Barotrauma in Emergency Medicine Medication

  • Author: Joseph Kaplan, MD, MS, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 9, 2011
 

Medication Summary

The primary medications in treatment of dysbaric injuries are oxygen, isotonic fluids, anti-inflammatory medications, decongestants, and analgesics.

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Acetylsalicylic acid

Class Summary

This agent is used to control pain and inflammation and to inhibit platelet aggregation.

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Aspirin (Anacin, Ascriptin, Bayer aspirin)

 

Blocks prostaglandin synthetase action, which, in turn, inhibits prostaglandin synthesis and prevents formation of platelet-aggregating thromboxane A2. By inhibiting prostaglandin synthesis, aspirin may also inhibit key steps in the inflammation process.

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Decongestants

Class Summary

These agents are used to open blocked sinuses or eustachian tubes to allow for equalization of pressure.

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Oxymetazoline (Afrin, Allerest)

 

Stimulates alpha-adrenergic receptors and causes vasoconstriction when applied directly to mucous membranes. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.

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Pseudoephedrine (Silfedrine, Sudafed)

 

Stimulates vasoconstriction by directly activating alpha-adrenergic receptors of the respiratory mucosa. Induces bronchial relaxation and increases heart rate and contractility by stimulating beta-adrenergic receptors.

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Narcotic analgesics

Class Summary

These agents are used to treat severe pain resulting from dysbaric injuries.

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Acetaminophen with codeine (Tylenol #3)

 

Indicated for the treatment of mild to moderate pain.

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Glucocorticoids

Class Summary

In studies of patients with spinal cord trauma, methylprednisolone has been shown to improve long-term neurologic outcome. It has not yet been approved for DCS but should be considered a treatment option.

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Methylprednisolone (Solu-Medrol, Depo-Medrol)

 

By reversing increased capillary permeability and suppressing PMN activity, may decrease inflammation. May also prevent neuronal damage by inhibiting prostaglandin synthesis.

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Inert Gas

Class Summary

Heliox may initially accelerate bubble shrinkage when administered on the surface. Heliox may be superior to 100% oxygen for treatment at sea level.

Oxygen

 

First line of treatment in dysbaric injuries. Administer at high flow with a tight-fitting nonrebreather mask.

Helium-oxygen (heliox)

 

Consists of 50% helium and 50% oxygen.

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Contributor Information and Disclosures
Author

Joseph Kaplan, MD, MS, FACEP  Attending Physician, Department of Emergency Medicine, Martin Army Community Hospital, Fort Benning

Joseph Kaplan, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Marshall E Eidenberg, DO  Staff Emergency Physician, Via Christi Regional Medical Center

Marshall E Eidenberg, DO is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Dana A Stearns, MD  Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital

Dana A Stearns, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David Eitel, MD, MBA  Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Basic US Navy dive table used to compare the patient's dive profile to the standard dive profile. Reprinted with permission of the US Navy.
US Navy dive table for altitude diving used to compare the patient's dive profile with the standard dive profile at altitude. Reprinted with permission of the US Navy.
 
 
 
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