UNDERSEA & HYPERBARIC MEDICINE CURRICULUM

The Hyperbaric Fellowship includes 10 clinical months, 1 research rotation, 1 diving rotation, and 1 month of vacation.  During the clinical months, the Fellows alternate between the two clinical training sites.  Additional clinical exposure and education occurs through Divers Alert Network (DAN) emergency referrals of diving accidents from the Gulf of Mexico, participation at the National Oceanographic and Atmospheric Administration Physician Diving Program (two dedicated weeks with > 80 CME credit), participation in the UHMS Fitness to Dive Training Program, as well as participation in multiple Diving Medical Techinician Trainng and Educational Programs.  The Research rotation is devoted to an individual research project and interface with the research staff and facilities at the Baromedical Institute of New Orleans.  By the end of the fellowship, the Fellows have completed a publishable quality work product that is presentable to a regional or national meeting.

Overall, the LSU School of Medicine Hyperbaric Medicine Fellowship Program offers one of the broadest experiences in Undersea and Hyperbaric Medicine in the United States.

  

PRIMARY DUTIES

Fellows work 15 days a month (with on-call responsibilities).  The shifts begin at 7 am.  During this time, the Fellow (under constant input from the Hyperbaric Medicine Attending) will work-up all new consultations, see all the patients of the day, and prepare the Grand Round Presentation for the week.

 

VACATION

One month of vacation is offered, in one or two week increments.

 

EDUCATIONAL LEAVE

Leave is available for approved projects.

 

RESEARCH

One presentation, in the form of a case report, book chapter, or other research opportunity is required.  Our faculty have many research interests, and will actively participate in helping the Fellow fulfill this obligation.

 

DIVING EDUCATION

Ideally situated in a very robust area of the country for diving, this Fellowship offers many opportunities for diving accident experience.  The interested Fellow has the ability to fly out to many diving accident scenes, and survey on site diving operations, as well as partake in the acute treatment of injured divers.

 

CURRICULUM

Lectures are given as part of the daily experience of the Fellow. In addition, Grand Rounds are held every Wednesday.  All patient' progress and cases are reviewed, and impromptu lectures are held on a variety of topics.  Following patient rounds, three hours of didactic lectures are given by the Hyperbaric Medicine Faculty.

 

 JOURNAL CLUB ARTICLES OF INTEREST

ARTERIAL GAS EMBOLISM

• Clarke D, et al.  “Pulmonary Barotrauma-Induced Cerebral Arterial Gas Embolism with Spontaneous Recovery:  Commentary on the Rationale for Therapeutic Compression.”  Aviation, Space and Environmental Medicine 2002.  73 (2):  139 - 146.
• Blanc P, et al.  “Iatrogenic Cerebral Air Embolism: Importance of Early HBO Therapy.”  Intensive Care Med 2002.  28:  559 - 563.

CARBON MONOXIDE

• Thom S.  “Functional Inhibition of Leukocyte B2 Integrins by HBO in CO-Mediated Brain Injury in Rats.”  Toxicology and Applied Pharmacology 1993.  123:  248 – 256.
• Weaver LK, et al.  “HBO for Acute CO Poisoning.”  NEJM 2002.  347 (14):  1057 – 1067.
• Piantadosi, CA.  “CO Poisoning.” Undersea & Hyperbaric Med 2004.  31 (1): 167 – 177.
• Hampson NB, et al.  “CO Poisoning:  Interpretation of Randomized Clinical Trials and Unresolved Treatment Issues.”  Undersea and Hyperbaric Medicine 2001.  28 (3): 157 – 164.

GAS GANGRENE / NECROTIZING INFECTIONS

• Hirn M, et al.  “Effect of HBO & Surgery on Experimental  Multimicrobial Gas Gangrene.”  Eur Surg Res 1993.  25: 265 – 269.
• Hollabaugh R, et al.  “Fournier's Gangrene: Therapeutic Impact Of HBO.”  Plastic & Reconstructive Surgery 1998.  101:  94 - 100.
• Korhonen K, et al.  “Management of Clostridial Gas Gangrene and the Role of HBO."  Annales Chirurgiae et Gynaecologiae 1999. 88:  139 – 142.

CRUSH INJURY; COMPARTMENT ISCHEMIA; OTHER ACUTE ISCHEMIAS

• Strauss, MB, et al.  “Delayed Use of HBO for Treatment of a Model of Anterior Compartment Syndrome.”  J OrthRes 1986.  4:  108 – 111.
• Nylander G, et al.  “Lipid Peroxidation Products in Post-Ischemic Skeletal Muscle & After Treatment with HBO.”  Scand J Plast Reconst Surg 1989.  23:  97 – 103.
• Bouachour G, et al.  “HBO in the Management of Crush Injuries:  A Randomized Double-Blind Placebo-Controlled Clinical Trial.”  J Trauma:  Injury, Infection, and Critical Care 1996.  41 (2):  333 – 339.
• Garcia-Covarrubias L, et al.  “Adjuvant HBO in the Management of Crush Injury & Traumatic Ischemia:  An Evidence-Based Approach.”  Am Surg 2005.  71 (2):  144 – 151.

DECOMPRESSION SICKNESS

• Dick EJ, et al.  “Acute Neurologic Decompression Illness in Pigs:  Lesions of the Spinal Cord & Brain.”  Lab Animal Sci 1997.  47 (1):  50 – 57.
• Barratt DM, et al.  “Decompression Illness in Divers:  A Review of the Literature.”  The Neurologist 2002.  8 (3):  186 – 202. 
• Castagna O, et al.  “Pre-Dive Normobaric O2 Reduces Bubble Formation in Scuba Divers.”  Eur J Appl Physiol 2009.

EXCEPTIONAL BLOOD LOSS ANEMIA

• Boerema I, et al.  “Life Without Blood. A Study Of The Influence Of High Atmosphere Pressure &  Hypothermia On Dilution Of The Blood.”  J CV Surg 1960.  133 - 146.
• Yamashita M.  “HBO Attenuates Cytokine Induction After Massive Hemorrhage.”  Am J Physiol Endocrinol Metab 2000.  278 (5):  E811 – E816.
• Greensmith JE.  “HBO Reverses Organ Dysfunction in Severe Anemia.”  Anesthesiology 2000.  93 (4):  1149 – 1152. 
• Van Meter K.  “A Systematic Review of the Application of HBO in the Treatment of Severe Anemia:  An Evidence-Based Approach.”   Undersea & Hyperbaric Medical Society 2005.  32 (1):  61 – 83. 

INTRACRANIAL ABSCESS

• Kulay M, et al.  “Stereotactic Aspiration &  Antibiotic Therapy Combined with HBO in the Management of Bacterial Brain Abscess.”  Neurosurg 2005.  57:  1140 - 1146.

REFRACTORY OSTEOMYELITIS

• Mendel V, et al.  “Synergy of HBO2 and a Local Antibiotic Carrier for Experimental Osteomyelitis Due to Staphylococcus Aureus in Rats.”  UHM 2004.  31 (4):  407 – 416. 
• Morrey BF et al.  “HBO &  Chronic Osteomyelitis.”  Clin Ortho Rel Res 1979.  144: 121 - 127. 
• Chen, CE, et al.  “Results of Chronic Osteomyelitis of the Femur Treated with HBO:  A Preliminary Report.”  Chang Gung Med J  2004.  27 (2):  91 – 97.

THERMAL BURNS

• Villanueva, E, et al.  "Hyperbaric Oxygen Therapy for Thermal Burns (Review).”  The Cochrane Database of Systemic Reviews 2004.  Issue 2.  Art No:  CD004727.  Pubs2.  DOI:  10.1002/14651858.

TRAUMATIC BRAIN INJURY

• Rockswold, et al.  “Results of a Prospective Randomized Trial for Treatment of Severely Brain-Injured Patients with HBO.”  J Neurosurg, 1992:  76:  929 - 934.
• Harch, P, et al.  “Hyperbaric Oxygen Therapy Improves Spatial Learning and Memory in a Rat Model of Chronic Traumatic Brain Injury.”  Brain Res 2007.   1174; 120 -129.

BRAIN INJURY / STROKE

• Collet, et al.  “HBO for Children with Cerebral Palsy: A Randomized Multicentre Trial.”  Lancet, 2001.  357:  582 - 586.
• Rusyniak, et al.  “HBOT in Acute Ischemic Stroke, Results of the HBO in Acute Ischemic Stroke Trial Pilot Study.”  Stroke 2003.  34:  571 - 574.

CENTRAL RETINAL ARTERY OCCLUSION

• Butler FK, Hagan C, Murphy-Lavoie H.  “HBOT & the Eye.”  UHM  2008.

NEW HORIZONS

• Van Meter K, et al.  “HBOT Returns the Rate of Return of Spontaneous Circulation After Prolonged Normothermic Porcine Cardiopulmonary Arrest.”  Resuscitation. 2008.
• Stavitsky Y, et al. “HBO &  Thrombolysis in Myocardial Infarction:  The ‘HOT MI’ Randomized Multi-Center Study.”   Cardiology 1998.  90: 131 - 136.
• Sharifi M, et al. “Usefulness of HBOT to Inhibit Restenosis After Percutaneous Coronary Intervention for Acute Myocardial Infarction or Unstable Angina Pectoris.”  Am J Cardiol 2004.  93: 1533-1535.
• Alex J, et al.  “Pretreatment with HBO & its Effect on Neuropsychometric Dysfunction and Systemic Inflammatory Response after Cardiopulmonary Bypass:  A Prospective Randomized Controlled Double-Blinded Trial.”  J Thoracic Cardiovasc Surg 2005.  130: 1623 - 1630.