injuries poisoning
Arterial Gas Embolism
Treatment of Arterial Gas Embolism
Immediate 100% oxygen Recompression therapy Divers thought to have arterial gas embolism should be recompressed as soon as possible ( Treatment references ). Transport to a Before transport, high-flow 100% oxygen enhances nitrogen washout by widening the nitrogen pressure gradient between the lungs and the circulation, thus accelerating reabsorption of the nitrogen-containing embolic bubbles. Hemodynamically unstable patients should remain in a supine position to facilitate maintenance of stable blood pressure and cardiac output. Transport by air may be justified if it saves significant time. It had been previously recommended against to minimize exposure to reduced pressure at altitude due to the possibility of bubble volume expansion. However, if the patient has been breathing high-flow oxygen, air transport is usually well tolerated. In addition, air ambulances capable of maintaining sea-level cabin pressure may be available. Unconscious patients with impaired airway reflexes should be kept in the lateral decubitus position to help prevent aspiration, if tracheal intubation is not feasible. Mechanical ventilation, vasopressors, and volume resuscitation are used as needed. Routine placement of all patients in the left lateral decubitus position (Durant’s maneuver) or Trendelenburg position, which was previously thought to prevent cephalad migration of bubbles, is not effective and is no longer recommended. Place unconscious patients with impaired airway reflexes in the lateral decubitus position until the airway can be protected with an endotracheal tube, after which the patient can be placed supine to facilitate care. Left lateral decubitus position (Durant’s maneuver) or Trendelenburg position are no longer routinely recommended. 1.Moon RE: Hyperbaric treatment of air or gas embolism: Current recommendations.Undersea Hyperb Med46(5):673-683, 2019. PMID: 31683367. 2.Mitchell SJ, Bennett MH, Moon RE: Decompression sickness and arterial gas embolism.N Engl J Med386(13):1254-1264, 2022. doi: 10.1056/NEJMra2116554 