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Arterial Gas Embolism

Arterial gas embolism is a dangerous condition that affects individuals and may have fatal consequences. Although this disorder is rare, it requires deep investigation in order to understand its symptoms and treatment. This malfunction occurs when the gas bubbles are concentrated in the arterial vasculature and block blood flow. It can happen during diving, various surgeries and procedures that can cause organ ischemia with loss of consciousness. The pressure of gas bubbles affects the entire body, and may damage a spinal cord, nerves, joints, etc. These conditions may lead to heart attack, paralysis, stroke and some other illnesses that may have fatal consequences, depending on the location of bubbles. It can occur during catastrophic events such as scuba diving, occupational or military diving. Although the percentage of such incidents is rather low, persons with serious heart abnormalities should avoid diving as it may cause fatal outcomes. The lack of awareness about etiology, epidemiology, symptoms, treatment, pathogenesis, and prevention requires providing more research in order to understand all these issues. Understanding of these issues will give a profound awareness of arterial gas embolism and help professionals to prevent this condition.

Etiology

Arterial gas embolism is a rather rare disease, but it may have fatal consequences. It affects both arterial and venous circulation depending on the place where the bubbles are formed. The malfunction of an artery begins when air blocks it because of the pressure caused by gas bubbles. Miller et al. (2014) reported that a venous gas embolism turns into arterial gas embolism because of the connection of both systems. The research asserts that circulation disorder occurs with ambient air as well as such gases as nitrogen, helium, and carbon dioxide (Gordy & Rowell, 2013). Entering the artery, gas bubbles block blood flow, which leads to CNC ischemia and damages other organs. It can be diagnosed via tests and requires immediate recompression. This condition may occur in various circumstances such as scuba diving, surgery, or childbirth; and its outcomes depend on the volume of air that enters the system.

Air embolism may also occur in the xylem of vascular plants, especially when suffering from water stress. The nature and amount of symptoms can range from the collapse of cardiovascular system to death. Therefore, in order to prevent complications, a person should be immediately treated. As a rule, all physicians regardless of their specialty know how to prevent and treat these complications. Arterial gas embolism is a result of emboli that is formed because of malfunction of blood circulation.

Miller et al. (2014) believes that the severity of this condition depends on the following features:

  • amount and composition of gas
  • the location of entry
  • a patient’s personal characteristics

The personal characteristics may include cardiopulmonary reserve, its size, and the type of intracardiac communication. If the gas penetrates the arterial circulation, it will enter all other organs in the body very quickly. As a result, the majority of organs will experience dysfunction, which can lead to death.

Epidemiology

Arterial gas embolism has a nonspecific nature, and it is difficult to determine the signs of this disorder. According to Kivi (2015), people at risk vary from the different types of divers to people working under the powerful pressure environments as well as those who undergo various surgical procedures (p. 43). The first records of this condition were reported in the 19th century, and nowadays it occurs in about 1 percent of individuals or even less (Gordy & Rowell, 2013). Although the diagnostic is rather complicated, it is evident that knowledge in the operational and technical aspects helps put a diagnosis and determine treatment. This abnormality occurs among scuba divers, and its estimated number is about five million people in the USA (Kivi, 2015). Although military and occupational divers have a smaller amount of incidents, they are in a larger risk group because of the specification of their work. Divers Alert Network (DAN) statistics shows that 2-3 incidents occur among 10,000 divers (Miller et al., 2014).

The risk of arterial gas embolism depends on several factors such as the depth of diving, patent foramen ovale, dehydration before diving, poor physical state, high-fat content, personal history, age, etc. Epidemiology of arterial gas embolism encourages divers to take observations and testing after finishing the dive. Animal studies have demonstrated that large-volume arterial gas embolism is lethal, although small-volume embolism is survivable. According to Tilton (2010), the lethal doze in humans is about 200-500 ml (p. 76). In the USA, the annual number of fatal incidents associated with diving range from 100 to 120; and the average age varies from 33 to 39 (Tilton, 2010). Unfortunately, the medical history is poorly monitored (about 40 percent), and frequent causes of death are hypertension and heart attack. The data is rather poor because local doctors do not specify the causes or the body is not found. These conditions identify that further research is needed in order to understand real statistics of arterial gas embolism.

Symptoms

Severe and dramatic symptoms of arterial gas embolism usually appear very fast, although sometimes they are delayed for twelve hours or can be triggered during the flight. At first, a person may experience joint pain, fatigue, and itching. According to Kivi (2015), these mild symptoms further progress to chest pain, visual impairment, dizziness, weakness, confusion, or paralysis (p. 165). Furthermore, the illness may be accompanied by rapid loss of consciousness, breathing difficulty, or convulsions that are especially life threatening. Some symptoms may be hidden because a diver has spent time in the water, and the origin of some kinds of pain or discomfort may be unclear such as numbness in an arm.

Arterial gas embolism that occurs after a blast or bomb explosion can lead to arteries or veins to open and fill with air. Depending on the explosion, embolism can be small or large. However, in both cases it is important to provide treatment in a medical facility. Aghababian (2010) reported that the symptoms manifest themselves immediately after the arrival on the land or in some cases even before it. The symptoms and signs include abnormal sensation, paralysis, dizziness, convulsion, blurred vision, or weakness of the extremities. A person may lose consciousness and sometimes stop breathing.

Some patients experience only pain without more serious consequences. Anxiety that is one of the common symptoms of arterial gas embolism is a sign of the dysfunctional air supply in different tissues. A patient who has a bloody cough shows a sign of this condition that indicates ruptured lung tissue or middle ear squeeze.

Treatment

One of the first measures is oxygen treatment that serves to deliver oxygen to a person’s body. Immediate recompression may be rather effective because it reduces the size of the bubbles due to absorption of gas. A patient who breaths 100 percent oxygen experiences a high pressure that decreases gas bubbles, and this leads to the reduction of ischemic injury. Treatment of this disorder should be fast because every minute matters in this procedure.

Miller et al. (2014) reported that physicians who treat arterial gas embolism should consider three goals such as:

  • Prevention of a source that causes it
  • Stopping its penetration
  • Resuscitation of a person if necessary

Furthermore, if a doctor knows that an individual may have complications after diving he/she must be ready to take appropriate measures. For example, he/she can put a person in a sitting position in order to prevent embolism from penetrating the brain, lungs, or heart.

In some cases, a doctor should stop embolism through surgery but in most cases treatment requires specific medications. Many findings suggest that a comatose patient needs endotracheal intubation or cardiopulmonary resuscitation in order to obtain ventilation and oxygenation (Kivi, 2015). Administration of oxygen allows physicians to decrease the size of air bubbles and remove gas from the bubbles. Furthermore, such means of treatment as hypoxemia and hypoxia are also often used in medicine. However, the primary goal is to regulate the blood pressure that can get high or low. The research asserts that specific drugs such as lidocaine, heparin, and fluorocarbons are also used in the treatment. They are known to reduce the size of the bubbles and improve the condition of the cardiovascular system (Tilton, 2010).

According to Aghababian (2010), the Trendelendburg position is an ideal decision because it stops the entrance of air bubbles to the coronary arteries and prevents a heart attack (p.124). This position forces the bubbles to remove from the arterial circulation, and also increases hydrostatic pressure. A large amount of oxygen is highly recommended both for arterial and venous gas embolism because it accelerates the bubbles and counteracts ischemia. Furthermore, early treatment proves to be more effective. Hyperbaric therapy is used in patients who suffer from this disorder, and helps to improve their tissue oxygenation.

Pathogenesis

Arterial gas embolism is accompanied with free gas that enters into the lungs. This is followed by the dysfunction of the pulmonary vessels. Air can enter the arterial circulation under severe decompression conditions that are followed by the tissue changes. Moreover, gases fill the hollow spaces and affect the body. An abnormal concentration of gas is dissolved into the blood vessels, and leads to bubbles being formed in different organs such as lungs, joints, skin, and central nervous system. As a result, bubbles activate blood coagulation and initiate a decompression sickness. Therefore, the arterial gas embolism is a complication of diving. It occurs because the pressure of water affects the ventilation of the lungs. For example, if a person descends 100 feet under the water, then the air in his/her lungs will expand four times its usual size. Sometimes, the air is not able to escape forming the bubbles that later move towards the heart and arteries. Larger bubbles that cannot enter the arteries lodge and make a plug that causes a blockage. These blockages may be formed in different organs leading to their malfunctioning. Thus, the most dangerous place is the brain, in which case the condition can have dangerous consequences or even death.

Prevention

Many studies assert that several conditions may force air to enter the lungs and lead to the arterial gas embolism (Gordy & Rowell, 2013). Persons who have asthma, heart disorders, lung infections, and emphysema should not practice scuba diving. For example, people who experience different heart abnormalities should avoid diving regardless of any circumstances. However, in many conditions doctors cannot determine health abnormalities for different reasons. Sometimes the disease can occur without any visual symptoms; therefore, thorough testing and medical observation should be provided to professional divers. They should abstain from alcohol, smoking and drugs because it will increase the risk. Kivi (2015) assumes that scuba divers should stay under the water according to standardized limits and never push them because about a half of all fatal cases are a result of breaking limits.

Recreational divers are at higher risk than professional ones because they are responsible for their health on their own and they are not a part of a team that is managed by an instructor. Therefore, such independent divers often break the regulations and codes of practice. On the other hand, professional divers feel responsibility for other team members or an employer that encourage them to follow the rules for their safety. To perform a safe dive, experts recommend making stops and descending thirty feet in a minute (Aghababian, 2010). Furthermore, it is advisable to limit diving to 100 feet otherwise it can be very risky and may cause arterial gas embolism. Also, it is forbidden to hold breath because this disorder usually happens in this condition.

Conclusion

Although, arterial gas embolism happens rather rarely in a human body it is a dangerous condition that affects individuals and may have fatal consequences. Therefore, it is necessary to provide a deep investigation in order to understand this condition. The formation of the gas bubbles blocks blood flow, so that this condition affects the entire body and damages a spinal cord, nerves, joints, etc. This may lead to heart attack, paralysis, stroke and some other illnesses that may have fatal outcomes, depending on the location of bubbles. It is known that it may occur during catastrophic events such as scuba diving, occupational or military diving. Although incidents are rare, individuals with serious heart abnormalities should be very attentive to professional and occupational diving that may cause fatal outcomes. The lack of etiology, epidemiology, symptoms, treatment, pathogenesis, and prevention requires providing more research in order to understand all these issues. A thorough research ensures profound awareness of arterial gas embolism and helps professionals to prevent this condition.

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