HBO Emergencies: Decompression Sickness (Bends) & AGE (Arterial Gas Embolism) Decompression Sickness (DCS) is caused by nitrogen bubble formation in the tissues of the body. It is associated with scuba diving, flying and tunneling/mining. Nitrogen gas is taken up by the tissue with the pressure of depth. There is respiratory “offgassing” upon ascent. If ascent occurs faster than bubble-free off gassing will allow, then bubbles will form. The resultant bubble formation is in the veins and soft tissue of the body. These bubbles damage the vessel wall and induce ischemia and clot formation. There is no diagnostic test for this condition. There are many presentations of DCS. Type 1 has a typical “pain only” presentation in the extremities. Any neurological abnormality or symptoms involving the trunk should be regarded as Type 2 DCS. These patients may present with dizziness, focal numbness or tingling, motor weakness, paralysis or urinary retention. Rapid uncontrolled ascent is associated with pulmonary overinflation and pneumothorax with resultant cerebral gas embolism (Decompression Illness). As a general rule for treatment if you suspect decompression sickness treat for decompression sickness with recompression - HBO. Please Visit our Diving Website for further information: www.divinghbo.com Arterial Gas Embolism (AGE) is caused by gas bubbles in the circulatory system. AGE or arterial gas embolism is a common complication of two divergent conditions: 1. Post diving in which there is rapid ascent. Air expands in the pulmonary alveoli. If air expands faster than can be ventilated the alveolar wall will expand forcing air directly into the capillaries surrounding the alveoli. Gas forms bubbles that travel in the systemic circulation where they will eventually occlude the vessel when the arteries/arterioles narrow. This will cause an area of occlusion and stroke symptoms if it occurs in the brain. Common presentation of CNS or brain AGE is stroke and seizure. 2.Iatrogenic or Medical procedure complications. The mechanism here is arterial gas which is associated frequently with arterial lines and arterial procedures such as angiography. . Arterial gas emboli are associated with medical procedures which include the procedures of laparoscopy, cardiac bypass surgery, fine needle lung biopsy, angiography, and the use of pressure cement guns and hip surgery. Central nervous system AGE is far more common than the average medical practitioner recognizes. A stroke occurring  during a medical procedure should be considered a possible arterial gas embolism until proven otherwise. Frequently, a CT scan will show air or gas in the arteries of the brain. Treatment for this condition is HBO compression therapy for bubble reduction and gas diffusion. HBO Saves Lives and Limbs Cerebral AGE Web Site Designed and Created by Robert David Tufft MD