Clinical Communiqué Volume 5 Issue 1 March 2018
Download PDF: Clinical Communiqué March 2018 Edition
In this edition
Case #1 SEE BLOOD, THINK AIR
Case #2 CLOSING OFF THE RISKS
Case #3 A SIMPLE BAG OF SALINE
Case #4 DECOMPRESSING THE PROBLEM
Expert Commentary BUBBLE TROUBLE: RARELY TRIVIAL POTENTIALLY LETHAL
Welcome to the first edition of the Clinical Communiqué for 2018. Before we look ahead for the year, it is worth recalling the June 2017 Clinical Communique. In that edition, we focussed on the complex issues surrounding the treatment of pain, and the risks associated with prescribing and combining sedative medications.
Shortly afterwards, in October 2017, the Victorian Government passed the Drugs, Poisons and Controlled Substances Amendment (Real-time Prescription Monitoring) Bill 2017, which establishes a real-time prescription monitoring system, to be known as SafeScript. Victoria is the first jurisdiction in Australia to enact a state-wide mandatory prescription monitoring system, and it is hoped that this will lead to safer prescribing practices and similar legislation in other states.
We are starting this year by focussing on a specific condition that occurs inadvertently and leads to potentially fatal consequences without warning. Sometimes you can perform a simple task a thousand times without a problem. Then just once, a rare and devastating event occurs that makes everyone involved question their practise of that previously viewed “simple” task. Gas embolism is one of those events – hard to diagnose, time critical, and difficult to treat. It does not discriminate between the old and the young, or the sick and the healthy. This edition of the Clinical Communiqué collates four very different cases of gas embolism with the common findings of rapid devastating deterioration and ultimately unsuccessful attempts at recovery.
Prevention is the best option, as early recognition of gas embolism sometimes is not early enough. Gas embolism may be a relatively rare clinical entity, but it is a diagnosis that must remain at the forefront of our minds when planning and performing any invasive procedures. Even minimally invasive procedures such as infusing intravenous fluids. Another distinctive feature of gas embolism is that it is not always iatrogenic in nature. Gas embolism is a well-known complication of scuba (self-contained underwater breathing apparatus) diving. With an increasing number of people undertaking diving activities for recreation and occupation, and the rise of adventure holiday dive packages, complications such as gas embolism need to be well understood and prepared for. If gas embolism following a dive is suspected in the community or emergency department setting, then it is important to know who to call, and to call early to access first aid advice, and if necessary facilitate transfer to the nearest decompression chamber.
The expert commentary has been written by Dr Geoff Frawley, a Melbourne-based anaesthetist with extensive experience in hyperbaric medicine. He provides a highly instructive overview of the causes, diagnosis and management of gas embolism.
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