CHS Treatment Planning & Protocols 3 — Questions and Answers
Question 1: Which condition represents the only absolute contraindication to hyperbaric oxygen therapy that must be resolved before treatment begins?
- Claustrophobia
- Untreated pneumothorax (Correct answer)
- Controlled hypertension
- History of ear surgery
Correct answer: Untreated pneumothorax
Untreated pneumothorax is the single absolute contraindication because increasing pressure can convert it to a life-threatening tension pneumothorax.
Question 2: Before initiating HBO2 in a patient with an implanted electronic device (e.g., pacemaker), the hyperbaric physician must verify:
- The device is made entirely of non-ferrous metal
- The device has been tested and approved for use at the planned hyperbaric pressure (Correct answer)
- The device can be temporarily deactivated during treatment
- The patient's cardiologist is available on standby
Correct answer: The device has been tested and approved for use at the planned hyperbaric pressure
Implanted electronic devices must have documented manufacturer pressure ratings confirming safety at the intended treatment depth before HBO2 proceeds.
Question 3: A diabetic patient presents for HBO2 with a blood glucose of 340 mg/dL. The appropriate action is:
- Proceed at a reduced treatment pressure
- Delay treatment until glucose is better controlled (Correct answer)
- Administer insulin and begin treatment within 30 minutes
- Treat normally since glucose level does not affect HBO2 outcomes
Correct answer: Delay treatment until glucose is better controlled
Significant hyperglycemia impairs wound healing and increases infection risk; glucose should generally be below 250 mg/dL before treatment.
Question 4: Which medication significantly increases the risk of CNS oxygen toxicity during HBO2 by inhibiting superoxide dismutase?
- Metformin
- Disulfiram (Antabuse) (Correct answer)
- Warfarin
- Prednisone
Correct answer: Disulfiram (Antabuse)
Disulfiram inhibits superoxide dismutase, a key antioxidant enzyme, markedly increasing CNS oxygen toxicity susceptibility during HBO2.
Question 5: During pressurization, a patient reports increasing ear pain and cannot equalize. The correct protocol response is:
- Continue pressurization and administer oral analgesics
- Continue pressurization slowly while coaching the patient
- Stop pressurization, allow equalization, then resume at a slower rate if successful (Correct answer)
- Abort the treatment and reschedule after tympanostomy tubes
Correct answer: Stop pressurization, allow equalization, then resume at a slower rate if successful
Pressurization should halt to prevent barotrauma; after successful equalization the rate can be slowed and the descent resumed.
Question 6: A pregnant patient with suspected severe CO poisoning presents to the hyperbaric facility. The correct approach is:
- Withhold HBO2 due to unacceptable fetal risk
- Treat with normobaric 100% oxygen only to avoid fetal exposure
- Proceed with HBO2 because maternal and fetal benefits outweigh theoretical risks (Correct answer)
- Delay treatment until after emergency cesarean delivery
Correct answer: Proceed with HBO2 because maternal and fetal benefits outweigh theoretical risks
Severe CO poisoning in pregnancy carries high fetal mortality risk, making HBO2 strongly indicated — benefits far outweigh theoretical fetal risks.
Question 7: A patient with a history of seizures is referred for HBO2. Before starting therapy, the hyperbaric physician must prioritize:
- Ordering a baseline EEG
- Evaluating current seizure control and anticonvulsant regimen (Correct answer)
- Performing 24-hour cardiac monitoring
- Completing a neuropsychological testing battery
Correct answer: Evaluating current seizure control and anticonvulsant regimen
HBO2 lowers the seizure threshold; adequacy of current seizure control and medications must be confirmed before proceeding with treatment.
CHS Treatment Planning & Protocols 3
Which condition represents the only absolute contraindication to hyperbaric oxygen therapy that must be resolved before treatment begins?