Dr Deco
Contributor
- Messages
- 2,384
- Reaction score
- 97
- # of dives
- I just don't log dives
Dear Readers:
Spontaneous Remission
Below is an abstract (edited for clarity) that speaks to the problem of what to do in the case of spontaneous remission on neurological DCS.
Arterial gas embolism with spontaneous recovery: rationale for therapeutic compression.
Clarke D, Gerard W, Norris T. Pulmonary barotrauma-induced cerebral arterial gas embolism with spontaneous recovery: commentary on the rationale for therapeutic compression. Aviat Space Environ Med 2002 Feb;73(2):139-46
Cerebral arterial gas embolism (CAGE) continues to complicate diving activities. Inadvertent breath holding or rapid buoyant ascent can quickly generate a critical state of lung over-pressure.
Bubbles are then free to embolize the systemic circulation via the pulmonary vasculature and the left heart. The brain is a common target organ. Bubbles that enter the cerebral arteries coalesce to form columns of gas as the vascular network narrows. Small amounts of gas frequently pass directly through the cerebral circulation without occlusion. Larger columns of gas occlude regional brain blood flow, either transiently or permanently, producing a stroke-like clinical picture.
In cases of spontaneous redistribution, a period of apparent recovery is frequently followed by relapse. The etiology of relapse appears to be multifactorial, and chiefly the consequence of a failure of reperfusion (= blood to start flowing again after the bubble has gone). Prediction of who will relapse is not possible, and any such relapse is of ominous prognostic significance. It is advisable, therefore, that CAGE patients who undergo spontaneous recovery be promptly recompressed while breathing oxygen.
Therapeutic compression will serve to antagonize leukocyte-mediated ischemia-reperfusion injury; protect against embolic injury to other organs; aid in the resolution of component cerebral edema; reduce the likelihood of late brain infarction reported in patients who have undergone spontaneous clinical recovery; and prophylax against decompression sickness in high gas loading dives that precede accelerated ascents and omitted stage decompression.
Dr Deco :doctor:
Spontaneous Remission
Below is an abstract (edited for clarity) that speaks to the problem of what to do in the case of spontaneous remission on neurological DCS.
Arterial gas embolism with spontaneous recovery: rationale for therapeutic compression.
Clarke D, Gerard W, Norris T. Pulmonary barotrauma-induced cerebral arterial gas embolism with spontaneous recovery: commentary on the rationale for therapeutic compression. Aviat Space Environ Med 2002 Feb;73(2):139-46
Cerebral arterial gas embolism (CAGE) continues to complicate diving activities. Inadvertent breath holding or rapid buoyant ascent can quickly generate a critical state of lung over-pressure.
Bubbles are then free to embolize the systemic circulation via the pulmonary vasculature and the left heart. The brain is a common target organ. Bubbles that enter the cerebral arteries coalesce to form columns of gas as the vascular network narrows. Small amounts of gas frequently pass directly through the cerebral circulation without occlusion. Larger columns of gas occlude regional brain blood flow, either transiently or permanently, producing a stroke-like clinical picture.
In cases of spontaneous redistribution, a period of apparent recovery is frequently followed by relapse. The etiology of relapse appears to be multifactorial, and chiefly the consequence of a failure of reperfusion (= blood to start flowing again after the bubble has gone). Prediction of who will relapse is not possible, and any such relapse is of ominous prognostic significance. It is advisable, therefore, that CAGE patients who undergo spontaneous recovery be promptly recompressed while breathing oxygen.
Therapeutic compression will serve to antagonize leukocyte-mediated ischemia-reperfusion injury; protect against embolic injury to other organs; aid in the resolution of component cerebral edema; reduce the likelihood of late brain infarction reported in patients who have undergone spontaneous clinical recovery; and prophylax against decompression sickness in high gas loading dives that precede accelerated ascents and omitted stage decompression.
Dr Deco :doctor: