[abstract]SEVERE DISTRIBUTIVE SHOCK DUE TO DECOMPRESSION SICKNESS

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[abstract]SEVERE DISTRIBUTIVE SHOCK DUE TO DECOMPRESSION SICKNESS

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Title: [abstract]SEVERE DISTRIBUTIVE SHOCK DUE TO DECOMPRESSION SICKNESS
Author: Gerbino T; Eaton C; Holm J
Abstract: INTRODUCTION: Distributive shock is a rare manifestation of decompression sickness. We present a case of severe distributive shock and acute respiratory failure due to decompression sickness. CASE: A 50-year-old technical diver without significant prior illnesses dived to maximum and average depths of 218 feet and 123 feet, respectively, with a total dive time of 63 minutes. Significant decompression time was omitted due to inadequate gas supply. Upon surfacing he developed respiratory distress, generalized weakness, loss of consciousness and cutis marmorata. He quickly developed pulmonary edema, hypoxia and hypercapnia, requiring intubation and mechanical ventilation with 100 percent oxygen and high levels of end-expiratory pressure. He was transferred from the emergency department to a multiplace hyperbaric chamber, where he was treated with a U.S. Navy Treatment Table 6. During hyperbaric oxygen therapy he developed progressive hypotension associated with worsening pulmonary and peripheral edema, hemoconcentration and hypoalbuminemia consistent with a severe capillary leak syndrome. There was progression of hypoxemia, hypotension and acidemia, leading to premature termination of the treatment at 30 fsw. Vasopressors, albumin and massive administration of intravenous fluids were required to treat hypotension through Day 3. He was liberated from mechanical ventilation on Day 10. Brain MRI at ICU discharge on Day 14 showed multifocal bilateral subacute infarcts. He was discharged on Day 21 fully ambulatory, with normal cardiopulmonary function and only ocular neurologic deficits. DISCUSSION: Severe distributive shock due to decompression sickness (“bends shock”) is rare but may occur in the setting of omitted decompression, wherein a large burden of undissolved intravascular gas is hypo-thesized to mediate endothelial injury and consequent capillary leak. Plans for hyperbaric oxygen in these patients should weigh risks and benefits, especially when supraphysiologic arterial oxygen tensions cannot be achieved and adequate ventilation is difficult. Modification of standard protocols should be con-sidered, as should liberal administration of colloid.
Description: Undersea and Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc.
URI: http://archive.rubicon-foundation.org/10849
Date: 2013

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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