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 ...
