gas embolism


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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.

air em·bo·lism

an embolism caused by air bubbles in the vascular system; venous air embolism can result from the introduction of air through intravenous lines, especially central lines, and generally must be substantial to block pulmonary blood flow and cause symptoms; arterial air embolism is also usually iatrogenic, caused by cardiopulmonary bypass or other intravascular interventions, occurs rarely after penetrating lung injury; small amounts of arterial air can cause death by blockage of coronary and/or cerebral arteries; small bubbles introduced into the venous system may similarly cause symptoms if they reach the arterial side. Compare: paradoxical embolism.
Synonym(s): gas embolism

air embolism

The presence of gas in blood vessels, which is most significant in the coronary and cerebral arteries. An estimated 100 cc of gas (air) may suffice to cause death, as it blocks blood flow, not unlike a vapour lock in a hydraulic system. To document AE at autopsy, the organ must be opened underwater to detect bubbling.

gas em·bo·lism

(gas em'bŏ-lizm)
Occlusion of one or more small blood vessels, especially in muscles, tendons, and joints, caused by expanding gas bubbles.

gas embolism

See AIR EMBOLISM.
References in periodicals archive ?
Avradopoulos, "Portal vein gas embolism from hydrogen peroxide ingestion," Annals of Emergency Medicine, vol.
Perez, "Fatal Cerebral Gas Embolism after Hemodialysis," Journal of Neurology and Stroke, vol.
Arterial Gas Embolism. Almost two-thirds of patients with AGE have alterations of consciousness, with seizures, focal deficits, and coma accounting for the majority of presentations [27,43-45].
This algorithm shows how overexpanding gas ruptures alveoli and produce air bubbles, which can be distributed through systemic circulation to other body tissues causing, sometimes, arterial gas embolism.
For arterial gas embolism, hyperbaric oxygen is the treatment of choice, as soon as cardiopulmonary stabilization has been achieved.
[Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases].
Scuba diving is not safe, as the foetus is not protected against decompression sickness and gas embolism. Horseriding, downhill skiing, ice hockey, gymnastics and cycling during pregnancy should be avoided because if you lose your balance and fall it could harm the unborn child.
On the basis of products, the overall market has been segmented into monoplace HBOT devices, multiplace HBOT devices and topical HBOT device On the basis of application type, the market has been segmented into wound healing, decompression sickness, infections, gas embolism and others.
Pulmonary interstitial emphysema with gas embolism in hyaline membrane disease.
It pierced a major vein which led to a fatal gas embolism, massive blood loss and cardiac arrest, an inquest was told.
An official cause of death was not given, but it is thought a provisional cause of death may be a gas embolism.
The initial HBOT was usually a RN62 (lasting a total of 4.75 hours, initially at a pressure of 2.8 ATA and then reduced to 1.9 ATA), which is the standard treatment used for the initial presentation of cerebral arterial gas embolism (CAGE) related to self-contained underwater breathing apparatus (SCUBA) diving accidents.