the right treatment. The nurse must know all approved indications that warrant hyperbaric oxygen therapy treatments, along with contraindications to the treatment.[4]
The use of hyperbaric medical therapy was first documented back in 1662 when a British physician named Henshaw [7] came up with "domicilium," [8]a pressurized airtight chamber operated with bellows to increase pressure. This innovative approach came before a few fundamental discoveries in gas physics, such as Boyle's Law and the discovery of oxygen. In the late 19th century, researchers like Paul Bert and J Lorrain Smith [7] started diving into the physiological effects of pressurized air, which eventually led to the establishment of the principles of hyperbaric medicine. Some significant advancements then followed, including Fontaine's creation of the first mobile hyperbaric operating theater in 1877, as well as Dr. JL Corning's pioneering work on hyperbaric chambers and treatment feasibility in the late 19th and early 20th centuries.
World War II brought about further developments, for example treating decompression sickness among Navy divers, with the introduction of pressurized oxygen therapy in the 1930s by Behnke and Shaw. Dr. Ite Boerema's groundbreaking study "Life Without Blood" in 1959 showcased the potential of hyperbaric oxygen therapy in sustaining life, paving the way for ongoing research and application in modern medicine.[8]
In hyperbaric nursing, it is important for nurses to grasp the physics of light, sound, buoyancy, and thermal dynamics to ensure that patients receive safe and effective care. When underwater, light gets weaker as it is absorbed and scattered, giving a blue tinge in underwater settings. Refraction can trick one's eyes, altering how one perceives size and distance. Hearing where sounds are coming from is trickier due to the faster speed of sound in water and its fading, making communication and situational awareness more challenging. Buoyancy, following Archimedes' principle, determines whether something floats, sinks, or stays neutral underwater, and factors like density affect the balance. Wearing wetsuits or dry suits prevents divers from getting dangerously cold, especially on deep or chilly dives, where they might need protective gear and warmed breathing gas to avoid losing heat. Understanding these physical principles helps hyperbaric nurses prioritize patient safety and comfort in underwater settings. [8]
Hyperbaric oxygen therapy (HBOT) involves breathing in pure oxygen at increased air pressure, typically between 2 and 3 times higher than normal. For some conditions, even higher pressures may be needed. Scientists have studied HBOT extensively, using principles from gas laws to understand how it works. It is crucial to have a good grasp of the 14 approved conditions for hyperbaric medical therapy because HBOT has a wide range of medical uses. These conditions cover everything from decompression sickness and carbon monoxide poisoning to thermal burns and necrotizing fasciitis.
HBOT works in several ways to provide therapeutic effects. Firstly, it shrinks gas bubbles in the blood and helps dissolve gas, which is crucial for conditions like decompression sickness and air embolism.
Breathing 100% oxygen under pressure helps to create favorable gradients, making it easier to get rid of unwanted gases and allowing oxygen to reach tissues with low oxygen levels. This is important for treating conditions such as carbon monoxide poisoning and ischemic injuries. HBOT also boosts the blood's ability to carry oxygen by increasing the concentration of oxygen in the plasma, ensuring that tissues receive more oxygen than they would through normal blood flow. This multi-pronged approach highlights how effective HBOT is in treating a wide range of medical conditions by using the basic principles of gas physics.
Hyperbaric oxygen therapy (HBOT) and diving are common, but they come with some risks. One common issue is middle ear barotrauma (MEBT), which happens when the gas volume changes, following Boyle’s law. It would need techniques to equalize pressure or adjustments in treatment depth. Dental implants can become less stable with repeated exposure to hyperbaric environments. If someone has untreated pneumothorax, they should not do HBOT because of the risk of tension pneumothorax during decompression. Oxygen toxicity can happen when there's too much oxygen pressure, so it is important to manage it carefully, for example, by reducing oxygen exposure or changing the treatment depth. It is also important to take precautions against chamber explosions, like making sure there are no combustible materials around and that patients follow safety protocols, including removing makeup and preventing static discharge.[9][10]
^Josefsen, L; Woodward, C; Lewis, D; Hodge, J; Camporesi, EM (1997). "The nursing role in hyperbaric medicine". Undersea and Hyperbaric Medicine (Annual Meeting Abstract). Archived from the original on April 15, 2013. Retrieved 2011-01-14.{{cite journal}}: CS1 maint: unfit URL (link)
^Greenberg, DA (1985). "Baromedical nursing specialization". Undersea and Hyperbaric Medicine (Annual Meeting Abstract). Archived from the original on April 15, 2013. Retrieved 2011-01-14.{{cite journal}}: CS1 maint: unfit URL (link)
^Jones, M. W.; Brett, K.; Han, N.; Cooper, J. S.; Wyatt, H. A. (2024). "Hyperbaric Physics". National Library of Medicine. StatPearls. PMID28846268. Retrieved April 28, 2024.
