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Arterial gas embolism
Last reviewed: 23.04.2024
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Arterial gas embolism is a potentially catastrophic phenomenon that occurs when gas bubbles enter the arterial system or form in it and clog the lumen of the vessels, causing ischemia of the organs. Arterial gas embolism can cause damage to the central nervous system with rapid loss of consciousness and other neurological disorders. Ischemia and other organs are possible. Diagnosis based on clinical data can be confirmed using visualization methods of research. Treatment consists in immediate recompression.
Gas emboli can enter the arterial bloodstream from ruptured alveoli after a light barotrauma, form inside the arterial vessel directly in case of severe caisson disease, or migrate from venous blood flow (venous gas embolism), or through a right-to-left shunt (uninfected oval opening, interatrial septal defect), or when the filtration capacity of the lungs is exceeded. Venous gas embolism, without getting gas into the arterial system, is less dangerous. Despite the fact that the most serious manifestation of this is embolism of cerebral vessels, arterial gas embolism can cause significant ischemia in other organs (for example, spinal cord, heart, skin, kidneys, spleen, GIT).
[Symptoms of arterial gas embolism
Symptoms develop within a few minutes of ascent and can include changes in consciousness, hemiparesis, motor or sensory deficiency, seizures, loss of consciousness, respiratory arrest and shock; death may come. Symptoms of barotrauma of the lungs or of type II caisson disease are also possible.
Other symptoms may be due to arterial gas embolism of the coronary arteries (eg, arrhythmias, AMI, cardiac arrest), skin (cyanotic marbling, focal pallor of the tongue) or kidneys (hematuria, proteinuria, kidney failure).
Diagnosis of arterial gas embolism
The diagnosis is based, first of all, on clinical data, with high probability, if the diver loses consciousness during or immediately after surfacing. It is difficult to confirm the diagnosis, because air can be reabsorbed from a damaged artery prior to research. However, visualizing methods that can help confirm the diagnosis include echocardiography (reveals air in the ventricles of the heart), ventilation perfusion scintigraphy (demonstrates the changes caused by embolism of the branches of the pulmonary artery), CT angiography of the chest (reveals air in the pulmonary veins), and CT of the head (it detects intraparenchymal gas and diffuse edema). With the same symptoms sometimes occurs caisson disease.
Treatment of arterial gas embolism
If a diver is suspected of gas embolism, a diver should be re-compressed as soon as possible. Transportation to the recompression chamber has an unconditional priority over all other measures. Transportation by air can be justified only if it saves considerable time, but the effect of low pressure at altitude needs to be minimized.
Before transportation, 100% O2 is produced by a large flow, washing out N, increasing the pressure gradient N between the lungs and the bloodstream, which accelerates the reabsorption of the emboli. Patients should be in position on the back.
Artificial ventilation of the lungs, the appointment of vasoconstrictive drugs and resuscitation are carried out as needed. The position of the patient lying on the left side or in the Trendelenburg position is no longer required.