Looking for any help I can get....

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    Hello everyone. I have been an RN for about 7 years. In my time I have worked in ER the longest (level 1 trauma center included), also spent time in an extremely tough CTICU (managed every kind of open heart patient as well as lung and heart transplant patients), spent time in disaster medicine (FEMA), and worked ortho/med/surg when I first graduated. I work at a large university hospital, and it operates one of two full time hbo departments in the entire city. As fate would have it, the full time HBO nurse at my hospital quit after 10 years of service, and gave very little notice. All part time/casual staff have also quit over the past several months. In a panic, the emergency department offered me the job 2 days ago (clinical coordinator/full time RN for HBO). Having no knowledge of hyperbaric medicine, or knowing what I was getting myself into....I accepted. The current hbo nurse leaves 1 week from tomorrow, and then it will be up to me to run the entire department, as well as train additional casual/part time staff. Today was my second day of training with the nurse. There is no formal class or orientation to take for this job. The only person in the entire hospital who truly understands how to run the department and handle every kind of hyperbaric emergency...adult and pediatric, leaves next Friday. This is a 40hr week position as well as being on call around the clock. In the two days I have spent with her so far, I am falling in love with hyperbaric medicine. It is unlike anything I know, and the autonomy and leadership given to me blow me away. The problem is that I have absolutely nobody to turn to for help. I am overseen by an ED physician who screens all patients. He loves HBO, is a really good guy....and has been doing this for years. Unfortunately, when it comes to equipment, and how to handle patients, there will be nobody in the entire hospital system for me to turn to.......so......I arrive at my questions....

    1.) What is the best publication to enroll in so I can begin learning as much about hyperbaric medicine as I can?
    2.) I am writing down every single bit of knowledge I can get from the current nurse, I am drawing diagrams, I am locating and reading every policy/instruction/teaching manual I can get my hands on. Do any of you seasoned hbo nurses have any really important tips for a starting nurse?

    I'm hoping that I can turn to this online community and draw from your knowledge base. At this time I am trying to arm myself with any resources I can in this field, and may post problems I encounter here.

    -Thanks
    -Dan
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    Ouch. That's a rough situation, but hang tough because you should be able to pull through. I don't think there is enough information to judge the best course of action for you. Are you running a monoplace or multiplace system? I'm -guessing- you're going to be working at a small monoplace practice, based on your need for outside help, so you don't have any other hyperbaric staff (even CHTs or operators) to support you.

    The first and most important thing you can do is to take a hyperbaric course somewhere. I would look for a clinical hyperbarics course rather then a "technical" one, though both will be valuable for different reasons (the clinical one will help you more initially as it deals more with physiology, while the technical one is more about protocols and the mechanics of hyperbarics.) After that, work on your CHRN. It's not going to be the end-all be-all of knowledge, but it's a good first step and passing that will show basic competency and will serve you well in the future. I would recommend more time learning before you're "on your own," but it sounds like you're pretty overtaken by events, and that isn't an option. Dick Clarke in Columbia, SC puts on a good clinical course, I was told. A good technical course is Dick Rutkowski's in Key Largo, if he's still alive.

    For references, the Navy Dive Manual is scary in size, but has a lot of information. Most of it isn't directly applicable, but it's free, so the price is right. There is a section in it on running a chamber, but that is mostly related to either doing planned or unplanned decompression of divers. The NOAA Dive Manual is also a good reference, but against, oriented towards diving rather then clinical hyperbarics practice. Those were the two text I used (in addition to some dog-earred dive manual my nurse manager had from his commercial diving days.) Of course, I was a paramedic training as a chamber op/tender, not as a nurse (while there was little difference in day-to-day operations in the practice I worked, there was a noticeable 'clinical knowledge' gap) but I needed to learn the technical end of things and the clinical was more OJT.

    With regards to how to do the job -now-. Step 1, worry about safety. Hyperbarics can be very dangerous and if you don't pay attention and your patients do something stupid, could not only be fatal to them but physically dangerous to your facility. Worry about fire hazards, make sure that everything that goes in your chamber is clean and NOT contaminated by the outside. This is particularly relevant if you are operating a 100% oxygen monoplace chamber. After that, worry about management of emergencies at depth. Most of them can simply be fixed by dropping the oxygen to room air and bringing them to the surface, and while you may -never- have an emergency in your chamber, if you do you need to react quickly and correctly. After that, it's just a matter of learning as much as you can, and getting more time and experience.

    Join the UHMS, go to that conference. You'll learn something, I don't know anyone who has ever been able to say they didn't learn something there, though I've never been myself.

    I'm not a CHRN, nor am I a hyperbaric nurse (just a new grad nurse) by the way, so I'm not qualified to talk about the clinical side of that much more then I already have. The technical side of chambers, I'll be happy to help as much as I can. I've worked the last couple years in commercial diving, mostly deep-water saturation work, providing medical and safety support. So I'm not a complete babe in the woods.

    Good luck.
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    Thanks for the outstanding information/reply/and support. Safety is definitely the most important priority. The nurse I'm replacing sometimes lets patients into the chamber with their clothes on. I'm planning on the changing the policy.....every patient that goes in, goes in naked with only a 100% cotton gown, pockets empty, no jewelry. Static electricity is my biggest fear. I also need to make sure that nobody enters the chamber with a device (example : AICD) that hasn't been tested/approved to handle the pressure I'm going to place it under. Its funny how 98 percent of nurses have no idea what hyperbarics is, or think its a cakewalk. I was one of them....now I'm learning otherwise. I think I'm subscribe to the group you recommended, read their bimonthly journal. Perhaps attend some conferences down the road. I was going to pursue my CEN, but knowing that I'm know expected to be one of the 2 authorities on hyperbaric medicine in the entire city, I think I'll pursue my hyperbaric certification. I need to eat....sleep...and breath hyperbarics for forseeable future.

    -Dan
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    http://www.hyperbaricnurses.org/ Please call them, they are very helpful. Also you didnt state what area of US you are located, but you can ask the association where is there a class for you to take. You should have policies, try to read each one for your diagnosis. Please also read you manual for your chambers, and call the manufacturer for any questions. If you need more help just re-post. What type of chambers do you have and how many ?
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    I know that in our multiplace we had patients go in in street clothes and it wasn't a problem. We made sure they covered their feet so oil/asphalt from their shoes didn't contaminate the chamber permanent, but it wasn't a major concern. It was a lax procedure, but having a serious chamber fire is unlikely below 23.5% O2, and we never came close to that, so it was low on our list of concerns. However, if I were completely new to the field OR were starting on my own, I think it's a better procedure to have patients change into scrubs or some other 100% cotton clothing that they keep at the chamber exclusively for their treatment.

    I would also be careful about making any immediate changes that may be 'insulting' to your outgoing man, unless it's to fix a direct safety hazard. S/he may end up being your best resource if he's still willing to answer the phone after he leaves, but if you make too many changes and he feels insulted, that avenue may become unavailable to you. And noone in the world is going to know that system as well as they do at least until you come into your own as the expert.
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    Thanks for all the help guys. I will be running a department with 2 monoplace chambers. I am located on the east coast. The outgoing hbo nurse is leaving the entire hospital system, and not telling a soul where she's going. She is washing her hands of this, and after next week I won't be able to turn to her with questions. You guys have provided some great links on here, I plan on checking them all out.
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    again, safety is the best thing. we have just had the first mono chamber fire in the us. http://cbs4.com/local/hyperbaric.chamber.explosion.2.999108.html
    at the last conference i attended in san antonio for the safety directors course, most agreed that they do not allow steet clothes - some patients do bring 100% undershirt & hanes pj bottoms ( from k-mart), but i have seen videos of people getting into chambers dressed in street clothes, ties etc.
    the course you need to take will teach you all of this, i agee dick clarkes' class is the best that comes to mind, and dick rutolowki ..yes he is still alive, i took his class- it is more geared towards more experienced personnell, so i wouldn't suggest that one at this time...but his class is a blast non the less. about the implants, yes you have done well. i call the company and ask for a fax copy of the ok stating up to what ata the device will handle & it goes on the first page of the patient file.
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    It sounds like you have a "nose" for the important things...safety being number one. I did hyperbaric nursing for 5 years while working in a Burn Unit (was cross trained). My course was given by one of the experts, Dr. Eric Kindwal (he has a textbook out you can look it up on Amazon). He had an amazing knowledge and breadth of experience and research. The course was 40 hours. We had (at the time) two monoplace chambers (I never worked with the multiplace chamber that came later). With the monoplace, you do have to be very vigilant about what the patients wear and what goes inside. Our patients had to wear 100 % cotton surgical scrubs (we provided). We always worked as a team. with a hyperbaric trained RT running the actual chamber, and the hyperbaric trained RN taking care of the patient. A HBO doc had to be present at the beginning of the dive and at the end and at q 15 monute intervals throughout. One of our chambers was an ICU monoplace in which we could run a ventilator, IV lines, and full monitoring. I only ever had one true emergency. A patient started seizing at depth. I followed protocol, and we did a rapid ascent. The patient was unharmed. One thing that comes to mind, is always check the blood sugar of diabetics prior to the dive. What would seem a normal reading were given hyper sugar solutions since the chamber makes the blood sugar drop precipitously. I worry for you that you have no resources to call on with questions, there on site. You need a mentor...


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