0071643192.pdf

ENVIRONMENTAL EMERGENCIES

TREATMENT

■ Typically resolves with rest
■ Supplemental O 2 as needed
■ Chest tube for large pneumothorax

ARTERIALGASEMBOLISM(AGE)

Arterial gas embolism is a form of pulmonary barotrauma that occurs during or
within 10 minutesof ascent.

PATHOPHYSIOLOGY

■ Overexpanding gas ruptures alveoli →air enters pulmonary venous circu-
lation and travels to L heart and systemic circulation →obstruction to flow
and symptoms.

SYMPTOMS/EXAM

■ Cerebral embolization (most common)
■ Sudden stroke-like symptoms, seizure, loss of consciousness, confusion
■ Coronary artery embolization
■ Symptoms and findings consistent with acute coronary syndrome

TREATMENT

■ 100% O 2 by mask
■ Recumbent/supine position
■ Intravenous fluids to increase perfusion
■ Rapid recompression in hyperbaric O 2 chamber

DECOMPRESSIONSICKNESS

Symptoms result from formation of nitrogen bubbles in tissue or vessels.
Nitrogen is highly fat soluble leading to CNS symptoms (see Table 13.14
for risk factors).

PATHOPHYSIOLOGY

■ As diver ascends →ambient pressure decreases and nitrogen bubbles come
out of solution →precipitate and coalesce in blood and tissues.

TABLE 13.14. Risk Factors for Decompression Sickness

Older age

Fatigue or heavy exertion

Dehydration

Obesity

Increased total length and depths of dive(s).

Diving at altitude

Rapid ascent

Flying after diving