UHM Journal-Based CME Volume 52, Issue 4

Table of Contents:

1. Reversal of a Globus Pallidus Injury in a Severe Carbon Monoxide Poisoned Patient
   Charles S. Graffeo, MD; Matthew J. Petitt, BS2; Lexie E. Neubauer, MD; Gail D. Steckler, DO; Barry J. Knapp, MD
2. Dermatologic medical ozone therapy complications treated with hyperbaric oxygen
   Patricia McCray, RN; Kelly Johnson-Arbor, MD
3. Recompression and Adjunctive Therapies in DCI Management in Divers: A Review of RCTs
   Thomas Fairhead, MBBS
4. Synergistic Neuroprotection by Caffeine and Astaxanthin Against CNS-OT
   Mia Rosenberg, BSc; Rafael Ezra, MSc; Ran Arieli, PhD; Uri Barash, PhD
5. Evaluation of the efficacy of modified low-dose HBO2 therapy
   Subhranshu Kumar, MD; Vishal Kansal, MD; Harsh Bir Singh Chaudhry, MD; Sourabh Bhutani, MD; Chandra Sekhar Mohanty, MD
6. Cerebral Arterial Gas Embolism During Watchman Device Implantation
   Brock Preheim, BA; Siamak Moayedi, MD; Kin Wah Chew, MD; Kinjal Sethuraman, MD, MPH
7. Case Report: Complete Coverage Of Chronic Sickle Cell Leg Ulcer Using Hyperbaric Oxygen Therapy Combined With Skin Grafting
   Koga Luhulla, MD, MMed; Queen Martin, MD; Agape Bhoke, BScN; Samira Mahfudh, MD, MMed; Aslam Nkya, MD, MMed; Albert Magohe, MD, MPH, MMed; Mbonea Yonazi, MD, MMed; Jay C. Buckey, MD
8. Safety Of Hyperbaric Oxygen Therapy In Patients Aged 75 And Older: A Multicenter Retrospective Study
   Andrea Neville Cracchiolo, MD; Daniela Maria Palma, MD; Erik Flavio Giuseppe Saporito, MD; Carmelo Palazzolo, MD; Salvatore Massimo Mannino, MD; Fabio Genco, MD; Filippo Vitale, MD; Luigi Profera, MD; Santi Maurizio Raineri, MD; Giuseppe Accurso, MD

Objectives:

• Describe the pathophysiology of carbon monoxide (CO) poisoning, including the formation of carboxyhemoglobin and its effects on tissue oxygen delivery.
• Identify clinical and laboratory features associated with severe CO poisoning, including neurologic, metabolic, and cardiovascular findings.
• Recognize characteristic neuroimaging findings of CO poisoning, particularly involvement of the globus pallidus on CT and MRI.
• Evaluate the potential role of HBO₂ therapy in patients with severe CO poisoning and poor prognostic indicators, based on clinical presentation and imaging findings.
• Differentiate the various methods of administration of medical ozone therapy
• Summarize the potential health benefits associated with medical ozone therapy
• Identify 3-4 risks associated with administration of medical ozone therapy
• Summarize the current randomized controlled trial (RCT) evidence evaluating recompression strategies and adjunctive therapies for diving-related decompression illness (DCI).
• Compare the key trial findings for (a) tenoxicam as an adjunct to recompression and (b) a shorter initial recompression table (FH01) versus a modified TT6 approach in mild DCI, focusing on impacts on recompression burden and short-term symptom resolution.
• Appraise the main methodological limitations and bias risks in the existing RCT literature (e.g., blinding, non-protocol interventions, incomplete follow-up) and identify priority directions for future research (including standardization of case definition/classification).
• Discover the pathophysiology of CNS-OT: Learn the role of reactive oxygen species (ROS) and pre-convulsive cerebral hyperemia in triggering seizures during hyperbaric hyperoxia.
• Uncover the mechanistic synergy of caffeine and astaxanthin: elucidate the pharmacological rationale for combining an adenosine receptor antagonist (caffeine) with a potent carotenoid antioxidant (astaxanthin) in mitigating CNS-OT.
• Recognize the paradigm of multi-target neuroprotection: Assess the clinical significance and efficacy of combined therapeutic strategies compared to monotherapy in extending the latency to hyperbaric oxygen-induced seizures.
• Learn how Hyperbaric Oxygen Therapy (HBO2) works and its role in treating soft tissue radiation injury.
• Comprehend the impact of modifying the standard HBO2 regimen and understand the unique features of different chamber types and their applications during various limitations.
• Understanding the importance of data collection and conducting studies, even simple ones, is crucial in this unique field. Research is highly needed, and small studies can lead to significant long-term outcomes. 
• Hyperbaric medicine physicians should be familiar with the Watchman procedure as an increasingly utilized medical procedure with risk of cerebral arterial gas embolism.
• Cerebral arterial gas embolism is a clinical diagnosis and should not depend on the visualization of air on neuroimaging.
• The possibility of cerebral gas embolism should be considered in patients emerging from anesthesia with neurologic deficits.
• To recognize chronic leg ulcer as a severe and treatment-resistant complication of sickle cell anemia.
• To understand the role of hyperbaric oxygen therapy as an adjunctive modality in the management of chronic sickle cell–related leg ulcers, including its use alongside skin grafting.
• To understand the central role that pre- and post-treatment clinical and instrumental assessment plays in reducing the risk of undesirable effects or adverse events in a patient population whose frailty is linked to both the high incidence of comorbidities and the reduced physiological reserve characteristic of this patient population. 
• Be clear about the values relating to vital functions (systolic and diastolic arterial blood pressure, heart rate, peripheral oxygen saturation, body temperature and blood glucose level) considered physiological to treat patients with acceptable safety limits.
• Understand that the risk of adverse effects, which is only slightly higher than that reported in other studies involving younger patients, is linked to the increased vulnerability of these individuals and can be controlled through proper clinical and instrumental assessment before and after HBO2, clear and friendly communication, and adequate preparation by medical, nursing, and technical staff.

Price:

• Non-Member: $180
  Regular UHMS Member: $140
  Associate UHMS Member: $100

Goal
For over 50 years the UHMS has been the primary source of information for hyperbaric medicine and physiology worldwide. This evidence based, peer-reviewed scientific journal-based CME has as its goal to address identified professional practice gaps and provide a quality CME opportunity which will improve scientific knowledge and skills for undersea, hyperbaric and wound care physicians, nurses and technicians, and other clinicians and personnel whose practice includes undersea, hyperbaric medicine and wound care.

Target Audience – Included in the “goal”

Date of the activity’s original release – August 25, 2026
Termination date – August 25, 2029

Accreditation Statement: The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statements: 

Physician CME: The Undersea & Hyperbaric Medical Society designates this journal-based activity for a maximum of 8 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing/RRT Contact Hours: 8.00
Wound Care Education Partners is a Florida based company and a licensed CE Provider through the Florida State Board of Nursing and the CE is reciprocal for nurses in the United States. Florida nursing credits are reciprocal and approved for nurses within all states. Receiving credit for Florida providers is simple, attend the course and our staff will upload your credits directly to the Florida State database. For out of state credit, we provide the necessary paperwork for you to file with the respective nursing board. License Types eligible for credits: RN, APRN, LPN, CNA, RCP, CRT, RRT

NBDHMT Category A: This journal-based activity is approved for 4.00 Category A and 4.00 Category B credit hours by National Board of Diving and Hyperbaric Medical Technology, P.O. Box 758, Pelion, South Carolina 29123.

NBDHMT Accreditation Statement: For CHT recertification purposes, the NBDHMT requires a minimum of nine of the minimum 12 required Category A credits relate directly to any combination of hyperbaric operations, related technical aspects and chamber safety.

CME For MOC Program Guide Designation Statements for ABMS Boards

As an accredited ACCME provider, the UHMS is now responsible to submit physician learner CME credits into the ACCME PARS system. However, it is the physician’s responsibility to submit the necessary information required to match with the ACCME PARS system. It is also the physician’s responsibility to check with their respective board(s) to see that the credits were applied accordingly.

 American Board of Anesthesiology (ABA)
“This activity contributes to the CME component of the American Board of Anesthesiology’s redesigned Maintenance of Certification in AnesthesiologyTM (MOCA®) program, known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements.”

American Board of Internal Medicine (ABIM)***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 8 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.”

American Board of Otolaryngology – Head and Neck Surgery (ABOHNS) ***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn their required annual part II self-assessment credit in the American Board of Otolaryngology – Head and Neck Surgery’s Continuing Certification program (formerly known as MOC). It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of recognizing participation.”

American Board of Orthopaedic Surgery (ABOS) ***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME of the American Board of Orthopaedic Surgery’s Maintenance of Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABOS credit."

American Board of Pathology (ABPath)
This activity has been registered to offer 8 AMA PRA Category 1 CreditsTM towards the American Board of Pathology’s Continuing Certification program Lifelong Learning credits.

American Board of Pediatrics (ABP) ***
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 8 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.”

American Board of Surgery (ABS) ***
“Successful completion of this CME activity [which includes participation in the evaluation component], enables the learner to earn credit toward the CME [and Self-Assessment] requirement(s) of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit."

American Board of Thoracic Surgery (ABTS) ***
“Successful completion of this CME activity [which includes participation in the evaluation component,] enables the learner to earn credit toward the CME [and Self-Assessment] of the American Board of Thoracic Surgery’s Maintenance of Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABTS credit."

American Board of Physical Medicine and Rehabilitation (ABPMR) ***
“Successful completion of this CME activity [which includes participation in the evaluation component,] enables the learner to earn credit toward the CME [and Self-Assessment / Improving Health and Health Care / Patient Safety] requirements of the American Board of Physical Medicine and Rehabilitation’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABPMR credit."

American Board of Preventive Medicine (ABPM)
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 8 credits towards the American Board of Preventive Medicine's Continuing Certification Program (CCP). It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABPM CCP credit.”

***Will require evaluation feedback

UHMS Disclaimer: The information provided at this CME activity is for Continuing Medical Education purposes only. The lecture content, statements or opinions expressed however, do not necessarily represent those of the Undersea and Hyperbaric Medical Society (UHMS), its affiliates or its employees.

Disclosure:
All individuals in control of content for this educational activity with their relevant financial relationship disclosed are listed below (if applicable). An individual who refuses to disclose relevant financial relationships will be disqualified from being in control of educational content at any time, and cannot have control of, or responsibility for, the development, management, presentation, or evaluation of the CME activity. 

Financial relationships are relevant if the following three conditions are met for the individual who will control content of the
education:

• A financial relationship, in any amount, exists between the person in control of content and an ineligible company.
• The content of the education is related to the products of an ineligible company with whom the person has a financial relationship.
• The financial relationship existed during the past 24 months

“None of the individuals in control of content (planners/faculty/reviewers/authors) for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.”

There are no relevant financial relationships with ineligible companies to mitigate for this educational activity.

No commercial support was received for this activity.

Hardware/Software Requirements:
Hardware required for a learner to participate in this journal-based enduring material activity includes:

• Computer with internet connection and a modern, updated browser
• Note: If using IE 6, IE 7, or IE 8 we cannot guarantee that the courses will work.
• Keyboard to take the quizzes

This journal-based Internet Enduring Material activity is produced for online use.

Provider Contact Information

If at any time during participation in this online CME enduring material event, a learner can contact UHMS, by clicking on "Contact Us" tab located on the far right hand side of the main menu bar found at the top of the screen. Also, the contact phone number and email address (hotlink) is always displayed on the top center of the screen, under the main menu bar.

Undersea and Hyperbaric Medical Society (UHMS)
631 U.S. Highway 1, Suite 307
North Palm Beach, FL 33408
Phone: +1-919-490-5140/877-533-8467
Fax: +1-919-490-5140
Email: uhms@uhms.org