CHS Patient Safety & Risk Management 3 — Questions and Answers
Question 1: A patient develops middle ear barotrauma during descent in a hyperbaric chamber. What is the APPROPRIATE clinical response?
- Continue descent at a slower rate and monitor the patient
- Stop compression, ascend slightly, and have the patient attempt equalization techniques (Correct answer)
- Administer decongestants and proceed with full pressurization
- Abort the treatment immediately and discharge the patient
Correct answer: Stop compression, ascend slightly, and have the patient attempt equalization techniques
Stopping compression, ascending slightly, and coaching the patient through equalization techniques (Valsalva, Frenzel) is the standard response to ear barotrauma during descent.
Question 2: Which blood glucose level should trigger postponement of hyperbaric oxygen treatment in a diabetic patient prior to pressurization?
- Less than 60 mg/dL or greater than 400 mg/dL (Correct answer)
- Less than 80 mg/dL or greater than 200 mg/dL
- Less than 100 mg/dL or greater than 300 mg/dL
- Any level outside of 120-180 mg/dL
Correct answer: Less than 60 mg/dL or greater than 400 mg/dL
Blood glucose below 60 mg/dL (hypoglycemia risk) or above 400 mg/dL (ketoacidosis risk) generally warrants postponement of HBO treatment for diabetic patients.
Question 3: What is the primary hazard associated with cotton clothing in a hyperbaric oxygen environment?
- Cotton absorbs oxygen and becomes toxic to the patient's skin
- Cotton is a fuel source that can ignite in an oxygen-enriched atmosphere (Correct answer)
- Cotton creates static electricity that can interfere with monitoring equipment
- Cotton fibers can block air filtration systems in the chamber
Correct answer: Cotton is a fuel source that can ignite in an oxygen-enriched atmosphere
Cotton, while less flammable than synthetic fabrics, remains a combustible fuel source that poses fire risk in the oxygen-enriched hyperbaric environment.
Question 4: A patient treated with bleomycin chemotherapy requires hyperbaric oxygen for a non-oncologic wound. What specific risk must be considered?
- Bleomycin reduces wound healing response, making HBO less effective
- Bleomycin sensitizes lung tissue to oxygen toxicity, increasing pulmonary fibrosis risk (Correct answer)
- Bleomycin reactivates under hyperbaric conditions and resumes anticancer activity
- Bleomycin increases seizure threshold, making CNS oxygen toxicity more likely
Correct answer: Bleomycin sensitizes lung tissue to oxygen toxicity, increasing pulmonary fibrosis risk
Bleomycin sensitizes pulmonary tissue to oxygen toxicity, and high-pressure oxygen can precipitate or worsen pulmonary fibrosis in patients who have received this drug.
Question 5: During a hyperbaric treatment, a patient in a multiplace chamber reports sudden severe chest pain. After ruling out musculoskeletal causes, what is the primary concern?
- Pulmonary oxygen toxicity causing pleuritic chest pain
- Arterial gas embolism or pneumothorax requiring immediate decompression evaluation (Correct answer)
- Middle ear barotrauma referred to the chest
- Anxiety-related chest tightness from claustrophobia
Correct answer: Arterial gas embolism or pneumothorax requiring immediate decompression evaluation
Sudden severe chest pain in a hyperbaric patient must raise immediate concern for arterial gas embolism or pneumothorax, both of which require urgent clinical evaluation.
Question 6: Which item must NEVER be brought into a hyperbaric chamber due to fire and explosion risk?
- Cotton-based wound dressings
- Petroleum-based ointments or lubricants (Correct answer)
- Saline irrigation solution
- Medical-grade silicone tubing
Correct answer: Petroleum-based ointments or lubricants
Petroleum-based products are combustible hydrocarbons that pose serious fire and explosion risk in oxygen-enriched hyperbaric environments and are absolutely prohibited.
Question 7: What is the significance of the UHMS (Undersea and Hyperbaric Medical Society) approved indications list for patient safety?
- It serves as a billing code reference for insurance reimbursement only
- It defines evidence-based conditions for which HBO has demonstrated safety and efficacy (Correct answer)
- It restricts all other uses of HBO regardless of physician judgment
- It is a voluntary marketing guideline without clinical significance
Correct answer: It defines evidence-based conditions for which HBO has demonstrated safety and efficacy
The UHMS approved indications list defines evidence-based conditions where HBO has proven safe and effective, protecting patients from unnecessary or harmful treatments.
CHS Patient Safety & Risk Management 3
A patient develops middle ear barotrauma during descent in a hyperbaric chamber.
What is the APPROPRIATE clinical response?