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| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Caption = |
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| DiseasesDB = 313 |
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| ICD10 = {{ICD10|O|88|0|o|85}}, {{ICD10|T|79|0|t|79}} |
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| ICD9 = |
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| OMIM = |
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| eMedicineSubj = |
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| MeshID = D004618 |
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| }}
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| __NOTOC__ | | __NOTOC__ |
| {{CMG}} | | {{Air embolism}} |
| {{SI}}
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| {{EH}} | | {{CMG}}; {{AE}} |
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| ==Overview==
| | {{SK}} Gas embolism; |
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| An '''air embolism''', or more generally '''gas embolism''', is a medical condition caused by [[gas]] bubbles in the bloodstream (''embolism'' in a medical context refers to any large moving mass or defect in the blood stream). Small amounts of air often get into the blood circulation accidentally during surgery and other medical procedures, but most of these in veins are stopped at the lungs, and a venous air embolism that shows [[symptom]]s is very rare. Death may occur if a large bubble of gas becomes lodged in the heart, stopping blood from flowing from the right [[Ventricle (heart)|ventricle]] to the [[lungs]] (this is similar to vapor lock in engine fuel systems). However, the amount of gas necessary for this to happen is quite variable, and also depends on a number of other factors, such as body position.
| | ==[[Air embolism overview|Overview]]== |
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| Gas embolism into an artery, termed arterial gas embolism, or AGE, is a more serious matter than in a vein, since a gas bubble in an artery may directly cause stoppage of blood flow to an area fed by the artery. The symptoms of AGE depend on the area of blood flow, and may be those of [[stroke]] or [[myocardial infarction|heart attack]] if the brain or heart (respectively) are affected.
| | ==[[Air embolism historical perspective|Historical Perspective]]== |
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| ==Pathogenesis== | | ==[[Air embolism classification|Classification]]== |
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| Air embolism can occur whenever a blood vessel is open and a pressure gradient exists favoring entry of gas. Because the pressure in most arteries and veins is greater than atmospheric pressure, an air embolus does not always happen when a blood vessel is injured. In the veins above the heart, such as in the head and neck, the pressure is less than atmospheric and an injury may let air in. This is one reason why [[surgery|surgeon]]s must be particularly careful when operating on the [[brain]], and why the head of the bed is tilted down when inserting or removing a [[central venous catheter]] from the [[jugular vein|jugular]] or [[subclavian vein]]s. | | ==[[Air embolism pathophysiology|Pathophysiology]]== |
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| When air enters the veins, it travels to the right side of the heart, and then to the lungs. This can cause the vessels of the lung to constrict, raising the pressure in the right side of the heart. If the pressure rises high enough in a patient who is one of the 20% to 30% of the population with a [[patent foramen ovale]], the gas bubble can then travel to the left side of the heart, and on to the brain or [[coronary circulation|coronary arteries]]. Such bubbles are responsible for the most serious of gas embolic symptoms.
| | ==[[Air embolism causes|Causes]]== |
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| [[physical trauma|Trauma]] to the lung can also cause an air embolism. This may happen after a patient is placed on a [[ventilator]] and air is forced into an injured vein or artery, causing sudden death. Breath-holding while ascending from scuba diving may also force lung air into pulmonary arteries or veins in a similar manner, due to the pressure difference. | | ==[[Air embolism differential diagnosis|Differentiating Any Disease from other Diseases]]== |
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| Air can be injected directly into the veins either accidentally or as a deliberate act. Examples include misuse of a [[syringe]], and [[industrial injury]] resulting from use of compressed air. However, despite being employed by writers of fiction as a clandestine method of murder, amounts of air such as would be administered by a single small syringe are not likely to suddenly stop the heart, nor cause instant death. Single air bubbles in a vein do not stop the heart, due to being too small. However, such bubbles may occasionally reach the arterial system through a [[patent foramen ovale]], as noted above, and cause random [[ischemic]] damage, depending on their route of arterial travel.
| | ==[[Air embolism epidemiology and demographics|Epidemiology and Demographics]]== |
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| ===Gas embolism in diving=== | | ==[[Air embolism risk factors|Risk Factors]]== |
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| '''Gas embolism''' is one of the [[diving disorders]] SCUBA divers sometimes suffer when they receive [[barotrauma|pressure damage]] to their lungs following a rapid ascent where the breath is inappropriately held against a closed [[glottis]], allowing pressure to build up inside the lungs, relative to the blood. It is termed "gas" because the diver may be using a diving [[breathing gas]] other than [[air]]. The gas bubbles can impede the flow of oxygen-rich blood to the brain and vital organs. They can also cause [[clot]]s to form in [[blood]] vessels.
| | ==[[Air embolism screening|Screening]]== |
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| Gas embolism and [[decompression sickness]] (DCS) may be difficult to distinguish, as they may have similar symptoms, especially in the [[central nervous system]]. The treatment for both is the same, because they are both the result of gas bubbles in the body. In a diving context, the two are often called [[decompression illness]] (DCI).
| | ==[[Air embolism natural history, complications and prognosis|Natural History, Complications, and Prognosis]]== |
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| | ==Diagnosis== |
| | [[Air embolism history and symptoms|History and Symptoms]] | [[Air embolism physical examination|Physical Examination]] | [[Air embolism laboratory findings|Laboratory Findings]] | [[Air embolism electrocardiogram|Electrocardiogram]] |[[Air embolism chest x ray|Chest X Ray]] | [[Air embolism CT|CT]] | [[Air embolism MRI|MRI]] | | [[Air embolism other imaging findings|Other Imaging Findings]] | [[Air embolism other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| | [[Air embolism medical therapy|Medical Therapy]] | [[Air embolism surgery|Surgery]] | [[Air embolism primary prevention|Primary Prevention]] | [[Air embolism secondary prevention|Secondary Prevention]] | [[Air embolism cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Air embolism future or investigational therapies|Future or Investigational Therapies]] |
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| Recompression is the most effective treatment of an air embolism. Normally this is carried out in a recompression chamber. This is because as pressure increases, the solubility of a gas increases.
| | ==Case Studies== |
| | | [[Air embolism case study one|Case #1]] |
| [[Oxygen first aid]] treatment is useful for suspected gas embolism casualties or divers who have made fast ascents or missed decompression stops. Most fully closed-circuit [[rebreather]]s can deliver sustained high concentrations of oxygen-rich [[breathing gas]] and could be used as an alternative to pure open-circuit oxygen [[resuscitator]]s.
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| ==External links== | |
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| * [http://www.scuba-doc.com/artgsemb.htm Arterial Gas Embolism]
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| {{Consequences of external causes}}
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| [[Category:Diving medicine]] | |
| [[Category:Medical emergencies]]
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| [[Category:Emergency medicine]]
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| [[Category:Intensive care medicine]]
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| [[it:Embolia gassosa arteriosa]]
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| [[pl:Zator gazowy]]
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| [[pt:Aeroembolismo]]
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| [[tr:Hava ambolisi]]
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| | [[Category:Pulmonology]] |
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