STRN and ORN of mandible

< Return to Consults

82yo male patient with STRN and ORN of the mandible (diagnosis SCC of lip 2016 w/radiation from 2016-2017) - the workup on this patient indicated a small right basilar pleural effusion on 3/21/2023 (known history of COPD). Small to moderate chronic bilateral pleural effusions were noted on CT w/o contrast on 11/14/2022. Again, these were documented as "stable effusions" on 9/10/2022. Other PMHx: Diastolic heart failure, CAD, RAS, stage 4 chronic kidney disease. I have received cardiac clearance from the patient's cardiologist, but he does not see an actual pulmonologist. He is prepared to dive next week 3/22/2023. Is there any additional workup that I need to do prior to diving him?

Mar 16, 2023 by Debbie Wietfeldt, DNP, APRN

4 replies

Mike White
MD, UHM, MMM, CWS

Debbie,

This is certainly a complicated patient. I know you have cardiac clearance but I would make sure the EF is > 30%. Additionally for the effusions, I would consider repeat CT of the chest and you may want to talk with Pulmonology about the safety of the undergoing HBO. Are you planning on taking him to 2.0 or 2.4ATA? Doing a quick literature search, I could not find anything specific for pleural effusions and HBO but I will try to look in some other references specifically for pleural effusion and HBO safety.

Mike White

Mar 16, 2023

Debbie Wietfeldt
DNP, APRN

Hi, Dr. White - this patient's EF is 55-60% on his echo from last month. We are planning to take him to 2.0 ATA, but have also discussed 1 ATA to see how he tolerates it. I know he is anxious to start. Would you recommend not diving him at all unless I have the repeat CT and pulmonology consult, or could I try diving at 1.0ATA (this was something I was considering with my medical director and our HBO consultants)?

Mar 16, 2023

Debbie Wietfeldt
DNP, APRN

I apologize for the above - I stated the above incorrectly. I am planning to dive the patient to 2.0 ATA at a rate of 1psi/min vs. 2psi/min. My above question should have been the following: Would you recommend not diving him at all unless I have the repeat CT and pulmonology consult, or could I try diving at 1psi/min? Once again, apologies for the above!

Mar 17, 2023

Mike White
MD, UHM, MMM, CWS

Debbie,

I looked in all of my references and could not find anything directly about pulmonary effusions. So I "phoned a friend". If the effusions are indeed small and you feel like you have a good explanation for the effusions (ie not malignant) then I can find nothing contradictory with the patient for HBO. If you want to repeat the CT to ensure the effusions are stable you certainly could but it not be an absolute, Sorry for the confusion.

Mike White

Mar 17, 2023

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

Basic Navigation

Feature Navigation

Solutions

Individuals:

Institutions:

Special Features:

Newsletter Signup