Hi! We have a maxillofacial surgeon's office that regularly sees patients with medication-related osteonecrosis of the jaw. They rarely start off with IV antibiotic treatment. The usual coarse is ma...
Patient with type 2 DM required a BKA with a history of Wagner 4 DFU prior. Developed eschar at the amputation site and was sent to vascular surgery, with further revascularization attempts made. He i...
11/15/24 by
Bill Khoury,
What protocols are out there for comfort care/palliative patients for the inpatient acute care setting?
Are there care-plans that are designed for comfort care/palliative care patients in the acute c...
Is there evidence that HBOT can help mental health? Specifically, depression and anxiety?
I'm looking for ideas and information on how to handle wound cleansers/dressings in the hospital outpatient department.
Do you have single use wound cleanser? Or do you keep one bottle and wipe it ...
A patient was referred back to HBOT in June 2024 by her maxillofacial surgeon and has completed 78 treatments since that time. Recent maxillofacial surgeon note states now stage 2. Surgeon continues t...
Hello! I have an 88-year-old male who is hoping to receive HBO TX. He had a Toria intraocular lens implanted in February 2024 to correct cataracts. Can you please help me to know if this lens is compa...
Is there a case study on the hbo effects on treating PTSD
11/5/24 by
Jay Braun,
Hello! A referral, from ID actually, was received for a patient with soft tissue radiation necrosis (radiation cystitis). Hx: prostate cancer, s/p radical prostatectomy. Current symptoms include pelv...
Unna boots versus urgo wraps
Any recommendations for patients that required myringotomy tubes as a result of Middle Ear barotrauma or eustachian tube dysfunction when finished with HBOT? We are trying to keep our ENTs up to date ...
Nearly every search I perform asking this question results in "Yes", Medicare will cover HBOT for Central Retinal Arterial Occlusion. Wound Reference specifically says "NO". How does this differ from ...
Hi. Looking for thoughts on this incoming referral for STRN from neurologist. Hx: Presented with memory issues and confusion, lesion on MRI, surgery Dec 2022, pathology (+) glioblastoma, EBRT plus te...
Hello,
For patients with a trach, how do you deliver your air break in a mono chamber? Thanks.
Hi I have a payer denial, BCBS of SC stating the HBO is investigational on the following patient's condition. It was preapproved with the codes below. I'm thinking this may be a coding issue. Would...
Hi! Our clinic received a referral for a patient with recurrent gross hematuria. History of T-cell large granular lymphocytic leukemia, s/p chemo and bone marrow transplant (2023). Developed hemorrha...
We have a diabetic with multiple comorbidities that has a surgical chronic wound from a spinal surgery. Has anyone done HBO for this type of wound in this location?
Hi, Are there any known issues with concurrent use of Zytiga and HBOT. We have a patient with radiation cystits and hematuria, history of adenocarcinoma of the prostate in 2012, >7000 cGy radiation, s...
We are a hospital based outpatient wound & hyperbaric center. We were told by our hospital coder that we can bill our patient visits based on either time or element complexity. In addition, one of the...
Hi, I have a 72 year old male referred by urology for radiation cystitis with hematuria. He has a history of a subdural hematoma, 4mm midline shift which required a craniotomy 3-4 years ago. No neurol...
Hello,
Are there other tips or tricks for bandages that slip. More specifically, on patients that have normal shaped leg contours. I am aware of using extra padding for " wine bottle shaped l...
I would like your thoughts of diving a patient with diagnosis of complex regional pain syndrome type 2. Past history of crush injury to right foot 18 years ago with recurring and worsening right foot ...
Patient referred to HBOT for STRN at site of right breast cancer s/p radiation to R breast in 2014. 45 Gy to whole R breast, 61 Gy to tumor bed, R breast. Presenting with pain, mild induration, and u...
Is it possible that Dakins, with a pH of 9-10, can really be noncytotoxic?
We have a patient who is diving for Late effects of radiation. The patient is only able to come on Monday Tuesday and Friday. Would this be a beneficial treatment plan for the patient, or should pat...
Are there any special precautions taken for an HBO candidate with an ICD, which is rated for pressurization. Assuming the patient meets all other criteria. I haven't seen any specific guidelines from ...
Hello I was wondering if Radiation Pneumonitis is an indication for hyperbaric medicine, STRN? The patient continues to have right pleural effusions that require drainage. What is the heal rate like?...
My question is regarding qualification for skin substitutes. Per the CMS LCD: "For purposes of this LCD a Failed Response is defined as an ulcer or skin deficit that has failed to respond to documente...
I was diving a patient for mandible RON. Most recent PET scan shows pelvic bone metastasis. ORAL surgeon called the patient stating that HBO is spreading cancer and she has to stop it. What would be a...
Hi! Dialysis Pt with history of PAD,left BKA, bedbound and right leg contracture. Right lateral foot has arterial ulcer with exposed tendon. Pt non adherent to offloading. Referred to vascular, pt is ...
Hello, I was wondering if velcro trach collars were allowed in Monoplace chambers.
Program director says if wound is sutured closed after debridement of Osteo, it then no longer qualifies for HBO because there is no open wound. I have always thought that sutured is not healed, and m...
Everyone says you can't have a thigh wound with Wagner Grade3, but the code is listed by CMS in Group 2. Thoughts?
I have a 75 y/o M who had an extensive multiloculated soft tissue abscess in the lower lumbar and sacral subcutaneous tissue. This measured 15 x 6 cm transversely and 14 cm superior to inferior. He ...
I cannot remember where I saw the information for total contact cast and HBO. The cast has to be done after the Patient's HBO treatment. Not before? So, if the patient had a doctor visit for cast plac...
I have been working with a 60 y.o. male over the last 9 days who came into the acute care setting w/cellulitis to the LLE which escalated significantly over his stay. Blood cultures came back positive...
I have read osteoradionecrosis -Mandible should be at 2.5ATA, however DFUs and Chronic Osteo can range from 2.0 to 2.5 ATA. What makes the difference in choosing 2.0 vs 2.5 ATA? Is 2.5ATA preferred ...
Located in Indiana. Over the past year we have received a couple denials for HBOT with Anthem Medicaid.
In the denial letter Anthem references the MCG 27th Edition Ambulatory Care Guideline for HB...
Hello,
Looking for clarification on proper use of the I70 codes that are listed under "Group 2 - Wound Ulcer Codes" and include various locations of the leg and foot.
I have a patient with DM, n...
Hi,
I have a patient with scleroderma and raynaud's disease with a painful necrotic ulcer of the right 2nd fingertip, non healing > 6 months. She has seen hand surgery who suggests avoidance of debri...
Hi,
I currently have very limited information on an incoming patient. History of oral cancer 12/2022 with 8 weeks radiation, most recent treatment 4/2023. Referred by surgeon for preparation of ir...
Wondering the recommendation for EEG leads in HBO. How long the glue needs to dry in order to safely treat patient in Multi Place Chamber. Also is there any safety concerns with having a E cylinder ...
We are an outpatient hospital based wound center in southern California under Noridian. Is Epifix amniotic tissue product covered under CMS for only venous leg ulcers, or does coverage extend to ulcer...
Hello, there was a post in May of 2022 regarding the Dexcom G6. The conclusion was that there are no significant safety concerns with subjecting Dexcom G6 CGM transmitters to hyperbaric environments b...
She is a 69 yrs old and an ambulatory patient and nutrition is adequate. She is T2DM and Blood glucose is well controlled with metformin and A1c is 5.6.
Recently she had a whipple surgery in 5 mo...
We have a patient who qualifies for HBOT DFU G3, however he does have a peritoneal catheter for dialysis. Is there any reason as to why he could not dive? We do not see a reason not to, but since th...
Hello,
We have an HBO candidate who had 17 SRT treatments over a year and a half ago. Just making sure that since it was not Ionizing radiation, it is not covered under HBO guidelines?
thank you...
70 year old male with cryoglobulinemic vasculitis, multiple ulcers to the feet and fingers, in various stages of tissue necrosis. The ulcers are quite extensive and he is at risk for amputation. His p...
Hello,
I am more accustomed to dealing with open wounds as opposed to dermatological issues ( fungal infections of the skin, dermatitis). Is there a good resource that can be useful for learni...
Hello there team,
We have been seeing an increase in patients with these acute and chronic inflammatory ulcers (via Pathology report) mostly with medial lower leg ulcers that are very fibrotic. ...
Hi Everyone. I just wanted to get your insight on how you restage your PI's. I have a had a recent discussion with a colleague and we differ on thoughts when to restage an unstageable. If you had p...
We have had multiple patient's lately that have a wound vac and the outside opening is small, but there is a cavity underneath that still needs a wound vac. The opening is closing faster than the cavi...
One of my providers asked about giving HBO at below 2.0 possibly 1.5ATA for a patient with CHF, for longer time period than 90minutes? Do you have any information related to this scenario?
87 yo patient seeking HBO for radiation injury after head/neck radiation. His extensive history of sarcomatoid sqamous cell carcinoma has demonstrated no recurrence since 2021 following cefemiplimab ...
I recently recieved a referral for treatment of Radiation proctitis in a patient who recieved 6000 cGy for HBOT. Radiation was done with Chemo for treatment of rectal adenocarcinoma. Problem is he c...
Are HBOT Trials for limb salvage covered by insurance if all appropriate pathways have been followed?
Hi
I’ve been caring for this malleolus injury for 6 weeks now.
On initial presentation, cellulitis present, heavily exudating. I have cleaned it well, de-sloughed and reduced in size with prontosa...
Hello! I was hoping to get an example of what needs to be included in a log for products like epifix.
I would also like to know what would need to be part of the patient record. Any links to where to...
Is it possible for a patient to present with the Skin Bends during treatment in a monoplace chamber? Knowing the patient is at pressure and that no inert gas is present we are stumped on what could be...
Are there any contraindications for using saline when cleansing wounds while using silver dressings?
Patient is 55 yo male with CO level of 16, Dm2, Renal failure on Dialysis presented to ER with dizziness, blurred vision, Tropinine elevated to 84.5, CT remarkable for old lacunae infarcts. EKG rate...
Hi, I have been trying to find any research related to the post-op healing duration of a compromised flap or graft regarding an appropriate window to refer to HBOT. Looking to provide education to ou...
Im hoping someone can provide some insight to some questions our podiatrist has regarding grading DFUs. We currently use the Wagner Classification system for grading diabetic foot ulcers in our clinic...
Hello. A patient was recently referred for HBOT from her radiation oncologist. Hx: In 2020, high grade urothelial carcinoma of bladder stage T2 N0. Bladder received total dose 6000 cGy at 200 Gy pe...
We are treating a patient for DFU. The patient has completed over 30 hyperbaric sessions in the Perry Sigma 40 monoplace chamber without issues. Over the past two sessions the patient has begun profus...
61 y/o male with stage 4 lung cancer with brain metastasis. His primary tumor of the RUL of the lung was removed via lobectomy. His 5.4 cm right frontal lobe brain metastatic lesion was also removed, ...
10/19/23 by
Bill Khoury,
Hello,
I am looking to see what other recommendations there are for diabetic patients and HBO in regard to hypoglycemic episodes. To clarify, I understand there are protocols for low glucose l...
Hello,
We are working up a 61 year old male for STRN, for a non-healing ulcer to the vertex of his scalp. (radiation was November 2022) He is currently on on taxol , carboplatin and Ketruda immun...
Hello,
We have a pt that will be starting HBO with the indication of Radiation cystitis secondary to ionizing radiation to his bladder. He has been taking Orgovyx (Lupron) for 8 months and will be...
Right now, I have 3 calcinosis cutis patients-one has end stage renal disease/renal osteodystrophy with secondary hyperparathyroidism; a second one has history of severe burns over 75% of his body; an...
76 y/o male morbidly obese male, approximately 270 pounds, history of gastric bypass with over 100 lb weight loss, with primary lymphedema and right lower extremity ulcers about 3% body surface area, ...
I received a referral from a local surgeon to manage an open surgical wound in a 46 yo patient on whom he had performed emergency surgery for incarcerated ventral hernia. He had put a wound vac on the...
For subsequent HBO treatments for CRAO after your initial treatment do you always titrate up starting from 2.0 ATA and stopping where there is response or do you start at the ATA that was effective wh...
We use mostly Puraply and Epifix, and log the application number, lot number, and waste in the EMR. We also separately keep a paper log of the same information, in case of a JCAHO visit. Do you know w...
I have a 90 y/o male patient who underwent thoracentesis about 3 months ago, looking for HBOT for radiation cystitis and intractable repeated urinary bleeding. Post tap cxr showed no pneumothorax, and...
The Zero G offloading device claimed to off load 100%. I do not see it listed in your product listing of off loading devices. It is hard to find information on Zero G. What happened to it? Is it still...
Regarding criteria for chronic refractory osteo: Imaging and/or bone cultures confirming diagnosis of osteomyelitis, medical management to which the patient did not respond (4-6 weeks of abx), and sur...
How should PTs bill for "non-skilled" wound care treatments, for treatments that don't require sharp debridement, compression, or wound vac? I'm thinking specifically a pt visit where a simple dressi...
6/5/23 by
Adam Copp,
Patient is here regarding worsening of the left lateral ankle ulcer no fever or chills. The patient is present with his wife. The ulcer has been present since 12/2019 per patient. The patient started ...
Has anyone ever heard of increased fluid or fluid shift in cancer patients during HBO? An oncologist told me he has seen it happen several times. I have a post radiation cysitis/proctitis patient wit...
HX: chronic wound ulcers on BLE, since September 2022 for right leg, left leg was present since July 2022. She got bit or broke down her left outer ankle and eventually healed. However, the wound has ...
I was approached last week by our infectious disease specialist who request HBO therapy for an HIV patient who has had persistent desquimation of his feet. The problem was felt to be due to antiretro...
There is controversy as to whether Benzocaine (Hurricane) should be used prior to bedside debridement. Any insight to this and what are other clinic's using.
Thank you!
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 (k...
Hello,
We have a 85 yr old male with radiation cystitis scheduled to start HBOT soon. He has a prosthetic R eye. First initial prosthetic eye was in 1951, with aprox 6 replacements. Any informat...
If a patient has DFU G3 or CROM along with arterial disease, would it be appropriate to dive these patients prior to bone debridement's/Amputation, given the patient has passed the TCOM challenge and ...
I have a patient who completed HBO for ORN #31 last April. His oncologist is requesting 10 additional dives due to patient having a tooth #31 extraction scheduled. There is a 10mm dept surrounding the...
Hello! New patient for HBOT. Hx metastatic renal cell carcinoma. Has not come in for a full evaluation yet and currently limited medical records. History of thoracentesis for past pleural effusions. H...
We have a 87 yr old male who has been ordered 40 HBO treatments for STRN (radiation cystitis). Pt has sleep apnea, CHF, and afib. His CXR findings: Heart is mildly enlarged. There is calcification of ...
Hi,
I'm looking to provide further education to staff regarding CXR prior to HBOT. I could not find chest imaging recommendation directly addressed within Wound Reference. What data does Wound Refe...
Patient: 66y/o male who had a radical prostatectomy for prostate cancer. Margins were positive as were the seminal vesicles. He then underwent external beam radiation to a total of 6800 CentiGrey. ...
As far as the Implantable Cardioverter Defibrillator (ICD) on the Use with Caution in a Monoplace Chamber Material List, the concern is the device withstanding pressure in the tank, per the list. Is ...
(in acute care setting) I have a 50 y.o. morbidly obese man with poorly controlled type 2 DM, recent A1c of 9.4 and came in with glucose >500. He has history of perineal abscess w/I&D back in 2020. Fo...
Hello! We have a patient with recent treatment for bladder cancer with Mitomycin instillation to the bladder that is referred for HBOT for CROM of the mandible due to side effects of Bisphosphonate me...
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 (k...
I have multiple questions regarding this solution.
Would it be appropriate to use Dakins in a surgical incision on post op day 4? Would Dakins break down fascial sutures? and if there were to be any...
Hello,
We have and HBO candidate with radiation cystitis bladder/perineum that has a history of seizures. His last seizure was 1 year ago (in that year he states he had 4 seizures). He is now on ...
Can you apply negative pressure to a wound caused by calciphylaxis after it has a debridement?
88, F, PMH of lymphedema, vascular disease, Hx of PE, Chronic embolism and thrombosis of other veins, long term Xarelto use, Lipoid dermato-arthritis, Hyperlipidemia, HTN, osteoarthritis. Patient has...
Hi! I have an incoming patient with an oncologist planning to start Liposomal-doxorubicin. The oncologist advised it is a distant little cousin to the usual Doxorubicin. It is much milder and the sid...
Are there any specific guidelines or parameters for blood pressure before starting hbot?
83 year old gentleman who was diagnosed with prostate cancer in 2012. He underwent external beam radiation.
Pt has already received 2 courses of HBO (37 session the first time then 25 additional sev...
Hi, I have a patient with a wagner 4 DFU in need of HBO to reduce her risk of amputation as she had a failed revascularization attempt, pulmonary disease. CT showing mild bronchiectasis, no blebs, PFT...
Can we get this covered for HBOT despite not being related to radiation? Using code M27.8 Other specified diseases of the jaw? Further research leads me to "medication-related osteonecrosis of the ja...
Hello,
Was wondering what your guideline was regarding treating a pt with a hx of Cisplatin chemotherapy for HBOT. Pt last dose was March of 2022. Thank you for any information
I wanted to know if there are any know or potential issues with patient's undergoing HBO with the Watchman device.
Thanks,
Bill Khoury
Patient is a 74-year-old with an extensive history of juvenile rheumatoid arthritis. Patient went off her treatment for rheumatoid arthritis in 2021. Since then she has developed several chronic ulcer...
Patient is an 83-year-old female with past medical history of hypertension, diabetes, hyperlipidemia, neuropathy, and CVA. Patient developed bilateral foot cellulitis due to diabetic ulcers 2 years ag...
86y/o female who presents with a right inner thigh stage 3 pressure ulcer x 1 year. Patient is wheelchair bound. Prior treatment include weekly debridement and Santyl, Prisma, Xeroform, Mepilex. We th...
94 yo male with an unstageable left heel wound that occurred in October 2022; unknown etilogy of wound. Wound with moderate amount of serous drainage, exudate, and "wet eschar" that is firmly attache...
71 y.o. female with nearly circumferential venous stasis ulcers present for multiple years that had received multiple different dressings. Dressings that have been tried include: Aquacel AG (but only ...
12/29/22 by
Sarah Hintz,
92 year old female. Wounds have been present since Feb 2022. Has had 2 surgical debridements. Treatments so far have failed. Used Acetic Acid, Santyl and currently Metro gel has failed. Ultra Mist has...
Hello,
I am looking for advice on treatment of a patient for STRN with history of CML (Chronic myelocytic leukemia) diagnosed about 4 year ago. He is currently being treated with Gleevac (imatinib m...
We currently do not take photos of wounds on inpatients. Our hospitalist staff is wanting us to consider starting. We have the newest version of Meditech as our EMR for inptatient and outpatient clini...
Pt has hx of prostate CA, with radiation therapy in 2016, was given 40 treatmensts of HBO 2 years ago with indications of gross hematuria with resolution.
2 months ago, his gross hematuria has retu...
Hi Wound Reference Leaders,
I was sent a pre-surgical skin flap patient for HBO. The surgeon is very concerned about flap failure because after cosmetic leg lengthening surgery he suffered skin ne...
89 year old with wound across chest that began as a small wound in left breast and spread over the past 9 months to right breast, she has breast cancer, treating with comfort measures now, I would lik...
How can one eradicate biofilm with non-antimicrobial dressings?
When coding and billing for CTP am I right that wound code is first like an L97 or and E11.621. Then a Q code ie. Q4159 how many units are used and JW if wasted. Then you add the application codes 152...
11/23/22 by
Kim Harris,
Having a discussion on what is now gold standard for wound cultures. I believe tissue biopsy is the gold standard however, it was discussed that in an outpatient setting DNA testing is best. Would lov...
11/11/22 by
Kim Harris,
ED patient yesterday with infection of colostomy diagnosis. Started on antibiotics. There is a <1 sq cm area of erosion on the stoma, periostomal skin is intact. What is the advice to the patient reg...
We have a patient being evaluated for HBO for radiation cystitis secondry to ionizing radiation of the bladder. He has Atelectasis from 1993 and it is intact but flaccid and does not significantly e...
We have a pt. who is 53 y.o. female with no past medical history who was admitted on 10/17/22 with DKA, hypokalemia, undiagnosed DM, and cellulitis to the posterior neck. Her DKA and electrolyte imbal...
Is compromised flap a CMS reimbursable diagnosis for HBO? DPM referring a non-diabetic patient s/p TMA w/ dehiscence, NCD20.29 no longer specifically lists failed flap, only failed graft as a covered...
We have a male patient with radiation cystitis with gross hematuria and clot retention requiring multiple cystoscopies, fulguration and episodes of inpatient CBI. He completed 60 HBOT on 8/22/22, thou...
Hi,
I have a radiation cystitis patient that had cataract surgery on one eye on August 24. He needs to start HBO asap but I don't remember how long a patient needs to wait post-op to begin HBO. Tha...
The insurance has authorized additional therapies beyond 60 sessions. The podiatrist for the HMO wants him to continue. He received 40 sessions March through June 2022. Then 20 more sessions August.
...
I am trying to get an accurate idea of the total amount of wound care clinics and wound care providers there are in the United States. Specifically addressing the number of outpatient clinics, and th...
Is it true that CMS does not cover Chronic Proctitis d/t Late Effects of Radiation because it is a muscle and not a soft tissue?
I am hoping to get some information on healing rates post MOHS procedures when patients are referred to a wound clinic versus the wound being managed by dermatology. Any published articles or data wou...
Hello we have a patient diagnosed with Buerger's disease. Would this qualify the patient for HBO under Arterial insufficiency?
Thank you in advance.
Can a compression dressing/wrap (ACE Wrap, 2 Layer, 4 Layer) be worn or kept on while using a Lymphedema Pump? Our service rep for the company we use to order Lymphedema Pumps states it is safe to lea...
Hi, just a safety HBO question. We have a patient being evaluated for HBO for ORN, with CT findings of mild bronchiectisis and bronchiolectisis. No blebs and assuming pulmonary function tests are not ...
Our Chief Medical Officer has asked me to provide "some scholarly/clinical articles about the clinical improvements noted with ABI information." Does anyone have anything that would satisfy this requ...
I just finished a new formulary for my hospital and was wondering if anyone knew of or has a basic dressing selection algorithm that I can use as a guidance for physicians and nurses that that can be ...
Hello! Is there a certain timeframe to wait after a pt has cataract surgery prior to starting HBO?
Hello I was reading the Evidence-based indications accepted by the UHMS and Medicare, and it mentioned < 4,000cGy of radiation. If one is unable to obtain radiation treatment notes does this not qual...
Hello,
This might be a silly question. I tried to research it, but when using an alginate dressing a superficial wound do you cut to fit or overlap? If it is draining large amounts I cannot imagin...
I am attempting to create a MDRPI prevention/management protocol for the hospitals that I manage. Is there anyway that I can receive guidance on creating an EBP protocol for MDRPI prevention/managemen...
Hello,
For small wounds that require a wound vac and have a tunnel, what is the best method for foam application? Is it best to not pack the tunnel if it is not deep or pack with white foam and bla...
Can a patient go into the hyperbaric chamber safely with a Dexcom sensor pad left in place?
I have a DM patient with an ulcer to the bone at the lateral malleolus level. Can I use the Wagner classification system? (Or does the ankle not count). I would like to do HBO on this patient. Than...
Hi,
I just have a general question regarding CMS guidelines for using the Marx protocol 20:10 for dental tooth extraction for a high risk patient, under the diagnosis of STRN. Has there been any issu...
Hello
I have a patient that has a severe case of Hidradenitis suppurativa along with Psoriasis. In 4/2021 he had a case of Fournier's gangrene that was surgically treated and closed with a wound vac...
Hello,
We have an HBO candidate (ORN)
Pt was taking Cis-Platin and Bleomycin
Both were D/C in February of 2021
Also pt has a lesion in mouth that they suspect is cancer, (it is at the same i...
Hello, we have a new pt referral for osteo, but he has an implanted BioMonitor 2 AF. All BIOTRONIK CRM devices are not recommended for HBO due to the potential for damage or impaired function of the...
We have a patient with a history of squamous cell carcinoma of the right head and neck who completed radiation therapy on 10/15/2021. She presented to otolaryngology with three week history of pain ...
We have a new referral for hyperbaric treatments (necrosis of bone and soft radiation) with history of SCC of scalp with two large open wounds. One wound measures 15x13x0.3 cm with 5.3x5.5 cm of expo...
We have a patient who has been receiving HBO in a monoplace chamber. The wound was not showing progress, so Podiatrist took into surgery and debrided the involved bone and resected the cuboid. She pla...
I saw a patient today with pyoderma gangrenosum for a Palliative Care consult. She has a very rare presentation of occasionally having mucosal lesions that are located in her throat that are quite pai...
What is the role of pentoxifylline (Trental) in venous stasis ulcers? Wound Reference is recommending 400 mg TID in addition to compression therapy to promote ulcer healing. Is it commonly used in w...
76-year-old female does wound has a duration of one year and six months but it has had a wound in this area that has healed prior. ABI is normal she is not diabetic
The ideology of this wound has ...
I need treatment suggestions for wound
Patient referral for HBO. CXR done for workup for HBO identified new Dx: Emphysema. Referred out to Pulmonologist who ordered CT Chest and PFT. Question, what should FEV1 value be pre-bronchodilator a...
Hi,
We have a patient who underwent and completed a course of HBO for ORN of the jaw 3 years ago successfully. Oral surgery will need to do another tooth extraction and questioned if further HBOT wou...
12/13/21 by
Bill Khoury,
We were trying to get information with regard to use of the Libre continuous glucose monitor in the chamber. We have an expired safety bulletin from 2019 - May 2020 stating the sensor is approved up t...
Have been using Medihoney. Yellow tissue is adhered and debridement was done last week
We have an HBOT candidate with a remote history of pneumothorax after central line placement (10 years ago) and subsequent pleurodesis. Would there be any issues or increased risk with treatment in a ...
11/10/21 by
Bill Khoury,
Have there been reports of hyperbaric oxygen therapy contributing to worsening pulmonary hypertension. I had a patient earlier this year that we were treating for Wagner grade 3 diabetic foot ulcer. ...
Hi, I'm working with my orthopedic surgeon to provide wound care to a patient's hand that's now undergone 2 surgeries for a removal of an abscess that started from IV drug use. There are some sutures ...
Patient with Hx: Soft Tissue Radionecrosis (Basal Cell Carcinoma of Sternum), with partial sternectomy and omental flap, Radiation Tx 6/2/20 - 7/20/20 (total 33 txs). Started HBO Therapy 8/17/21. Orde...
Does anyone have any experience with the MESI mTABLET ABI/TBI?
We have a patient on our list for hyperbaric treatments that has a Liva Nova annuloplasty (mitral) ring inserted in 2020 and a Atriclip LAA exclusion system also inserted in 2020. We plan on diving hi...
Wondering if anyone has used HBOT to treat calciphylaxis in addition to sodium thiosulfate and proper wound care? Also wondering if anyone has had Medicare make an exception and cover HBOT treatments...
This patient has an unstageable pressure ulcer to hip with hard, adherent eschar. What is the best treatment recommendation for the patient?
This wound began as a DFU plantar surface and erupted medially. Surgical debridement about 4 weeks ago. NPWT was applied in surgery, patient was referred to outpatient wound care 1 week post-op. No co...
Currently treating a cancer patient who smokes marijuana for pain control. We coached him not to smoke prior to treatments but I'm having trouble finding any studies or recommendations regarding safe...
We have been seeing this patient off and on for at least 3 years, she has a non-surgical fistula, mess is seen. She has been seen at Mayo and here in Newton and no surgical option has been given. At t...
What is the official definition of a diabetic foot ulcer? Is any wound on the foot of a diabetic considered a diabetic foot ulcer. I have a patient with diabetes and paraplegia with a pressure ulcer...
Question about wound I have been trying to manage:
Allergies: The patient is allergic to penicillin and sulfa drugs.
Past Medical History: Anoxic brain damage, chronic respiratory failure with...
I was wondering how long you recommend a patient take a break from HBOT after an adverse reaction. For example, if they had an oxygen toxicity seizure, but no lasting effects, when would you resume tr...
I have a patient who has confirmed venous insufficiency and GSV reflux, with normal ABIs, who has been unable to undergo surgery due to recurrent pseudomonas pneumonia and COPD exacerbations. He requi...
General question: In working with our Patient Relations Staff in the Quality Department, they have posed questions regarding how a wound is determined to be clustered. I seem to remember reviewing the...
Is NPWT contraindicated in a wound bed where osteomyelitis has been confirmed? I was thinking yes but wanted to confirm. Specifically this is for a stage 4 large sacral wound.
Is NPWT contraindicated in a wound bed where osteomyelitis has been confirmed? I was thinking yes but wanted to confirm. Specifically this is for a stage 4 large sacral wound.
Pt has had multiple ulcers over 20 years that have closed with minimal wound care. This time the wound has been open for 2 years when he presents to us. ABX and now a wound vac have been employed and ...
20 yo female has had a wound since 2019. Original injury was a laceration that developed into necrotizing fasciitis. CRP still elevated at 50. How long does the CRP remain elevated in a noncomplica...
Has anyone used Actigraft? Would you share your experience?
I have a 28 yo male patient with Cutaneous Crohn's Disease and Rheumatoid Arthritis, both diagnosed when he was 8 years old. Patient is currently taking Taltz for his autoimmune disease. Patient state...
Have been treating this wound for approx 1 year. Pt is Diabetic last A1c 5.6, PAD, Kidney disease, has history of multiple amputations with infections, including LLE BKA several years ago. Pt has seve...
40 y/o F, no PMHx. Scalding water burn x4 wks ago. PCP placed on Amoxicillin and mupirocin. Was improving, then started blistering and worsening redness at 3 weeks. Started on Cipro, SSD with foam dre...
The Zero-G Offloading device (Prefabricated AFO with Ankle Joint) suggests using the HCPCS codes L1971, L2220 X2, L2265 when ordering. Can you tell me exactly what the three different codes are for?
I have a resident in a SNF that had a Stage 3 pressure ulcer on his hip- had been improving for months with the use of collagen and then began to deteriorate recently. Started noticing increased bleed...
I am working on my DNP project and studying the percentage of patients having ABI done on first visit. One barrier is due to compliance, the MD's prefer to do US instead. Any resources the you know of...
History of present illness:
51 year old female who was seen at SLJ ER on 7/21/2020 with a 3 wk history of decreased appetite and generalized weakness and malaise. She had had prior colonoscopy and en...
Hello, Is it ever appropriate to classify a wound as " diabetic ulcer" if on the upper limb? I was under the impression that diabetic ulcers are the foot? Thank you
This friction and shear ulcer is not responding to any treatment, any suggestions? I have been using allograft injections which is helping but patient is not very compliant when it comes to cleaning a...
Pt has been using antifungal. He said he had an antifungal allergy so we've tested it in spots before with no issues. This visit he shows up with this rash looking stuff but the rash is not everywhere...
I have a stubborn wound that I can't get to heal. Patient wih 30 year h/o lipodermatosclerosis now with penetrating osteoma cutis. Always probes to bone - I can't get it covered after trying 6 months....
Currently, the procedure codes for the different offloading devices are as follows:
- Orthotic and Prosthetic Procedures, Devices - Walking boots (L4360, L4361, L4386, L4387, L4631) are covered for ...
Hi. What would be an effective TX for fungal infection of the pannus with a partial thickness open area 2.5cmx1cmx0.1cm. I do not have access to interdry. For now i requested nystatin and placed skin....
Patient completed course of hyperbarics to heal ulcer in right foot. Patient was subsequently diagnosed with osteomyelitis in same foot and returned to be treated. Does the treatment number "1 of #" s...
Hello, I am not sure if any of you have noticed an increase in DTI on covid patients even with interventions. There is a white by NPIAP regarding the differential between covid skin manifestations and...
72-year old female history spina bifida, has been wheelchair-bound for last 10 years. Has long-term colostomy and had suprapubic urinary cath placed about a year ago but still leaking urine from uret...
This wound is stalled. It is being debrided but my concern is not debrided agressively enough. How far back should this be taken each time? What should be done with wound bed in this case?
Patient had silicone injections directly into the penis about 20 years ago. No other pertinent medical history. I've tried mult types of dressings, wound gels, collagen, Santyl, but nothing heals this...
During this COVID crisis and the need to use Telehealth, will payment be allowed for both the home health agency as well as the provider if both services provided on the same day?
Also, with telehe...
Hello team! Posting on behalf of a colleague. Colleague would like to know our thoughts regarding the etiology of the ulcer and if ok to proceed with surgical debridement.
47 y/o male with hx panc...
DOES HB COVERAGE PLUS KILL COVID 19?
here in CA we have closed schools and are doing screenings the entrances to hospital and ER. We are also screening at the outpatient clinic. We are trying to do our part in social distancing and have ...
Does a patient who had PBI catheter radiation therapy for breast cancer more than 6 months ago and now has nonhealing wound at the site of catheter placement qualify for HBO therapy? I am not clear o...
Recent abdominal wall debridement for infected seroma. Ventrio mesh placed approximately two months ago for large incisional hernia. . Intact and does not appear infected. 13 cm X 7 cm open wound to ...
Hello, what options are there for MASD? I have Triad and Z-guard as options. Thank you
MRI reveals Osteonecrosis of hip post radiation for CA several years ago. Patient with debilitating pain.
Is there a way to provide HBO for this patient as osteoradionecrosis although not mandible o...
36 yo, developmentally disabled. Wheelchair bound. Epilepsy. Tissue abscess. Possible abuse in care home. Heel photo and foot.
Hi all. I have heard and read a lot of controversy regarding Kennedy terminal ulcers that is is no longer a valid diagnosis. When a dti suddenly appears a day after admission and patient is on hospice...
Hi. If you have a softening of eschar that is loose and slough can be seen at wound edges and on the heel do you debride? No s/s of infection. Good pulses, previous IR done for arterial disease. Press...
Hi. This may sound silly, but what criteria is there to consider a wound infected? I often see one criteria met and iv ABT ordered, such as erythema no pruluence or fever but no signs of local infecti...
Hi. What is a general standard dressing/ surgical site care? Do you let the surgeon dictate what to use? Thanks
Hi. What options are there for breast cancer with strong odor, necrotic tissue, large amount of serous fluid and pain? Thanks
Several physicians in our group are wondering if we should be providing any prophylaxis when we put total contact casts on patients for treatment of DFU. Have you any information regarding this issue?
Not sure if anyone has used an infrared camera to detect possible pressure injury that cannot be seen yet. Any success with preventing hospital aquired pressure injuries? Thanks
At there alternatives to daily packing for infected abcess. Pt has severe pain with change?
Hi. When a patient has a dti to sacrum but there is a small area of epidermal skin loss, do you treat the open area? Or is just a foam dressing and offloading adequate? Thanks.
This patient has been on Silver alginate for 6 months with NO improvement. Cultures taken on 7/30/19 MRSA & Stenotrophomonas Maltophilia
Foul odor, white cheesy like substance over wound. Sm...
Interesting case for discussion, sending on behalf of a colleague - 50 yo male patient s/p surgical excision of large mass on neck. Wound vac applied after excision. Colleague is concerned about possi...
what does the FEV1 need to be to do HBOT
Is there still a 6 month waiting period prior to beginning HBO treatment for post radiation proctitis or enteritis? Whether there are external visible wounds or not?
Is a sigmoidoscopy or a colonosco...
Is the disposable NPWT- PICO safe to use with HBO if the battery pack is removed during treatment but the dressing is left on the patient? Patient has recently had transmetatarsal amputation and I be...
Does anyone have any sure fire tricks to heal recurrent pilonidal cysts? Specifically ones that have been previously excised and healed, now recurrent after months or even years and are culture negat...
Greetings-
The physician ordered the following:
POSTTRAUMATIC WOUND INFECTION, SUBSEQ
Note: sp shingles, worse with manipulation,
Plan: Mupirocin (BACTROBAN) 2 % Top Oint - Apply to affected area(...
We have a pt that we are changing 3M wraps and Xtrasorb dressings twice a week. Wife is telling us with in 24 hours it is leaking through and they are using plastic bags to keep carpet and shoes dry. ...
We have a pt that has had a colyectomy and has setons X 2 in his rectal area. Pt has constant drainage. His skin in the gluteal clave and rectal area is horrible. We have tried ABX, topical and oral ...
Can we use Aquacel AG under Santyl for a wound dressing
Treating a boarder line low blood sugar for HBOT's (112mg/dl) in a IDDM peritoneal dialysis pt.
Since orange juice could elevate potassium levels, is cranberry or apple juice the preferred juice t...
When is silver foam contraindicated for use in a wound with a wound vac dressing? Thank you.
Greetings-
What recommendations would you make for this scalp cellulitis? The patient is also on IV ABX. Thanks.
What are the Appropriate wounds for Maggot Therapy?
2/22/18 by
Bethanie,
Dressing Recommendations scrape/fall in workout pants.
Greetings-
What type of foam would you recommend as well as the pressure for suction. Thanks!
-amy
We have a patient here today who is diabetic and has pressure ulcers to L ischium, L calf and R plantar foot. My question is am I correct in remembering anything hip or below should be graded vs. stag...
Please advise the type of dressing that would be best for skin tears and folks on Coumadin. Thanks!
Could you offer any suggestions for debridement devices for PT's curettes vs scalpels? Thank you.
We are considering bringing a single pulsed lavage product into our community hospital system to go across the continuum including our homecare and ECF. Have you seen that be successfully implemented ...
We have a lady with a radiation injury (open ulcer) on her right ankle due to skin cancer from several years ago. She is currently receiving radiation to areas on her face for cancerous lesions. No ...
