gas embolism

Gas Embolism 

Definition

Gas embolism, also called air embolism, is the presence of gas bubbles in the bloodstream that obstruct circulation.

Description

Gas embolism may occur with decompression from increased pressure; it typically occurs in ascending divers who have been breathing compressed air. If a diver does not fully exhale upon ascent, the air in the lungs expands as the pressure decreases, overinflating the lungs and forcing bubbles of gas (emboli) into the bloodstream. When gas emboli reach the arteries to the brain, the blood blockage causes unconsciousness. Gas embolism is second only to drowning as a cause of death among divers.

Gas embolism may also result from trauma or medical procedures such as catheterization and open heart surgery that allow air into the circulatory system.

Causes and symptoms

Gas embolism occurs independent of diving depth; it may occur in as little as 6 ft of water. It is frequently caused by a diver holding his breath during ascent. It may also result from an airway obstruction or other condition that prevents a diver from fully exhaling.

The primary sign of gas embolism is immediate loss of consciousness; it may or may not be accompanied by convulsions.

Diagnosis

Any unconscious diver should be assumed to be the victim of gas embolism, regardless of whether consciousness was lost during or promptly after ascent. A doctor may also find pockets of air in the chest around the lungs and sometimes a collapsed lung from overinflation and rupture. Coughing up blood or a bloody froth around the mouth are visible signs of lung injury.

Treatment

Prompt recompression treatment in a hyperbaric (high-pressure) chamber is necessary to deflate the gas bubbles in the bloodstream, dissolve the gases into the blood, and restore adequate oxygenated blood flow to the brain and other organs. Recompression by returning the diver to deeper water will not work, and should not be attempted. The patient should be kept lying down and given oxygen while being transported for recompression treatment.

Key terms

Compressed air — Air that is held under pressure in a tank to be breathed underwater by divers. A tank of compressed air is part of a diver's scuba (self-contained underwater breathing apparatus) gear.

Compression — An increase in pressure from the surrounding water that occurs with increasing diving depth.

Decompression — A decrease in pressure from the surrounding water that occurs with decreasing diving depth.

Emboli — Plural of embolus. An embolus is something that blocks the blood flow in a blood vessel. It may be a gas bubble, a blood clot, a fat globule, a mass of bacteria, or other foreign body. It usually forms somewhere else and travels through the circulatory system until it gets stuck.

Hyperbaric chamber — A sealed compartment in which patients are exposed to controlled pressures up to three times normal atmospheric pressure. Hyperbaric treatment may be used to regulate blood gases, reduce gas emboli, and provide higher levels of oxygen more quickly in cases of severe gas poisoning.

Recompression — Restoring the elevated pressure of the diving environment to treat gas embolism by decreasing bubble size.

Before the diver receives recompression treatment, other lifesaving efforts may be necessary. If the diver isn't breathing, artificial respiration (also called mouth-to-mouth resuscitation or rescue breathing) should be administered. In the absence of a pulse, cardiopulmonary resuscitation (CPR) must be performed.

Prognosis

The prognosis is dependent upon the promptness of recompression treatment and the extent of the damage caused by oxygen deprivation.

Prevention

All divers should receive adequate training in the use of compressed air and a complete evaluation of fitness for diving. People with a medical history of lung cysts or spontaneous collapsed lung (pneumothorax), and those with active asthma or other lung disease must not dive, for they would be at extreme risk for gas embolism. Patients with conditions such as alcoholism and drug abuse are also discouraged from diving. Individuals with certain other medical conditions such as diabetes may be able to dive safely with careful training and supervision.

Resources

Organizations

American College of Hyperbaric Medicine. PO Box 25914-130, Houston, Texas 77265. (713) 528-0657. http://www.hyperbaricmedicine.org.

Divers Alert Network. The Peter B. Bennett Center, 6 West Colony Place, Durham, NC 27705. (800) 446-2671. http://www.diversalertnetwork.org.

Undersea and Hyperbaric Medical Society. 10531 Metropolitan Ave., Kensington, MD 20895. (301) 942-2980. http://www.uhms.org.

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gas embolism,

an occlusion of one or more small blood vessels, especially in the muscles, tendons, and joints, caused by expanding gas bubbles. Gas emboli can rupture tissue and blood vessels, causing decompression sickness and death. This phenomenon commonly affects deep-sea divers who rise too quickly to the surface without adequate decompression. Gas emboli are most dangerous in the central nervous system because of associated neurologic changes, such as syncope, paralysis, and aphasia. Such emboli are extremely painful. The prevention and treatment of gas emboli involve gradual decompression of atmospheric gases, especially nitrogen, that are dissolved in the blood. Compare air embolism, fat embolism. See also decompression sickness.