CHT Patient Care & Monitoring in Hyperbaric Settings 3 — Questions and Answers
Question 1: Which of the following patients would require the MOST careful monitoring for pulmonary oxygen toxicity during a prolonged HBO treatment course?
- A 45-year-old with a healing diabetic foot ulcer receiving 20 treatments
- A 60-year-old receiving daily HBO for 60 consecutive days for radiation tissue damage (Correct answer)
- A 30-year-old diver with decompression sickness receiving a single Table 6 treatment
- A 55-year-old with carbon monoxide poisoning receiving three treatments
Correct answer: A 60-year-old receiving daily HBO for 60 consecutive days for radiation tissue damage
Pulmonary oxygen toxicity (Lorraine Smith effect) is associated with cumulative oxygen exposure; patients receiving many consecutive treatments are at highest risk.
Question 2: What is the MOST appropriate patient position during HBO therapy for a patient with a suspected air embolism?
- Upright sitting position to facilitate breathing
- Left lateral decubitus (Durant's position) with Trendelenburg (Correct answer)
- Prone position to reduce intracranial pressure
- Supine with legs elevated 30 degrees
Correct answer: Left lateral decubitus (Durant's position) with Trendelenburg
Left lateral decubitus with Trendelenburg positioning helps trap air in the right ventricle and prevents it from entering the pulmonary artery.
Question 3: A patient on anticoagulant therapy is scheduled for HBO treatment. Which assessment finding would be MOST important to document before initiating therapy?
- Current blood pressure reading
- Recent INR or coagulation study results (Correct answer)
- Fasting blood glucose level
- Tympanic membrane temperature
Correct answer: Recent INR or coagulation study results
Anticoagulated patients have increased bleeding risk; current coagulation values (INR/PT) must be reviewed and documented before HBO therapy.
Question 4: During a hyperbaric treatment, a patient's SpO2 reading drops to 88% on the transcutaneous monitor. What should the CHT consider FIRST?
- Immediately abort the treatment
- Check the sensor placement and consider probe artifact before clinical intervention (Correct answer)
- Increase chamber pressure to improve oxygenation
- Administer epinephrine via the pass-through port
Correct answer: Check the sensor placement and consider probe artifact before clinical intervention
Transcutaneous monitors can give artifact readings due to sensor placement, movement, or perfusion issues; verify sensor placement before escalating care.
Question 5: Which of the following is a recognized CONTRAINDICATION to hyperbaric oxygen therapy?
- Healed tympanic membrane perforation
- Untreated pneumothorax (Correct answer)
- Stable angina with medical management
- Type 2 diabetes mellitus
Correct answer: Untreated pneumothorax
An untreated pneumothorax is an absolute contraindication to HBO because pressurization can convert it to a tension pneumothorax.
Question 6: A patient receiving HBO for a non-healing wound reports new chest tightness and shortness of breath after the 30th treatment. This presentation is MOST consistent with:
- Cardiac arrhythmia unrelated to HBO
- Pulmonary oxygen toxicity (Correct answer)
- CNS oxygen toxicity
- Claustrophobic reaction
Correct answer: Pulmonary oxygen toxicity
Chest tightness and dyspnea after many HBO sessions suggests pulmonary oxygen toxicity (Lorraine Smith effect) from cumulative oxygen exposure.
Question 7: When preparing a critically ill ICU patient for hyperbaric oxygen therapy, which piece of equipment requires SPECIAL consideration before chamber entry?
- Standard pulse oximetry probe
- Cuffed endotracheal tube with air-filled cuff (Correct answer)
- ECG monitoring leads
- Peripheral IV line
Correct answer: Cuffed endotracheal tube with air-filled cuff
Air-filled cuffs compress under pressure and expand during decompression, risking extubation or tracheal damage; cuffs must be filled with sterile water or saline.
CHT Patient Care & Monitoring in Hyperbaric Settings 3
Which of the following patients would require the MOST careful monitoring for pulmonary oxygen toxicity during a prolonged HBO treatment course?