Secondary deterioration in a patient with cerebral and coronary arterial gas embolism after brief symptom resolution: a case report.

IF 0.8 4区医学 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Diving and hyperbaric medicine Pub Date : 2024-03-31 DOI:10.28920/dhm54.1.61-64

Ryota Tsushima, Kosuke Mori, Shohei Imaki

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引用次数: 0

Abstract

Introduction: Hyperbaric oxygen treatment (HBOT) is recommended for arterial gas embolism (AGE) with severe symptoms. However, once symptoms subside, there may be a dilemma to treat or not.

Case presentation: A 71-year-old man was noted to have a mass shadow in his left lung, and a transbronchial biopsy was performed with sedation. Flumazenil was intravenously administered at the end of the procedure. However, the patient remained comatose and developed bradycardia, hypotension, and ST-segment elevation in lead II. Although the ST changes spontaneously resolved, the patient had prolonged disorientation. Whole- body computed tomography revealed several black rounded lucencies in the left ventricle and brain, confirming AGE. The patient received oxygen and remained supine. His neurological symptoms gradually improved but worsened again, necessitating HBOT. HBOT was performed seven times, after which neurological symptoms resolved almost completely.

Conclusions: AGE can secondarily deteriorate after symptoms have subsided. We recommend that HBOT be performed promptly once severe symptoms appear, even if they resolve spontaneously.

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一名脑部和冠状动脉气体栓塞患者在症状短暂缓解后病情继发恶化：病例报告。

简介建议对症状严重的动脉气体栓塞（AGE）患者进行高压氧治疗（HBOT）。然而，一旦症状消退，治疗与否可能会陷入两难境地：一名 71 岁的男性被发现左肺有肿块阴影，在镇静状态下进行了经支气管活检。手术结束后静脉注射了氟马西尼。然而，患者仍处于昏迷状态，并出现心动过缓、低血压和 II 导联 ST 段抬高。虽然ST段变化自发消失了，但患者出现了长时间的意识障碍。全身计算机断层扫描显示，左心室和脑部出现多个黑色圆形通透点，证实了AGE。患者接受了吸氧并保持仰卧。他的神经症状逐渐好转，但又再次恶化，因此必须进行 HBOT。共进行了七次 HBOT，之后神经症状几乎完全缓解：结论：AGE 可在症状缓解后二次恶化。我们建议，一旦出现严重症状，即使症状自行缓解，也应立即进行 HBOT 治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diving and hyperbaric medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

1.70

自引率

22.20%

发文量

审稿时长

>12 weeks

期刊介绍： Diving and Hyperbaric Medicine (DHM) is the combined journal of the South Pacific Underwater Medicine Society (SPUMS) and the European Underwater and Baromedical Society (EUBS). It seeks to publish papers of high quality on all aspects of diving and hyperbaric medicine of interest to diving medical professionals, physicians of all specialties, scientists, members of the diving and hyperbaric industries, and divers. Manuscripts must be offered exclusively to Diving and Hyperbaric Medicine, unless clearly authenticated copyright exemption accompaniesthe manuscript. All manuscripts will be subject to peer review. Accepted contributions will also be subject to editing.