Professional Documents
Culture Documents
Provisional Fellow
Arterial Gas Embolism 2006
Photos Dr Robert Wong.
What Causes it?
• Diving accidents. 10% of Fremantle’s 40 per year
– Presentation.
– Pathophysiology.
– Treatment.
– Case report
• Iatrogenic.
– Review of Diagnosis and management.
Venous Versus Arterial Air.
Promotes trapping:
surface tension at the leading end
CAGE
Bubble size is important:
small bubbles redistribute
large bubbles occupying several branching arteries
may trap, 50-60micron bubbles.
Blood Pressure:
hypotension promotes trapping
hypertension and vasodilatation promote
redistribution
• Bubbles that trap cause ischaemia in the
downstream territory
• Ischaemic neurones - loss ion homeostasis
• cascade of events leading to necrosis
• duration of trapping is critical (bubble size)
CAGE
• Bubbles that redistribute damage endothelium
• stripping surfactant => leakiness of capillaries
• impaired autoregulation
• expression of adhesion molecules - leukocytes
accumulation, secondary ischaemia.
Ascent Rate
3 metres in
10 minutes
9 Metres
Attendant commences
Ascent Rate 100% Oxygen for 30 mins
3 metres in É 9 metres to surface
10 minutes
Ascent Rate
3 metres in
12m 5 minutes
Ascent Rate
3 metres in
5 minutes
18m
At 12 metres
First Atte ndant
Ascent Rate bec omes ‘patient' on
24m 3 metres in
5 minutes
100% Oxygen
Sec ond Attendant
Ascent Rate
3 metres in lock s in for remaind er
30m 5 minutes of tre atment
• Erect CXR
– Bubble load to CNS.
HBOT No HBOT
Full Recovery Dead Full Recovery Dead
• 1980-1999
• Retrospective study of all patients who
received HBOT for CAGEmbolism.
• Better outcome if treated within 6 hours.p<0.05
• Venous 3hour delay versus 8 hours Arterial
– Most arterial source was CBP, anesthetised
patients.
• Impaired consciousness 70%
• Focal motor deficit 60%
• Seizures 11%
• Visual 10%
• Dysarthria/Aphasia 5%
• Cardiovascular instability in 26%
• Respiratory disturbances in 23%.