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Published byEthelbert Kelley Modified over 8 years ago
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Comprehensive Healthcare Solutions How I learned to love “PRESSURE” The Joys of HBO
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Comprehensive Healthcare Solutions “HAPPY” Patients
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Comprehensive Healthcare Solutions Unhappy Patients Barotrauma (squeeze) Otic (ear) Pulmonary (lung) GI (colon) Dental (tooth) Sinus
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Comprehensive Healthcare Solutions Sighing is a marker for stress
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Comprehensive Healthcare Solutions Boyle’s Law
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Comprehensive Healthcare Solutions Pressure-Volume Relationship
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Comprehensive Healthcare Solutions Is Boyle’s Law an issue for every pressure vessel?
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Comprehensive Healthcare Solutions Delta Sub
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Comprehensive Healthcare Solutions Unhappy Patients Barotrauma (squeeze) Ear (most common) Pulmonary (most serious) GI (colon) Dental (tooth) Sinus
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Comprehensive Healthcare Solutions Pulmonary Barotrauma Tissue damage Emphysema Pneumothorax Air embolism
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Comprehensive Healthcare Solutions Lung Anatomy
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Comprehensive Healthcare Solutions Mediastinal Shift
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Comprehensive Healthcare Solutions Tension Pneumothorax
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Comprehensive Healthcare Solutions Diagnosis Chest pain ↑ Blood Pressure ↓ Respiratory Rate ↑ Breath sounds ↓ Bell Tympany ← Hyper-resonance ← Tracheal shift →
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Comprehensive Healthcare Solutions Chest Tube
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Comprehensive Healthcare Solutions Questions?
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Comprehensive Healthcare Solutions The Ear Under Pressure
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Comprehensive Healthcare Solutions Why Talk About Ears Most frequent pressure related injury Poor understanding of equalization techniques Ear damage (Barotrauma) is… *PREVENTABLE*
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Comprehensive Healthcare Solutions Pressure-Volume Relationship
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Comprehensive Healthcare Solutions Ear at Sea Level
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Comprehensive Healthcare Solutions Ear at 2.6 FSW
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Comprehensive Healthcare Solutions Locked Ear at 3.9 FSW
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Comprehensive Healthcare Solutions Forceful Valsalva
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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! }
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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
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Comprehensive Healthcare Solutions What is “Ear Fear”? Pressure is uncomfortable Childhood pain -> adult fear Retrograde tear duct inflation Confusion over instructions
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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”
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Comprehensive Healthcare Solutions Otoscopy Identify landmarks Check mobility of the TM Verify TM bulge with presssurization of the middle ear
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Comprehensive Healthcare Solutions Normal Ear
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Comprehensive Healthcare Solutions Pneumatic Otoscopy
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Comprehensive Healthcare Solutions Bony Exostosis
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Comprehensive Healthcare Solutions Hemotympamum
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Comprehensive Healthcare Solutions Video Otoscopy
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Comprehensive Healthcare Solutions Pressurization Techniques Valsalva Maneuver (1704) Frenzel Maneuver (1932) Lowry Technique (1950s) Combination maneuver Pressurize and swallow
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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!
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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
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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”
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Comprehensive Healthcare Solutions Teaching Techniques Bazooka vs Otovent
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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”
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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
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Comprehensive Healthcare Solutions Doc’s Motto: Never give up… there is always a way In extreme cases consider PE tubes
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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
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Comprehensive Healthcare Solutions Where to get more information Doc’s Diving Medicine Homepage “divingdoc.com”
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