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{{SK}} Gas embolism
==Overview==
==Overview==
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 [[vein]]s 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.


Gas embolism into an [[artery]], termed [[artery|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 [[symptom]]s 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.
==Historical Perspective==
 
==Classification==
 
==Pathophysiology==
==Pathophysiology==
Air embolism can occur whenever a blood [[vessel]] is open and a pressure gradient exists favoring entry of gas. Because the pressure in most [[artery|arteries]] and [[vein]]s is greater than [[atmospheric pressure]], an air [[embolus]] does not always happen when a blood [[vessel]] is injured. In the [[vein]]s 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.


When air enters the [[vein]]s, it travels to the right side of the heart, and then to the lungs. This can cause the [[vessel]]s 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 [[embolus|embolic]] [[symptom]]s.
==Causes==
 
==Differentiating {{PAGENAME}} from Other Diseases==


[[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 artery|pulmonary arteries]] or [[vein]]s in a similar manner, due to the pressure difference.
==Epidemiology and Demographics==


Air can be injected directly into the [[vein]]s 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 [[artery|arterial]] travel.
==Risk Factors==
===Gas Embolism in Diving===
 
''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]] [[vessel]]s.
==Screening==
 
==Natural History, Complications, and Prognosis==
===Natural History===
 
===Complications===
 
===Prognosis===
 
==Diagnosis==
===Diagnostic Criteria===
 
===History and Symptoms===
 
===Physical Examination===
 
===Laboratory Findings===
 
===Imaging Findings===
 
===Other Diagnostic Studies===


Gas [[embolism]] and [[decompression sickness]] (DCS) may be difficult to distinguish, as they may have similar [[symptom]]s, 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).
==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
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.


[[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.
===Surgery===
===Primary Prevention===
 
If an [[artery|arterial]] gas [[embolism]] resulting from [[patent foramen ovale]] is suspected, an exam by [[echocardiography]] may be performed to [[diagnosis|diagnose]] the defect. In this test, very fine (microscopic) bubbles are introduced into a patient's vein by agitating saline in a [[syringe]] to produce the bubbles, then injecting them into an arm [[vein]]. A few seconds later, these bubbles may be clearly seen in the [[ultrasound]] image, as they travel through the patient's [[right atrium]] and [[ventricle]]. At this time, bubbles may be observed directly crossing a septal defect, or else a [[patent foramen ovale]] may be opened temporarily by asking the patient to perform the [[Valsalva maneuver]] while the bubbles are crossing through the right heart-- an action which will open the [[foramen ovale|foramen]] flap and show bubbles passing into the left heart. Such bubbles are too small to cause harm in the test, but such a [[diagnosis]] may alert the patient to possible problems which may occur from larger bubbles, formed during activities like scuba diving.
===Prevention===


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Diving medicine]]
[[Category:Medical emergencies]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]


{{WikiDoc Help Menu}}
{{WS}}
{{WS}}
 
{{WH}}
 


=Encephalitis Table=
=Encephalitis Table=
Line 62: Line 86:
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ataxia]], [[lethargy]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ataxia]], [[lethargy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Multiple sclerosis]]: clinically, [[nystagmus]], [[internuclear ophthalmoplegia]], [[Lhermitte's sign]]; on imaging, well-demarcated ovoid lesions with possible T1 hypointensities (“black holes”)
| style="padding: 5px 5px; background: #F5F5F5;" |[[Multiple sclerosis]]: clinically, [[nystagmus]], [[internuclear ophthalmoplegia]], [[Lhermitte's sign]]; on imaging, well-demarcated ovoid lesions with possible T1 hypointensities (“black holes”)
[[Acute disseminated encephalomyelitis]]: ; on imaging, diffuse or multi-lesion enhancement, with indistinct lesion borders
[[Acute disseminated encephalomyelitis]]: clinically, [[somnolence]], [[myoclonic]] movements, and [[hemiparesis]]; on imaging, diffuse or multi-lesion enhancement, with indistinct lesion borders
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Substance abuse]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Substance abuse]]'''
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|-
|-
|}
|}
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01= Do I know how this works?}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=Yes, I'm an Honors Student |B02=No shot, this is wicked hard. }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01= Are you smart enough to split it off?}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01= Yes, I'm an Honors Student |D02= No, I guess I'm a pleb. |D03= Well wait, maybe some practice will help}}
{{familytree | |!| | | |!| | | | |,|-|^|.| }}
{{familytree | E01 | | |!| | | E02 | | E03 |E01= Good job. Way to live up to the hype. |E02= Yes! Practice Always Helps! |E03= Have you not seen this?}}
{{familytree | |!| | | |!| | | | |!| | | |!| }}
{{familytree | |!| | | |!| | F01 |'| | F02 |F01= You can learn anything in an hour! |F02= Go home and go to sleep. }}
{{familytree | |!| | | |`|-|-|-|!|-|.| | |!| }}
{{familytree | |`|-|-| G01 |-|-|'| |`|-| G02 | |G01= HONORS STUDENTS ARE NUMBER #1! |G02=RIP My GPA. }}
{{familytree/end}}




==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 20:20, 8 August 2016

PCSK-9 News

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Sandbox AG from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

Template:WS Template:WH

Encephalitis Table

Reference list includes:[1][2]

Disease Similarities Differentials
Meningitis Classic triad of fever, nuchal rigidity, and altered mental status Photophobia, phonophobia, rash associated with meningococcemia, concomitant sinusitis or otitis, swelling of the fontanelle in infants (0-6 months)
Brain abscess Fever, headache, hemiparesis Varies depending on the location of the abscess; clinically, visual disturbance including papilledema, decreased sensation; on imaging, a lesion demonstrates both ring enhancement and central restricted diffusion
Demyelinating diseases Ataxia, lethargy Multiple sclerosis: clinically, nystagmus, internuclear ophthalmoplegia, Lhermitte's sign; on imaging, well-demarcated ovoid lesions with possible T1 hypointensities (“black holes”)

Acute disseminated encephalomyelitis: clinically, somnolence, myoclonic movements, and hemiparesis; on imaging, diffuse or multi-lesion enhancement, with indistinct lesion borders

Substance abuse Tremor, headache, altered mental status Varies depending on type of substance: prior history, drug-seeking behavior, attention-seeking behavior, paranoia, sudden panic, anxiety, hallucinations
Electrolyte disturbance Fatigue, headache, nausea Varies depending on deficient ions; clinically, edema, constipation, hallucinations; on EKG, abnormalities in T wave, P wave, QRS complex; possible presentations include arrhythmia, dehydration, renal failure
Stroke Ataxia, aphasia, dizziness Varies depending on classification of stroke; presents with positional vertigo, high blood pressure, extremity weakness
Intracranial hemorrhage Headache, coma, dizziness Lobar hemorrhage, numbness, tingling, hypertension, hemorrhagic diathesis
Trauma Headache, altered mental status Amnesia, loss of consciousness, dizziness, concussion, contusion

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
Do I know how this works?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes, I'm an Honors Student
 
 
 
 
 
 
 
No shot, this is wicked hard.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Are you smart enough to split it off?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes, I'm an Honors Student
 
No, I guess I'm a pleb.
 
 
 
 
 
Well wait, maybe some practice will help
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Good job. Way to live up to the hype.
 
 
 
 
 
 
Yes! Practice Always Helps!
 
Have you not seen this?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
You can learn anything in an hour!
 
 
 
Go home and go to sleep.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
HONORS STUDENTS ARE NUMBER #1!
 
 
 
 
 
 
 
 
RIP My GPA.
 
 
 
 
 
 
 
 
 


References

  1. ↑ Eckstein C, Saidha S, Levy M (2012). "A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis". J Neurol. 259 (5): 801–16. doi:10.1007/s00415-011-6240-5. PMID 21932127.
  2. ↑ De Kruijk JR, Twijnstra A, Leffers P (2001). "Diagnostic criteria and differential diagnosis of mild traumatic brain injury". Brain Inj. 15 (2): 99–106. doi:10.1080/026990501458335. PMID 11260760.
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