Hyperbaric oxygen therapy for arterial gas embolism in Jordan
علاج الانصمام الغازي الشرياني بالأكسجين المضغوط
Arterial gas embolism is the entry of gas bubbles into the arteries, blocking blood flow to the brain, the heart or other organs. Treating it with hyperbaric oxygen means moving the patient rapidly into a pressurised chamber, where raised pressure shrinks the bubble while high-concentration oxygen speeds the gas back into solution and out of the body, and supplies the tissue that has been cut off. This is an accepted emergency indication, and it is a treatment measured in minutes and hours rather than days. Gas embolism occurs in diving, particularly after a rapid ascent or breath-holding while ascending, and it may accompany decompression sickness, in which nitrogen bubbles form in blood and tissue. It also occurs as a medical complication during insertion or removal of a central venous catheter, in some endoscopic and surgical procedures, with mechanical ventilation, or after chest trauma. In Jordan, diving in Aqaba makes this a realistic emergency, and it is important to know that symptoms can appear hours after leaving the water. Symptoms depend on which artery is blocked: loss of consciousness or confusion, weakness or numbness on one side, difficulty speaking or seeing, severe dizziness, seizure, chest pain, breathlessness or palpitations. In decompression sickness there may instead be deep joint pain, itching and rash, extreme fatigue, or leg weakness and bladder disturbance pointing to spinal cord involvement. The first steps are not the chamber. Call emergency services immediately, give the highest available concentration of oxygen, and keep the patient lying flat. Do not put the person back into the water. **Returning a diver to depth to re-pressurise them is a dangerous myth that can kill, and it is not first aid.** The patient must not fly or be transported over high mountain routes before the specialist team is consulted, because falling pressure makes bubbles worse. The limits are explicit. Hyperbaric oxygen does not repair neurological damage that has already become established; improvement with surface oxygen does not mean cure and does not remove the need for recompression; and some patients need more than one session and may be left with residual symptoms. **An untreated pneumothorax must be drained before a patient enters the chamber, as it is an absolute barrier that is never bypassed.**
Procedure steps
- 1
First aid and arranging urgent transfer
Call emergency services at once, give the highest available concentration of oxygen, and keep the person lying flat, neither head-up nor head-down. Never return them to the water. Give oral fluids only if they are fully alert and able to swallow, record the time of the last dive or the last medical procedure, and alert the team so transfer to the nearest chamber-equipped centre can be arranged.
- 2
Medical assessment and excluding chamber barriers
In the emergency department, consciousness, neurological power, speech, vision, breathing and cardiac status are assessed, and associated injuries such as chest trauma are sought. Conditions that prevent entry are excluded, above all a pneumothorax, which must be drained before pressure is raised. Medications, chronic illnesses, ears and sinuses are reviewed and pregnancy is asked about. The decision is an urgent clinical one and is not delayed for unnecessary tests.
- 3
Recompression inside the chamber
Pressure inside the chamber is raised according to an established protocol for gas embolism and decompression sickness, shrinking the bubble and driving gas back into solution while high-concentration oxygen supplies the injured tissue and speeds gas elimination. The first session in these conditions is longer than a routine wound session and is run with continuous monitoring of vital signs and neurological status.
- 4
Ear equalisation and in-chamber safety
A conscious patient is shown how to equalise ear pressure by swallowing or moving the jaw before pressurisation, and fire-safety rules apply, so no oil-based product, perfume, lighter, phone or electronic device enters the chamber. **Severe ear pain that will not clear, or bleeding from the ear, must be reported at once and stops pressurisation**, and in an unconscious patient ear equalisation is managed medically.
- 5
Reassessment and follow-up sessions
After the session the neurological examination is repeated and compared with the findings before it. Some patients improve after a single session, while others need repeated sessions over several days until improvement plateaus. Follow-up is arranged for any residual symptoms, and the patient is told when flying, travel to altitude or a return to diving may be allowed, which is a medical decision rather than the patient's own.
Before the procedure
This is an emergency, and preparing must never mean delaying. Call for help first and start oxygen. Tell the team the details that change decisions: the time, depth and duration of the last dive and how many dives that day, whether the ascent was rapid or breath-holding occurred, whether air or another gas mixture was used, and exactly when symptoms began after leaving the water. If the event followed a medical procedure, report the procedure, its timing and the catheter site. Report all medications and chronic illnesses, especially any lung disease, asthma, previous collapsed lung or chest surgery, any ear surgery or perforated eardrum, and any epilepsy or seizures, and say if you are pregnant or might be. Mention any cold, blocked nose or sinus infection. Do not drink alcohol or take sedatives. Do not fly or travel over high mountain routes before consulting the team. Oil-based products and perfumes are removed before entry, and no phone, lighter or smart watch goes into the chamber, as this is a fire-safety rule.
After the procedure
Attend every session and follow-up requested and do not stop because you feel better, since some neurological symptoms need repeated sessions and early improvement may only be partial. Drink adequate fluids if permitted, rest, and do not drive until dizziness, weakness and blurred vision have fully resolved. Do not fly, travel to high altitude, or return to diving without explicit medical clearance and for as long as the team specifies. Report any residual symptom to your doctor even if it seems minor: numbness, weakness, tremor, unusual fatigue, or disturbance of balance, memory or bladder function. If the event was dive-related, review the cause with your doctor and retrain on slow ascents and safety stops before any return. **Seek care immediately for returning or worsening weakness or numbness, difficulty speaking or seeing, a seizure or loss of consciousness, chest pain or breathlessness, back pain with bladder disturbance, or severe ear pain, bleeding from the ear or hearing loss.**
Expected duration
The first recompression session for gas embolism and decompression sickness is longer than a routine wound session and may run for several hours depending on the protocol used. Some patients improve after one session, while others need additional shorter sessions over several days until neurological improvement plateaus, and what matters most is starting as early as possible.
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