Dysbaric cerebral air embolism in Hawaii

doi:10.1016/S0196-0644(87)80679-0

Annals of Emergency Medicine

Volume 16, Issue 5, May 1987, Pages 535-541

https://doi.org/10.1016/S0196-0644(87)80679-0 Get rights and content

Cerebral air embolism is a major cause of death and disability among sport scuba divers. To better define the epidemiologic and clinical manifestations of this infrequently encountered disorder, the records of all recompression treatments in Hawaii from 1976 through 1979 were reviewed. Forty-two cases of dysbaric air embolism (DAE) were identified on the basis of clinical criteria, accounting for 18% of the patients undergoing recompression treatment for diving-related disorders during this four-year period. In 22 patients (52%), DAE was part of a dysbarism syndrome that involved one or more forms of decompression sickness and/or in which DAE could not be differentiated from neurologic decompression sickness. The presenting signs and symptoms varied, with asymmetric multiplegia being the most common finding. Two patients died, giving a case fatality rate of 5% for those who survived until reaching the recompression chamber. Overall, 78% of the cases manifested either complete (61%) or substantial (17%) recovery with recompression and adjunctive medical measures. Traditional concepts of dysbaric cerebral air embolism are not adequate to explain the spectrum of clinical manifestations encountered in this condition.

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Citation Excerpt :
Several studies have demonstrated that risk for pulmonary barotrauma is increased in the presence of lung abnormalities.37 Treatment of cerebral and circulatory abnormalities related to AGE requires recompression in a hyperbaric chamber.38,39 The increased pressure reduces the volume of intravascular gas and improves perfusion.
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1997, Emergency Medicine Clinics of North America
The evaluation and management of medical problems related to diving used to be strictly under the aegis of a limited number of physicians involved in military or occupational medicine. The influences of technology and affluence, however, have contributed to increased diving activities in science, industry, and especially recreation. Recent estimates place the number of sport divers in the United States at approximately 5 million, with another several hundred thousand new divers being trained annually. Accordingly, the incidence of diving-related disorders has increased. The Divers' Alert Network (DAN) recorded 1164 diving-related injuries treated in 1994 alone, in addition to 97 fatalities. These numbers do not reflect injuries not reported to DAN.¹⁹ Furthermore, the proliferation of hotel-hosted dive courses in tropical vacation spots has greatly increased the number of rapidly trained, relatively unsophisticated divers who then fly home again, often shortly after completing their last dive. Therefore, treatment of diving-related problems may be encountered by emergency physicians in diverse geographic locations.
The medical problems associated with diving are all related to the fact that divers are exposed to environments for which humans are poorly adapted and which contain potentially hazardous life. Some common problems involve exposure-related illness and traumatic injuries, but medical management does not significantly differ compared with the nonaquatic environment. Dermatitides, infections, and envenomations related to marine flora and fauna can be banal or exotic, but an appropriately detailed discussion exceeds the scope of this article. The vast majority of dangerous diving-related medical conditions, however, are caused by the effects of changes in pressure underwater and the necessity for a source of breathable air, usually supplied by a self-contained underwater breathing apparatus (SCUBA). This article focuses on these concerns.
Risk factors for pulmonary barotrauma in divers
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Pulmonary barotrauma (PBT) of ascent is a feared complication in compressed air diving. Although certain respiratory conditions are thought to increase the risk of suffering PBT and thus should preclude diving, in most cases of PBT, risk factors are described as not being present. The purpose of our study was to evaluate factors that possibly cause PBT.
We analyzed 15 consecutive cases of PBT with respect to dive factors, clinical and radiologic features, and lung function. They were compared with 15 cases of decompression sickness without PBT, which appeared in the same period.
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These results indicate that divers with preexisting small lung cysts and/or end-expiratory flow limitation may be at risk of PBT.

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Original contributionDysbaric cerebral air embolism in Hawaii

Emerg Med Clin North Am

Emergency Medicine

Ann Emerg Med

Delayed treatment of dysbarism — a retrospective review of 50 cases

JAMA

Review of arterial air embolism in submarine escape

Air embolism as a result of submarine escape training

US Armed Forces Med J

Intrapulmonary air trapping in submarine escape training casualties