Arterial gas embolus

,A complication of diving accidents and vascular access procedures.

Arterial gas embolism (AGE) is a complication of lung barotrauma of ascent.

Symptoms develop quickly and often dramatically.

In one study symptoms occurred during ascent, at the surface, or within five minutes after arrival at the surface in 92% of cases.

Latency longer than 10 minutes is rare.

AGE can occur after an ascent  to the surface  from the depth as shallow as 1 m.

There are many accidental and iatrogenic causes of AGE.

AGE can occur in divers if expanding compressed air is trapped in the lungs as ambient pressure falls during the assent to the surface, causing rupture of aveolar capillary membranes and gas entry into the pulmonary vasculature.

Bubbles are introduced into the arterial circulation where they can cause multifocal ischemia, and may occur after diving related, iatrogenic, or accidental pulmonary barotrauma or by direct iatrogenic introduction of gas into the vasculature.

Large intra-arterial bubbles can cause arterial occlusion, ischemia, and infarction.

Clinical manifestations suggest cerebral involvement, often distributed in multiple cerebral vascular territories, with multifocal manifestations.

Brain effects after bubble induced ischemia are similar to a stroke, including excitatory neurotransmitter release, oxidative oxidative stress, inflammation, and an immune response.

Initial manifestations include loss of consciousness (39%), followed by confusion, dizziness, and presyncope, hemiplegia, visual changes, headache, dysphasia, and seizures.

Half the cases have underlying pulmonary barotrauma, such as chest pain and hemoptysis.

Obstructing bubbles in arterial gas embolism may resolve or be redistributed into the venous circulation spontaneously or in response to recompression.

It may be associated with endothelial injury, information, and placement leak.

Among divers, decompression sickness is significantly more common than AGE: AGE accounts for about 6.5% of cases.

It may be difficult to clinically differentiate the compressive sickness for material gas embolism and divers.

It occurs when breathing gas is introduced to the circulation on the arterial side via lung over-pressure trauma. 

Patients may suffer strokes, heart attacks, pulmonary embolism with shortness of breath and chest pain.

Patients may suffer strokes, heart attacks, pulmonary embolism with shortness of breath and chest pain. 

It is difficult to distinguish AGE from DCS, but is rarely necessary for physicians to be able to distinguish between the two: the treatment is the same. 

Sometimes AGE and DCS are lumped into a single entity, Decompression Illness (DCI).

Treatment of diving-associated gas embolus is recompression in a hyperbaric oxygen chamber.

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