CHT CHT Wound Care & Hyperbaric Indications 2 — Questions and Answers
Question 1: Crush injuries benefit from HBOT primarily because:
- High pressure mechanically closes wound edges
- HBOT reduces tissue edema, preserves hypoxic tissue viability, and limits reperfusion injury (Correct answer)
- Oxygen at pressure cauterizes damaged blood vessels
- HBOT removes necrotic debris from crushed tissue
Correct answer: HBOT reduces tissue edema, preserves hypoxic tissue viability, and limits reperfusion injury
HBOT reduces edema through vasoconstriction while maintaining tissue oxygenation, limits reperfusion injury, and preserves marginally viable tissue in crush injuries.
Question 2: Gas gangrene (clostridial myonecrosis) benefits from HBOT because:
- High pressure physically destroys Clostridium spores
- Hyperoxia is directly bacteriostatic/bactericidal to anaerobic Clostridium and inhibits alpha-toxin production (Correct answer)
- HBOT replaces the need for emergent surgical debridement
- Oxygen prevents further gas formation in infected tissue
Correct answer: Hyperoxia is directly bacteriostatic/bactericidal to anaerobic Clostridium and inhibits alpha-toxin production
High tissue oxygen tensions are toxic to obligate anaerobes like Clostridium perfringens and inhibit alpha-toxin production, making HBOT a valuable adjunct to surgery and antibiotics.
Question 3: For refractory osteomyelitis, HBOT is best used as an adjunct to:
- Radiation therapy and corticosteroids
- Surgical debridement and culture-directed antibiotic therapy (Correct answer)
- Physical therapy and protective casting only
- Hyperbaric pressure without antibiotics
Correct answer: Surgical debridement and culture-directed antibiotic therapy
HBOT is adjunctive to surgical debridement and appropriate antibiotics for refractory osteomyelitis, enhancing leukocyte oxidative killing and antibiotic efficacy in hypoxic bone.
Question 4: Sudden sensorineural hearing loss treated with HBOT should ideally begin within:
- 24 hours of onset only
- 2 weeks of symptom onset (Correct answer)
- 3 months of onset as a hard deadline
- 6 months of symptom onset
Correct answer: 2 weeks of symptom onset
HBOT for sudden sensorineural hearing loss is most effective when initiated within 2 weeks of onset, though treatment may still be considered up to 3 months after onset.
Question 5: Necrotizing soft tissue infections (NSTI) are treated with HBOT as an adjunct to:
- Hyperbaric chamber pressure as the sole intervention
- Broad-spectrum antibiotics without surgery
- Emergent surgical debridement and broad-spectrum antibiotics (Correct answer)
- Wound vac therapy and dressing changes alone
Correct answer: Emergent surgical debridement and broad-spectrum antibiotics
HBOT is strictly adjunctive in NSTI — emergent surgical debridement and broad-spectrum antibiotics are the primary and life-saving treatments; HBOT supports recovery.
Question 6: A Wagner Grade IV diabetic foot wound is best described as:
- Superficial ulcer not penetrating to subcutaneous tissue
- Deep ulcer with osteomyelitis or abscess
- Partial foot gangrene (forefoot or heel) (Correct answer)
- Complete gangrene of the entire foot
Correct answer: Partial foot gangrene (forefoot or heel)
Wagner Grade IV describes partial foot gangrene (forefoot or heel), while Grade III involves deep ulcer with bone/joint infection and Grade V is whole foot gangrene.
CHT CHT Wound Care & Hyperbaric Indications 2
Crush injuries benefit from HBOT primarily because: