Arterial Gas Embolism
Any neurological symptoms or loss of consciousness upon surfacing is considered AGE until proven otherwise. Treatment is supplemental O2, IV fluids, and most importantly, a hyperbaric chamber - Tyler Humphrey MD
HWN Suggests
Diving Emergencies for Dummies, Part II
The one complication of barotrauma that does require immediate treatment in a hyperbaric chamber is arterial gas embolism (AGE). This occurs when a diver fails to maintain an open airway or holds his or her breath during ascent, resulting in expansion of gas in the alveoli with subsequent rupture – the so-called pulmonary over-pressure syndrome. Air can then dissect into the pulmonary veins and make its way through the systemic circulation, including the cerebral and coronary arteries. This may manifest as a sudden onset of unconsciousness, myocardial infarction, stroke syndromes or seizures. Because emergency compression in the hyperbaric chamber can effectively shrink these gas bubbles and…
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Diving Injuries and Air Embolism
The majority of patients with dysbaric AGE present with neurological signs and symptoms, but spontaneous respiration and heart rate are maintained. Just as in the more seriously injured divers, onset of symptoms occurs during ascent or within minutes after surfacing. The clinical spectrum of neurological disturbances ranges from focal signs such as monoparesis or discrete sensory deficits to diffuse brain dysfunction, as manifested by confusion, stupor, or coma. In response to prompt recompression and hyperbaric oxygenation, most patients have complete resolution of all neurological deficits.
How to Avoid Rapid Ascents and Arterial Gas Embolism
AGE is one of the most serious medical emergencies a diver may experience. It can occur following a rapid ascent without adequate exhalation and is one of the reasons for the golden rule of scuba: never hold your breath.
Articles of Interest
Decompression Sickness and Arterial Gas Embolism
Arterial gas embolism, in which bubbles introduced into the arterial circulation cause multifocal ischemia, may occur after diving-related, iatrogenic, or accidental pulmonary barotrauma or by direct iatrogenic introduction of gas into the vasculature. Because it may be difficult to clinically differentiate decompression sickness from arterial gas embolism in divers and the treatment protocols for the two disorders are the same, the term “decompression illness” is sometimes used to indicate the presence of decompression sickness, arterial gas embolism, or both...
Scuba Emergencies (ascent)
Supine. 100% NRB while transporting to hyperbaric facility, intubate if necessary.
Resources
StatPearls
Treatment of cerebral gas embolism is immediate recompression on pure oxygen. First-aid includes placing the patient on 100% oxygen by nonrebreather mask or demand mask until recompression. Unstable patients or those with a Glasgow coma scale less than eight may be intubated for treatment when the chamber can support a ventilator.
