Barotrauma Medication

Updated: Jun 16, 2017
  • Author: Joseph Kaplan, MD, MS, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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Medication

Medication SummaryFurther inpatient/outpatient medication

The primary medications in treatment of dysbaric injuries are oxygen, oxygen-helium, [32, 33, 34]  isotonic fluids, anti-inflammatory medications, decongestants, and analgesics.

Sinus and middle ear squeeze are treated identically. Decongestants are used to reduce the pressure differential. Administer oxymetazoline (Afrin) 0.05%, 2 squirts each nostril bid. Performing the Valsalva maneuver immediately after spray forces the medication into the osteo and helps to open them quickly. Administer pseudoephedrine (Sudafed) 60-120 mg PO bid/qid. Anti-inflammatory medications treat the pain. Administer aspirin 325-650 mg PO q4-6h. NSAIDs also may be used in standard dosages. Narcotic analgesics may be appropriate to treat more severe pain, eg, acetaminophen 300 mg with codeine 30 mg (Tylenol #3) 1-2 tablets PO q4-6h.

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Acetylsalicylic acid

Class Summary

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

Aspirin (Anacin, Ascriptin, Bayer aspirin)

Aspirin blocks prostaglandin synthetase action, which, in turn, inhibits prostaglandin synthesis and prevents the 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.

Oxymetazoline (Afrin, Allerest)

Oxymetazoline 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.

Pseudoephedrine (Silfedrine, Sudafed)

Pseudoephedrine stimulates vasoconstriction by directly activating alpha-adrenergic receptors of the respiratory mucosa. It induces bronchial relaxation and increases the 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.

Acetaminophen with codeine (Tylenol #3)

Acetaminophen with codeine is indicated for 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.

Methylprednisolone (Solu-Medrol, Depo-Medrol)

By reversing increased capillary permeability and suppressing PMN activity, methylprednisolone may decrease inflammation. It 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

Oxygen is the first line of treatment in dysbaric injuries. Administer it at high flow with a tight-fitting nonrebreather mask.

Helium-oxygen (heliox)

Helium-oxygen consists of 50% helium and 50% oxygen.

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