Therapy

This includes immediate measures and HBO46. 4.1 Emergency care

- Against the actual embolus42, the injured vessel should be compressed and obstructed immediately; the patient must be placed on the left side (if possible) to collect the gaseous mass in the tip of the right ventricle so as to free the pulmonary arterial tract. Ventilation with 100% oxygen must be provided as soon as possible to begin denitrogenation. In cases of general anaesthesia with nitrous oxide, the latter must be stopped immediately as it makes the embolus obstruction worse34,86.

In cases where a catheter is inserted in the right atrium, fast aspiration can

52,79,87

sometimes remove large quantities of air52,79,87. Other methods (right ventricle puncture, opening of the pulmonary infundibulum, aortic clamping, etc.) can only be considered during heart or thoracic surgery.

- Cardiac arrest requires immediate conventional resuscitation (chest compression, controlled ventilation)

- Cardiovascular collapse must be corrected quickly because hypotension enables embolus to become lodged. Vascular volume should be restored and perfusion pressure maintained - with vasopressive drugs if necessary.

- Convulsions or agitation require benzodiazepines or barbiturates, while avoiding circulatory depression.

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