Arterial gas embolism - Revision history

DMartinPAC: /* Evaluation */

2026-01-27T16:10:09Z

Evaluation

← Older revision		Revision as of 16:10, 27 January 2026
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	*[[echocardiography\|TEE]]: most sensitive, invasive not available in emergencies		*[[echocardiography\|TEE]]: most sensitive, invasive not available in emergencies
	*Doppler US: noninvasive; air in chamber = high pitch sound		*Doppler US: noninvasive; air in chamber = high pitch sound
			*Divers with suspected AGE should likely be screened for patent foramen ovale

	==Management<ref>*Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.</ref><ref>Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76.</ref>==		==Management<ref>*Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.</ref><ref>Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76.</ref>==

DMartinPAC: /* ManagementShaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. /

2026-01-27T16:08:55Z

Management*Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76.

← Older revision		Revision as of 16:08, 27 January 2026
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	**Durant's maneuver - left lateral decubitus and Trendelenburg (head down)		**Durant's maneuver - left lateral decubitus and Trendelenburg (head down)
	**Traps air in apex of RV, relieves obstruction of pulmonary outflow tract		**Traps air in apex of RV, relieves obstruction of pulmonary outflow tract
			*Hyperbaric oxygen therapy - descent to an equivalent pressure/depth of 60 feet of sea water (fsw) (US Navy Treatment Table 6) causes any gas bubble to be crushed to approximately 40% of its original size, as well as easing the entry of those gasses into solution so they can be removed with respiration
	*May require open surgical or angiography for recovery of residual intracardiac or intrapulmonary air		*May require open surgical or angiography for recovery of residual intracardiac or intrapulmonary air

DMartinPAC: /* Background */

2026-01-27T16:03:50Z

Background

← Older revision		Revision as of 16:03, 27 January 2026
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	**Due to negative intrathoracic pressure from spontaneous breathing		**Due to negative intrathoracic pressure from spontaneous breathing
	*Diving related		*Diving related
	**Results from pulmonary barotrauma (most common) and decompression sickness, most commonly in last 10m of ascent.		**Results from pulmonary barotrauma (most common) and decompression sickness, most commonly in last 10m of ascent. Patients with a patent foramen ovale may shunt normally-present venous system bubbles into the arterial system with any effortful action which causes valsalva.
	**Classically presents as LOC within 2 minutes of surfacing, can lead to stroke-like symptoms.		**Classically presents as LOC within 2 minutes of surfacing, can lead to stroke-like symptoms.
	***A "lucid interval" of asymptomatic period after initial symptoms, lasting perhaps hours, until progressive decompensation is common. Any report of LOC, seizure-like activity, stroke-like symptoms, or other temporary neurologic impairment within 10 minutes of surfacing, '''even if it has since resolved''', should result in high suspicion for AGE ~~secondary to either pulmonary overinflation or patent foramen ovale~~ and emergent recompression therapy (hyperbaric chamber treatment) should be pursued. Consult hyperbarics/dive medicine if available or call Divers Alert Network +1-919-684-9111.		***A "lucid interval" of asymptomatic period after initial symptoms, lasting perhaps hours, until progressive decompensation is common. Any report of LOC, seizure-like activity, stroke-like symptoms, or other temporary neurologic impairment within 10 minutes of surfacing, '''even if it has since resolved''', should result in high suspicion for AGE and emergent recompression therapy (hyperbaric chamber treatment) should be pursued. Consult hyperbarics/dive medicine if available or call Divers Alert Network +1-919-684-9111.

	===Prevention===		===Prevention===

DMartinPAC: /* Background */

2026-01-27T16:01:05Z

Background

← Older revision		Revision as of 16:01, 27 January 2026
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	**Results from pulmonary barotrauma (most common) and decompression sickness, most commonly in last 10m of ascent.		**Results from pulmonary barotrauma (most common) and decompression sickness, most commonly in last 10m of ascent.
	**Classically presents as LOC within 2 minutes of surfacing, can lead to stroke-like symptoms.		**Classically presents as LOC within 2 minutes of surfacing, can lead to stroke-like symptoms.
			***A "lucid interval" of asymptomatic period after initial symptoms, lasting perhaps hours, until progressive decompensation is common. Any report of LOC, seizure-like activity, stroke-like symptoms, or other temporary neurologic impairment within 10 minutes of surfacing, '''even if it has since resolved''', should result in high suspicion for AGE secondary to either pulmonary overinflation or patent foramen ovale and emergent recompression therapy (hyperbaric chamber treatment) should be pursued. Consult hyperbarics/dive medicine if available or call Divers Alert Network +1-919-684-9111.

	===Prevention===		===Prevention===

Bchap23: /* ManagementShaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. /

2024-08-02T23:38:08Z

← Older revision		Revision as of 23:38, 2 August 2024
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	*[[CPR]] in large air embolus		*[[CPR]] in large air embolus
	*Positioning		*Positioning
	**Durant's maneuver - left lateral decubitus and Trendelenburg		**Durant's maneuver - left lateral decubitus and Trendelenburg (head down)
	**Traps air in apex of RV, relieves obstruction of pulmonary outflow tract		**Traps air in apex of RV, relieves obstruction of pulmonary outflow tract
	*May require open surgical or angiography for recovery of residual intracardiac or intrapulmonary air		*May require open surgical or angiography for recovery of residual intracardiac or intrapulmonary air

Blsimpso: /* External Links */

2021-09-17T12:13:56Z

External Links

← Older revision		Revision as of 12:13, 17 September 2021
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	==External Links==		==External Links==
			*[https://www.merckmanuals.com/professional/injuries-poisoning/injury-during-diving-or-work-in-compressed-air/arterial-gas-embolism Merck Manual - Arterial Gas Embolism]

	==References==		==References==

ElavemanMD: /* See Also */

2020-07-19T20:13:38Z

ElavemanMD: /* ManagementShaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. /

2020-07-19T20:12:57Z

← Older revision		Revision as of 20:12, 19 July 2020
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	**Immediately cover puncture site with saline soaked gauze		**Immediately cover puncture site with saline soaked gauze

	===~~Scuba~~ Related===		===Diving Related===
	*[[IVF]] (increases tissue perfusion)		*[[IVF]] (increases tissue perfusion)
	*Rapid recompression		*Rapid recompression, [[Hyperbaric medicine\|hyperbaric oxygen therapy]]

	==Disposition==		==Disposition==

ElavemanMD: /* Background */

2020-07-19T20:11:59Z

Background

← Older revision		Revision as of 20:11, 19 July 2020
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	*Dialysis related		*Dialysis related
	**Due to negative intrathoracic pressure from spontaneous breathing		**Due to negative intrathoracic pressure from spontaneous breathing
	*~~Scuba~~ related		*Diving related
	**Results from pulmonary barotrauma (most common) and decompression sickness		**Results from pulmonary barotrauma (most common) and decompression sickness, most commonly in last 10m of ascent.
			**Classically presents as LOC within 2 minutes of surfacing, can lead to stroke-like symptoms.

	===Prevention===		===Prevention===
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	*Trendelenburg for insertion/removal of IJV and subclav lines		*Trendelenburg for insertion/removal of IJV and subclav lines
	*Reverse Trendelenburg for femoral		*Reverse Trendelenburg for femoral
			*Slow and controlled ascent when diving, with special precaution to exhale during ascent in the last 10m so the lungs do not over-pressurize.

	==Clinical Features==		==Clinical Features==

ElavemanMD: /* Differential Diagnosis */

2020-07-19T19:49:25Z

Differential Diagnosis

← Older revision		Revision as of 19:49, 19 July 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Scuba diving DDX}}

	{{Dialysis complications DDX}}		{{Dialysis complications DDX}}

	~~{{Scuba diving DDX}}~~

	==Evaluation==		==Evaluation==

← Older revision		Revision as of 20:13, 19 July 2020
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	*[[Dialysis complications]]		*[[Dialysis complications]]
	*[[Scuba diving emergencies]]		*[[Scuba diving emergencies]]
			*[[Diving medicine]]
			*[[Hyperbaric medicine]]

	==External Links==		==External Links==

Arterial gas embolism - Revision history

DMartinPAC: /* Evaluation */

DMartinPAC: /* Management*Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. */

DMartinPAC: /* Background */

DMartinPAC: /* Background */

Bchap23: /* Management*Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. */

Blsimpso: /* External Links */

ElavemanMD: /* See Also */

ElavemanMD: /* Management*Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. */

ElavemanMD: /* Background */

ElavemanMD: /* Differential Diagnosis */

DMartinPAC: /* ManagementShaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. /

Bchap23: /* ManagementShaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. /

ElavemanMD: /* ManagementShaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76. /