AGE does it hurt

[twinkles]

Having just turned 52, I will share that age does hurt, but what I am asking about is does arterial gas embolism (AGE) hurt?

Actually, make that broader and just say any gas expansion injury to the lungs. Would there be pain associated with it? Or could a diver have a small lung over expansion injury and not realize it?

 

[Teamcasa]

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A ScubaBoard Staff Message...

Moved to Diving Medicine...

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[fisherdvm]

Honestly, I really don't know. I know that the pleura and the pericardium hurts when inflammed. I know that if you cough alot, you can pull your diaphram, break a rib, etc, and it hurst. I really don't know if AGE will hurt. My guess is that acutely it will hurt. But after a bronchi or alveoli blows out .... it will just be a chest discomfort. If blood goes into the pleura/pericardium - it will likely hurt. If a bubble lodge in your coronary artery, it will hurt - like a heart attack. If it goes in your spinal cord or brain - I guess it depends on where it lodges....

I guess you'll be having too much respiratory distress to really worry about the pain.

 

[bleeb]

Having just turned 52, I will share that age does hurt, but what I am asking about is does arterial gas embolism (AGE) hurt?

Are you talking about the injury that lets gas into the blood stream, or the embolism? I'm not an medic of any form, but here's a thought about the latter: It might depend where the bubble ends up. IIRC from a CPR course once, a heart attack can feel like you've been kicked in the chest. A stroke can feel like the mother of all headaches. So the answer to the question would be yes, but not always.

Actually, make that broader and just say any gas expansion injury to the lungs. Would there be pain associated with it? Or could a diver have a small lung over expansion injury and not realize it?

From a third hand description of a local dive fatality several years back, it didn't sound like pain is guaranteed, if you're looking for that as a definitive symptom.

 

[headsqueeze]

First let me put in my disclaimer - I just completed my NAUI course and will do my open water in May. Second, I don't recall diagnosing a pulmonary venous embolism in my medical practice of 15 years. (Why would I, I'm in Kansas right?) However, diving med and physiology is a really cool subject and I've done some reading about it. Also, I've seen plenty of pulmonary related problems similar to diving barotrauma in my medical practice and tiny rural hospital emergency room.

Emphysema/COPD/Bronchiectasis is common, and I've seen barotrauma in these patients. CPAP, or BiPAP can cause barotrauma as can overinflation injuries during CPR in patients w/ normal lung tissue. Ventilation during surgery or ICU settings can induce barotrauma too. If someone w/ emphysema presents w/ a TIA or a stroke, it is usally attributed to a plaque embolism and not a pulmonary venous embolism. There is simply no way to diagnose the difference.

The short answer? It's painless (in the chest) if the pleura or lung lining is not damaged. So, yes a diver could experience a small pulmonary venous embolism and not realize it - is that vertigo really 'vertigo' or is it a TIA from a painless small pulmonary venous embolism? MRIs of the brain from commercial divers show increased numbers white matter signals consistent w/ microstrokes.

The long answer? You asked about a lung expansion injury and the injury is painful if the pleura is affected. Even a small pneumothorax is painful, but usually w/ a deep inspiration.

An emboli in the pulmonary artery is painful, but these are not from pulmonary barotrauma. Remember, the pulmonary artery carries blood to the lungs. The pulmonary veins carry oxygen rich (and possibly an overexpansion air bubble) into the organ circulation (brain, heart, kidney, limbs...).

I guess I've seen enough over the years to know that subtle symptoms may actually represent a dangerous situation. It's easy to deny away the symptoms to something minor.

 

[stimpy4242]

One thing I would like to add and I think you might be confused on this, an AGE is NOT the same as a lung overexpansion injury. Perhaps the latter causes the earlier, but they are not the same. Barotrauma, or in other words an injury caused by pressure and in this case an increase in pressure can cause the lungs to rupture. That can hurt. Having an air bubble floating around in your bloodstream, doesn't hurt. Not many pain receptors in the blood stream. Now with this all being said, you ask about an aterial gas embolism and while arteries carry blood away from the heart and veins towards the heart, lets assume you mean an AGE in the oxygen rich blood which except for as explained above means in your arteries. If that air bubble blocks additional blood flow and more importantly oxygen from getting to tissue than, the effect that bubble has on dieing tissue from lack of oxygen can hurt. Thats why a heart attack hurts, because of the lack of oxygen to tissue. So I hope I have broken down the information in a way that helps you decide what you are really asking. If you mean the lung trauama or just mean getting an AGE which of course can come from ascending too fast and bring dissolved nitrogen out of solution and into bubbles floating in your blood stream.

Bottom Line, the actual AGE itself doesn't hurt, but what it can cause, mostly likely does. Keep in mind your own predisposition to pain and age (the one about getting old) does play a role in your perception of pain. Diabetics can often have a lack of sensation of pain during a heart attack, often reffered as a silent heart attack, because of neuropathy, a symptom of diabetes. They might be able to have an AGE and not feel its effects.