Arterial gas embolism 動脈氣栓
(Tintinalli's Emergency Medicine)
Arterial gas embolism 動脈氣栓
當氣體進入左側血管系統會造成動脈氣栓, 潛水的情況通常是由肺部氣壓傷引起, 不慎進入靜脈循環的氣體可經由肺部動靜脈分流或心臟內分流進入左側循環, 不論來源為何, 當氣體在全身發生栓塞, 分布狀態主要是由血流而非重力決定(頭部高低影響不大)
Arterial gas embolism occurs when air enters the left side of the vascular system. In the setting of diving, this most often results from pulmonary barotrauma. Air inadvertently introduced into the venous circulation can cross from the right side of the circulation from intracardiac or pulmonary arteriovenous shunts. Air bubbles may also arterialize through these same shunts, sometimes making the source of arterial bubbles difficult to determine.13 Whatever the source, when air embolizes systemically, distribution depends mainly on blood flow and not gravity.
臨床表徵 Clinical Features
氣栓造成最大的影響在腦部, 導致各種中風症狀, 在罕見狀況, 潛水導致的肺部氣壓傷引起動脈氣栓會造成突然無呼吸, 心跳停止. 造成心血管崩潰的機制是由於氣體在中樞血管床的大靜脈大動脈導致.
The most dramatic effect of arterial gas embolism is on the brain, resulting in a variety of stroke syndromes, symptoms, and signs, depending on the part of the brain affected. Rarely, diving-related arterial gas embolism from pulmonary barotrauma causes immediate apnea and cardiac arrest. The mechanism of cardiovascular collapse appears to be air in the entirety of the large arteries and veins of the central vascular bed.14
肺部氣壓傷引起的動脈氣栓, 通常在上升或突然浮出水面發生. 如果病患沒有立即死亡, 腦部氣栓的症狀通常包括：喪失意識，癲癇，失明，失去方向感，半側偏癱
血壓突然上升讓動脈氣體進入靜脈循環可能使得症狀突然改善，有時候病患到達醫師面前的時候，殘存的症狀可能很輕微，尤其是 parietal lobe syndrome 最容易被忽略．
The effects of arterial gas embolism secondary to pulmonary barotrauma usually occur on ascent or immediately upon surfacing. If the victim does not die immediately, the symptoms of cerebral arterial gas embolism often include loss of consciousness, seizure, blindness, disorientation, or hemiplegia. Symptoms may spontaneously improve as the gas enters the venous cerebral circulation after a spike in blood pressure. Sometimes, by the time the patient reaches the clinician, the only signs that remain are subtle defects. In particular, parietal lobe signs and symptoms are easily overlooked. A cascade of inflammatory processes also occurs in air embolism, just as in decompression sickness.
Arterial gas embolism 動脈氣栓
當氣體進入左側血管系統會造成動脈氣栓, 潛水的情況通常是由肺部氣壓傷引起, 不慎進入靜脈循環的氣體可經由肺部動靜脈分流或心臟內分流進入左側循環, 不論來源為何, 當氣體在全身發生栓塞, 分布狀態主要是由血流而非重力決定(頭部高低影響不大)
Arterial gas embolism occurs when air enters the left side of the vascular system. In the setting of diving, this most often results from pulmonary barotrauma. Air inadvertently introduced into the venous circulation can cross from the right side of the circulation from intracardiac or pulmonary arteriovenous shunts. Air bubbles may also arterialize through these same shunts, sometimes making the source of arterial bubbles difficult to determine.13 Whatever the source, when air embolizes systemically, distribution depends mainly on blood flow and not gravity.
臨床表徵 Clinical Features
氣栓造成最大的影響在腦部, 導致各種中風症狀, 在罕見狀況, 潛水導致的肺部氣壓傷引起動脈氣栓會造成突然無呼吸, 心跳停止. 造成心血管崩潰的機制是由於氣體在中樞血管床的大靜脈大動脈導致.
The most dramatic effect of arterial gas embolism is on the brain, resulting in a variety of stroke syndromes, symptoms, and signs, depending on the part of the brain affected. Rarely, diving-related arterial gas embolism from pulmonary barotrauma causes immediate apnea and cardiac arrest. The mechanism of cardiovascular collapse appears to be air in the entirety of the large arteries and veins of the central vascular bed.14
肺部氣壓傷引起的動脈氣栓, 通常在上升或突然浮出水面發生. 如果病患沒有立即死亡, 腦部氣栓的症狀通常包括：喪失意識，癲癇，失明，失去方向感，半側偏癱
血壓突然上升讓動脈氣體進入靜脈循環可能使得症狀突然改善，有時候病患到達醫師面前的時候，殘存的症狀可能很輕微，尤其是 parietal lobe syndrome 最容易被忽略．
The effects of arterial gas embolism secondary to pulmonary barotrauma usually occur on ascent or immediately upon surfacing. If the victim does not die immediately, the symptoms of cerebral arterial gas embolism often include loss of consciousness, seizure, blindness, disorientation, or hemiplegia. Symptoms may spontaneously improve as the gas enters the venous cerebral circulation after a spike in blood pressure. Sometimes, by the time the patient reaches the clinician, the only signs that remain are subtle defects. In particular, parietal lobe signs and symptoms are easily overlooked. A cascade of inflammatory processes also occurs in air embolism, just as in decompression sickness.
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