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HYPERBARIC OXYGEN THERAPY
INDICATION Diabetic Lower Extremity Ulcer
QUALIFYING CRITERIA
Wagner grade 3 or greater diabetic lower extremity ulcer, non-healing despite over 30 days standard wound care treatment and optimization of the measures indicated below
EVALUATION MEASURES OPTIMIZED
-Nutritional status (Albumin, Pre-Albumin, nutritional consult, as indicated)
-Glucose control (HgbA1-C, Endocrinology consult, as indicated)
-Vascular status (ABI, arterial ultrasound, angiogram, vascular surgery evaluation, as indicated) -Debridement (removal of all non-viable tissue present)
-Off-loading (maximizing pressure relief)
-Maintenance of granulation tissue (with appropriate dressings, debridements)
-Infection (treated with topical & oral antibiotics, as needed)
HBO RISK ASSESSMENT
Barotrauma risks:
Upper respiratory infections, Prior radiation treatment to head or neck, Tracheostomy, Ear problems or surgery, Sinus obstruction, Emphysema, Pneumothorax
Pulmonary risks:
Currently seeing a pulmonologist, Tuberculosis, COPD, Asthma, History of smoking
Cardiac risks:
Currently seeing a cardiologist, Congestive heart failure, Hypertension, Diuretic use
History of prior or current malignancy:
Surgery, Radiation therapy, Chemotherapy (Bleomycin administration within 12 months)
Ophthalmic risks:
Retinal detachment surgery, Glaucoma
Confinement anxiety
Dialysis: More than 48 hours since last dialysis
Any implants: Pacemaker or AICD, Glucose monitor
Pregnancy
Diabetes: Diabetes medicine–insulin, Diabetes medicine–oral hyperglycemic agent
Seizures: Seizure medications
Underlying currently using these medications:
Aspirin, Chemotherapy, Digoxin, Narcotics, Phenothiazine, Prednisone, Antabuse, Sulfamylon, Amiodarone
CONSENT
The patient is an appropriate candidate for hyperbaric oxygen therapy as they have failed to respond to treatment and have displayed no measurable signs of healing for at least 30 consecutive days. Hyperbaric Oxygen Therapy would be an essential adjunct in the resolution and treatment of this patient's presenting problem. The patient does have sufficient physiologic and psychological stamina to undergo the rigors of hyperbaric oxygen therapy. Having no absolute contraindications to treatment, I recommend the following: Hyperbaric oxygen treatments at 2.0 ATA in 100% oxygen for 90 minutes per treatment for a total of *** sessions.
I have discussed the possible benefits and risks of hyperbaric oxygen therapy with this patient. These include, but are not limited to: fire, barotrauma of the ears, sinuses, and lungs to include air embolism, pneumothorax, central nervous system oxygen toxicity resulting in seizure, hypoglycemia, cataracts, myopia, exacerbation of congestive heart failure or pulmonary edema, and confinement anxiety. The patient has verbalized an understanding of these risks, the significant time and transportation commitment, and has indicated willingness to commit to this therapy.