Undersea & Hyperbaric Medicine Journal Volume 43, Issue #4

Course overview

Learner Objectives As a result of having attended the meeting, the participants should have had the opportunity to: 1. To describe the implementation of a quality improvement (QI) project that aimed at improving and standardizing glucose checks on patients with diabetes undergoing hyperbaric oxygen (HBO2) therapy. 2. Understand CAGE, an extremely rare complication of EGD and the treatment protocols with hyperbaric medicine. Currently, there are only 13 documented cases of cerebral arterial gas embolism following EGD Subject Matter 1. Applying quality improvement methods in a hyperbaric oxygen program: reducing unnecessary glucose testing 2. A favorable outcome despite a 39-hour treatment delay for arterial gas embolism: case report Teaching Methods • Journal Reading • Examination of material • Evaluation of activity Evaluation Methods Evaluation is offered through the online educational portal with 3 graded questions each UHM Journal paper and an overall evaluation at completion of the Journal-based activity. References: 1. Weiss LD, Van Meter KW. Cerebral air embolism in asthmatic scuba divers in a swimming pool. Chest. 1995 Jun;107(6): 1653-1654. 2. Nicolin G, Parkin P, Mabbott D, Hargrave D, Bartels U, Tabori U, et al. Natural history and outcome of optic pathway gliomas in children. Pediatr Blood Cancer. 2009 Dec 15; 53(7): 1231-1237. 3. Wherrett CG, Mehran RJ, Beaulieu MA. Cerebral arterial gas embolism following diagnostic bronchoscopy:delayed treatment with hyperbaric oxygen. Can J Anaesth. 2002 Jan; 49(1): 96-99. 4. Morris WP, Butler BD, Tonnesen AS, Allen SJ. Continuous venous air embolism in patients receiving posi- tive end-expiratory pressure. Am Rev Respir Dis. 1993 Apr;147(4): 1034-1037. 5. Madden D, Lozo M, Dujic Z, Ljubkovic M. Exercise after SCUBA diving increases the incidence of arterial gas embolism. J Appl Physiol (1985). 2013 Sep 1; 115(5): 716-722. 6. Butler BD, Hills BA. Transpulmonary passage ofvenous air emboli. J Appl Physiol (1985). 1985 Aug; 59(2):543-547. 7. Vik A, Brubakk AO, Hennessy TR, Jenssen BM, Ekker M, Slordahl SA. Venous air embolism in swine:transport of gas bubbles through the pulmonary circulation. J Appl Physiol (1985). 1990 Jul; 69(1): 237-244. 8. Moon RE. Hyperbaric oxygen treatment for air or gas embolism. Undersea Hyperb Med. 2014 Mar-Apr; 41(2):159-166. 9. Clarke D, Gerard W, Norris T. Pulmonary barotrauma- induced cerebral arterial gas embolism with spontaneous recovery: commentary on the rationale for therapeutic compression. Aviat Space Environ Med. 2002 Feb; 73(2):139-146. 10. Navy Department. Diving medicine and recompression chamber operations. NAVSEA 0910-LP-106-0957. U.S. Navy Diving Manual. Rev 6. 2008;5. 11. Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: A systematic review. World J Gastrointest Endosc. 2013 Aug 16; 5(8): 359-365. 12. Pandurangadu AV, Paul JA, Barawi M, Irvin CB. A case report of cerebral air embolism after esophagogastroduo- denoscopy: diagnosis and management in the emergency department. J Emerg Med. 2012 Dec; 43(6): 976-979. 13. Akhtar N, Jafri W, Mozaffar T. Cerebral artery air embolism following an esophagogastroscopy: a case report. Neurology. 2001 Jan 9; 56(1):136-137. 14. Bou-Samra G, Darby PJ, Christensen GD. Cerebral air embolism during endoscopy. Mo Med. 1997 Dec; 94(12):704-707. 15. Christl SU, Scheppach W, Peters U, Kirchner T. Cerebral air embolism after gastroduodenoscopy: complication of a duodenocaval ¿stula. Gastrointest Endosc. 1994 May-Jun;40(3): 376-378. 16. Demaerel P, Gevers AM, De Bruecker Y, Sunaert S, Wilms G. Stroke caused by cerebral air embolism during endoscopy. Gastrointest Endosc. 2003 Jan; 57(1): 134-135. 17. Green BT, Tendler DA. Cerebral air embolism during upper endoscopy: case report and review. Gastrointest Endosc. 2005 Apr; 61(4): 620-623.