Diving medical officers as hospitalists: a case of arterial gas embolism following a routine GI procedure

2020 ◽  
pp. 621-624
Author(s):  
Stephen M. Hughes ◽  
◽  
Joni Hodgson ◽  
Michael F. Richards ◽  
◽  
...  
Keyword(s):  
Rare Complication ◽  
Military Medicine ◽  
Hospital Setting ◽  
Hospital Environment ◽  
Neurological Deficits ◽  
Gas Embolism ◽  
Arterial Gas Embolism ◽  
Diving Medicine ◽  
Hyperbaric Medicine ◽  
Medicine Team

Arterial gas embolism is a well-described and frequently seen injury encountered in both civilian and military diving operations. It is becoming increasingly reported and potentially increasingly more common in the hospital environment as a complication of more frequent gastroenterology procedures. We present a case of a 49-year-old, active-duty female who developed significant left-sided neurological deficits manifesting as diffuse left-sided weakness, subjective confusion, and severe headache following esophagogastroduodenoscopy. With increased clinical suspicion for arterial gas embolism, the patient was evaluated by the hyperbaric medicine team at our facility and subsequently treated to near-resolution of symptoms by multiple hyperbaric oxygen treatments. This case highlights the importance of considering this rare complication during or following common invasive procedures. Furthermore, the unique training and experience of physicians with expertise in diving medicine and their ability to recognize these types of injury in the hospital setting highlights the importance of continued training in these fields within Military Medicine in addition to civilian Undersea and Hyperbaric Medicine fellowships.

Cerebral arterial gas embolism from attempted mechanical thrombectomy: recovery following hyperbaric oxygen therapy

2017 ◽  
Vol 18 (2) ◽  
pp. 134-136 ◽  
Author(s):  
Louise Segan ◽  
Fiona Permezel ◽  
Wei Ch’ng ◽  
Ian Millar ◽  
Mark Brooks ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Hyperbaric Oxygen ◽  
Acute Ischaemic Stroke ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Mechanical Thrombectomy ◽  
Rare Complication ◽  
Endovascular Intervention ◽  
Gas Embolism ◽  
Arterial Gas Embolism

Cerebral arterial gas embolism is a recognised complication of endovascular intervention with an estimated incidence of 0.08%. Its diagnosis is predominantly clinical, supported by neuroimaging. The treatment relies on alleviating mechanical obstruction and reversing the proinflammatory processes that contribute to tissue ischaemia. Hyperbaric oxygen therapy is an effective treatment and has multiple mechanisms to reverse the pathological processes involved in cerebral arterial gas embolism. Symptomatic cerebral arterial gas embolism is a rare complication of endovascular intervention for acute ischaemic stroke. Although there are no previous descriptions of its successful treatment with hyperbaric oxygen therapy following mechanical thrombectomy, this is likely to become more common as mechanical thrombectomy is increasingly used worldwide to treat acute ischaemic stroke.

scholarly journals Impaired consciousness when scuba diving associated with vasovagal syncope

2020 ◽  
Vol 50 (4) ◽  
pp. 421-423
Author(s):  
Peter Wilmshurst ◽  
◽  
Margaret Clamp ◽  
Keyword(s):  
Vasovagal Syncope ◽  
Oxygen Toxicity ◽  
Scuba Diving ◽  
Toxic Effects ◽  
Gas Embolism ◽  
Impaired Consciousness ◽  
Scuba Divers ◽  
Nitrogen Narcosis ◽  
Arterial Gas Embolism ◽  
Hyperbaric Medicine

(Wilmshurst P, Clamp M. Impaired consciousness when scuba diving associated with vasovagal syncope. Diving and Hyperbaric Medicine. 2020 December 20;50(4):421–423. doi: 10.28920/dhm50.4.421-423. PMID: 33325026.) Introduction: Drowning is likely to result from impairment of consciousness when scuba diving. Causes include toxic effects of breathing gas, including nitrogen narcosis and oxygen toxicity, and arterial gas embolism. Methods: Review of the medical records of scuba divers who had impaired consciousness underwater that could not be attributed to toxic effects of breathing gas or arterial gas embolism. Results: Four scuba divers had episodes of impaired consciousness when at shallow depths (8−18 m) underwater. The descriptions of the episodes were very similar. Three had histories of recurrent episodes of vasovagal syncope on land. Conclusions: Absence of other causes for their impaired consciousness underwater leads to the conclusion that the probable cause was vasovagal syncope.

scholarly journals Cerebral arterial gas embolism proven by computed tomography following transthoracic echocardiography using bubble contrast

2020 ◽  
Vol 50 (3) ◽  
pp. 300-302
Author(s):  
Neil DG Banham ◽  
◽  
Jacqui Saw ◽  
Graeme J Hankey ◽  
Darshan Ghia ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Transthoracic Echocardiography ◽  
Rare Complication ◽  
Contrast Echocardiography ◽  
Left Middle Cerebral Artery ◽  
Gas Embolism ◽  
Arterial Gas Embolism ◽  
Computed Tomography Scanning ◽  
Left Middle ◽  
Tomography Scanning

A 75 year-old male developed features of an acute stroke following bubble contrast echocardiography, which was shown on emergent computed tomography scanning to be a result of cerebral arterial gas embolism (CAGE) to the left middle cerebral artery. Ischaemic stroke symptoms have previously been reported as a rare complication of bubble contrast echocardiography. Radiologically proven CAGE from bubble contrast echocardiography had not been reported at the time this case occurred. Immediate provision of 100% oxygen and administration of hyperbaric oxygen are recommended treatments for CAGE and were associated with a substantial recovery for this patient.

Hyperbaric treatment of air or gas embolism: current recommendations

2019 ◽  
pp. 673-683
Author(s):  
Richard E. Moon ◽  
Keyword(s):  
Animal Studies ◽  
Decompression Sickness ◽  
Bubble Formation ◽  
Endothelial Damage ◽  
Neurological Deficits ◽  
Breath Hold ◽  
Gas Embolism ◽  
Hyperbaric Treatment ◽  
Pulmonary Capillaries ◽  
Venous Gas Embolism

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac “vapor lock” and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence-based review of adjunctive therapies is presented.

scholarly journals Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature

2021 ◽  
pp. 405-413
Author(s):  
Cecelia Allison ◽  
Vaibhav Sharma ◽  
Jason Park ◽  
Clemens M. Schirmer ◽  
Ramin Zand
Keyword(s):  
Rare Complication ◽  
General Pattern ◽  
Treatment Protocol ◽  
Case Series ◽  
Altered Mental Status ◽  
Cortical Blindness ◽  
Neurological Deficits ◽  
Cerebral Angiogram ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast

Contrast-induced encephalopathy (CIE) is a rare complication that arises from exposure to iodinated contrast medium and can result in a range of symptoms, including cortical blindness, aphasia, focal neurological deficits, and altered mental status. We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.

scholarly journals SARS-CoV-2 detection status associates with bacterial community composition in patients and the hospital environment

Microbiome ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Clarisse Marotz ◽  
Pedro Belda-Ferre ◽  
Farhana Ali ◽  
Promi Das ◽  
Shi Huang ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Rna Virus ◽  
Bacterial Community Composition ◽  
Hospital Setting ◽  
Amplicon Sequencing ◽  
Hospital Environment ◽  
Rrna Gene ◽  
Sequence Variant ◽  
Care Providers ◽  
Single Amplicon

Abstract Background SARS-CoV-2 is an RNA virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Viruses exist in complex microbial environments, and recent studies have revealed both synergistic and antagonistic effects of specific bacterial taxa on viral prevalence and infectivity. We set out to test whether specific bacterial communities predict SARS-CoV-2 occurrence in a hospital setting. Methods We collected 972 samples from hospitalized patients with COVID-19, their health care providers, and hospital surfaces before, during, and after admission. We screened for SARS-CoV-2 using RT-qPCR, characterized microbial communities using 16S rRNA gene amplicon sequencing, and used these bacterial profiles to classify SARS-CoV-2 RNA detection with a random forest model. Results Sixteen percent of surfaces from COVID-19 patient rooms had detectable SARS-CoV-2 RNA, although infectivity was not assessed. The highest prevalence was in floor samples next to patient beds (39%) and directly outside their rooms (29%). Although bed rail samples more closely resembled the patient microbiome compared to floor samples, SARS-CoV-2 RNA was detected less often in bed rail samples (11%). SARS-CoV-2 positive samples had higher bacterial phylogenetic diversity in both human and surface samples and higher biomass in floor samples. 16S microbial community profiles enabled high classifier accuracy for SARS-CoV-2 status in not only nares, but also forehead, stool, and floor samples. Across these distinct microbial profiles, a single amplicon sequence variant from the genus Rothia strongly predicted SARS-CoV-2 presence across sample types, with greater prevalence in positive surface and human samples, even when compared to samples from patients in other intensive care units prior to the COVID-19 pandemic. Conclusions These results contextualize the vast diversity of microbial niches where SARS-CoV-2 RNA is detected and identify specific bacterial taxa that associate with the viral RNA prevalence both in the host and hospital environment.

scholarly journals The Implementation of Active Environmental Surveillance in a Veterinary Referral Hospital Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s409-s409
Author(s):  
Emily Feyes ◽  
Dixie Mollenkopf ◽  
Thomas Wittum ◽  
Dubraska Diaz-Campos ◽  
Rikki Horne
Keyword(s):  
Veterinary Medicine ◽  
Hospital Setting ◽  
Ohio State University ◽  
Hospital Environment ◽  
State University ◽  
Environmental Surveillance ◽  
University College ◽  
Animal Contact ◽  
Contact Surfaces ◽  
The Ohio State University

Emily Feyes, The Ohio State University College of Veterinary Medicine; Dixie Mollenkopf, The Ohio State University College of Veterinary Medicine; Thomas Wittum, The Ohio State University College of Veterinary Medicine; Dubraska Diaz-Campos, The Ohio State University College of Veterinary Medicine; Rikki Horne, The Ohio State University College of Veterinary MedicineBackground: The Ohio State University College of Veterinary Medicine (OSU-CVM) Antimicrobial Stewardship Working Group (ASWG) uses monthly environmental surveillance to understand the effectiveness of our veterinary medical center (VMC) infection control and biosecurity protocols in reducing environmental contamination with multidrug resistant organisms. Monthly surveillance allows us to monitor trends in the recovery of these resistant organisms and address issues of concern that could impact our patients, clients, staff, and students. Methods: The OSU-CVM ASWG collects samples from >100 surfaces within the companion animal, farm animal, and equine sections of our hospital each month. Sampling has been continuous since January 2018. Samples are collected from both human–animal contact and human-only contact surfaces using Swiffer electrostatic cloths. These samples are cultured for recovery of Salmonella spp, extended-spectrum cephalosporin-resistant Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae (CPE), and methicillin-resistant Staphylococcus spp. Results: The recovery of these antibiotic resistant target organisms is low in the environment of our hospital. Recovery from human-only contact surfaces (19.8%) is very similar to recovery from human–animal contact surfaces (25.5%). We commonly recover Enterobacteriaceae (E.coli, Klebsiella spp, and Enterobacter spp) that are resistant to extended-spectrum cephalosporins (496 of 2,016; 24.6%) from the VMC environment. These antibiotic-resistant indicator bacteria are expected in a veterinary hospital setting where use the of β-lactam drugs is common. Recovery of both Salmonella spp and CPE has remained very low in our hospital environment over the past 19 months: 16 of 2,016 (0.7%) for Salmonella and 15 of 2,016 (0.8%) for CPE. Discussion: The active environmental surveillance component of our antimicrobial stewardship program has allowed us to reduce the threat of nosocomial infections within our hospital and address environmental contamination issues before they become a problem. Our consistently low recovery of resistant organisms indicates the effectiveness of our existing cleaning and disinfection protocols and biosecurity measures. Due to the nature of our patient population, we do expect to find resistant organisms in the patient-contact areas of the hospital environment. However, our similar rates of resistant organisms from human-only surfaces (eg, computer keyboards, door handles, telephones, and Cubex machines) indicates a need to improve our hand hygiene practices. These data are now supporting the implementation of a new hand hygiene campaign in our veterinary hospital.Funding: NoneDisclosures: None

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