Comprehensive Healthcare Solutions How I learned to love “PRESSURE” The Joys of HBO

Comprehensive Healthcare Solutions “HAPPY” Patients

Comprehensive Healthcare Solutions Unhappy Patients Barotrauma (squeeze) Otic (ear) Pulmonary (lung) GI (colon) Dental (tooth) Sinus

Comprehensive Healthcare Solutions Sighing is a marker for stress

Comprehensive Healthcare Solutions Boyle’s Law

Comprehensive Healthcare Solutions Pressure-Volume Relationship

Comprehensive Healthcare Solutions Is Boyle’s Law an issue for every pressure vessel?

Comprehensive Healthcare Solutions Delta Sub

Comprehensive Healthcare Solutions Unhappy Patients Barotrauma (squeeze) Ear (most common) Pulmonary (most serious) GI (colon) Dental (tooth) Sinus

Comprehensive Healthcare Solutions Pulmonary Barotrauma Tissue damage Emphysema Pneumothorax Air embolism

Comprehensive Healthcare Solutions Lung Anatomy

Comprehensive Healthcare Solutions Mediastinal Shift

Comprehensive Healthcare Solutions Tension Pneumothorax

Comprehensive Healthcare Solutions Diagnosis Chest pain ↑ Blood Pressure ↓ Respiratory Rate ↑ Breath sounds ↓ Bell Tympany ← Hyper-resonance ← Tracheal shift →

Comprehensive Healthcare Solutions Chest Tube

Comprehensive Healthcare Solutions Questions?

Comprehensive Healthcare Solutions The Ear Under Pressure

Comprehensive Healthcare Solutions Why Talk About Ears Most frequent pressure related injury Poor understanding of equalization techniques Ear damage (Barotrauma) is… *PREVENTABLE*

Comprehensive Healthcare Solutions Pressure-Volume Relationship

Comprehensive Healthcare Solutions Ear at Sea Level

Comprehensive Healthcare Solutions Ear at 2.6 FSW

Comprehensive Healthcare Solutions Locked Ear at 3.9 FSW

Comprehensive Healthcare Solutions Forceful Valsalva

Comprehensive Healthcare Solutions The Present Strategy How do we most often judge middle ear equalization ability? Test of pressure??? Patient query??? “Reactive” instead of “Proactive” I HOPE NOT! }

Comprehensive Healthcare Solutions Objectives Recognize “Ear Fear” Assess pressurization effort with “Doc’s Technique” Become proficient in 3 methods of Middle Ear pressurization Learn PROACTIVE intervention

Comprehensive Healthcare Solutions What is “Ear Fear”? Pressure is uncomfortable Childhood pain -> adult fear Retrograde tear duct inflation Confusion over instructions

Comprehensive Healthcare Solutions Assessing Equalization Effort The Doc’s Technique: Watch The Nose Inflate! Palpate firmness of inflation and compare it to your own equalization effort Watch for “Excessive Effort”

Comprehensive Healthcare Solutions Otoscopy Identify landmarks Check mobility of the TM Verify TM bulge with presssurization of the middle ear

Comprehensive Healthcare Solutions Normal Ear

Comprehensive Healthcare Solutions Pneumatic Otoscopy

Comprehensive Healthcare Solutions Bony Exostosis

Comprehensive Healthcare Solutions Hemotympamum

Comprehensive Healthcare Solutions Video Otoscopy

Comprehensive Healthcare Solutions Pressurization Techniques Valsalva Maneuver (1704) Frenzel Maneuver (1932) Lowry Technique (1950s) Combination maneuver Pressurize and swallow

Comprehensive Healthcare Solutions Antonio Valsalva Pinch nostrils closed Increase pressure in chest Cheeks tight, not puffed out Should not be a prolonged effort engorgement – venous return never on ascent!

Comprehensive Healthcare Solutions Herman Frenzel “Luftwaffe” “The Throat Piston” Close vocal cords Pinch nostrils closed Raise the back third of tongue Feel “Adams Apple” elevate

Comprehensive Healthcare Solutions Advantages Does not adversely effect blood flow Independent of respirations Can be performed with mouth open Easy to teach and practice “Bobbing Adams Apple”

Comprehensive Healthcare Solutions Teaching Techniques Bazooka vs Otovent

Comprehensive Healthcare Solutions So Many Methods So Little Time Pressurization methods work best “Eustachian Tube Awareness” Combination methods work well but are harder to learn Perform effective technique “Early and Often”

Comprehensive Healthcare Solutions How Hard to Blow Never “forceful” - just “ADEQUIT” Never blow hard to relieve ear squeeze. Pressurization is a preventive maneuver Never perform a Valsalva on ascent. Use swallow, yawn or jaw thrust

Comprehensive Healthcare Solutions Doc’s Motto: Never give up… there is always a way In extreme cases consider PE tubes

Comprehensive Healthcare Solutions Summary Watch out for “Ear Fear” and the “Excessive Effort” sign Watch the nose for proper inflation Bob your Adams Apple Verify ME pressurization prior to treatment by watching the TM bulge

Comprehensive Healthcare Solutions Where to get more information Doc’s Diving Medicine Homepage “divingdoc.com”