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[Diving accident-induced arterial gas embolism]
P D Nijk1, T P van Rees Vellinga, J M van Lieshout
1Admiraal De Ruyter Ziekenhuis, afd. Spoedeisende Geneeskunde, Goes.
Nederlands Tijdschrift Voor Geneeskunde
|September 8, 2017
Summary
A sport diver experienced severe neurological symptoms after a rapid ascent, developing arterial gas embolism and decompression sickness. A patent foramen ovale allowed venous bubbles to enter arterial circulation, leading to spinal cord damage.
Area of Science:
- Diving Medicine
- Cardiovascular Physiology
- Neurology
Background:
- Scuba diving involves nitrogen absorption into tissues under pressure.
- Rapid ascents can cause pulmonary barotrauma and arterial gas embolism.
- Decompression sickness involves venous nitrogen bubbles, but can lead to arterial bubbles in certain conditions.
Observation:
- A 53-year-old diver presented with hypovolemic shock and progressive limb paresis after an emergency ascent from 47 meters.
- The diver's condition worsened during recompression therapy.
- A patent foramen ovale was identified as the cause for arterial bubble entry.
Findings:
- The patient suffered both arterial gas embolism from pulmonary barotrauma and decompression sickness.
- Nitrogen bubbles entered the arterial circulation via the patent foramen ovale.
- Despite maximal treatment, the patient experienced persistent neurological deficits due to spinal cord damage.
Implications:
- Patent foramen ovale is a critical risk factor for severe diving accidents.
- Understanding paradoxical embolism is crucial for managing diving-related neurological injuries.
- This case highlights the potential for catastrophic outcomes in divers with undiagnosed cardiac shunts.
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