title: Cerebral arterial gas embolism with delayed treatment and a fatal outcome in a 14-year-old diver.
abstract: In today's recreational diving climate, diving fitness examinations are not mandatory, and even divers who go for these examinations may not have routine chest X-rays (CXR) done in the absence of respiratory symptoms or a past history of respiratory problems. We present a case of an ultimately fatal cerebral arterial gas embolism in a 14-year-old boy with an undiagnosed lung cyst, the contribution of which to his death is uncertain. Various factors such as lack of oxygen first aid at the remote dive site; poor communication; lack of diving medicine expertise, poor oxygen administration and management in a local hospital and long delay to recompression therapy contributed to the poor outcome. It is imperative that dive operators and physicians working in close proximity to popular dive sites be educated on how to recognise and treat diving emergencies and be well-acquainted, as should divers, with the contact numbers of diving medical hotlines that offer timely and appropriate advice in case of emergency.
authors.affiliation: Divers Alert Network Asia-Pacific. johnl@danasiapacific.org
authors.forename: John
authors.initials: J
authors.lastname: Lippmann
authors.forename: Andrew
authors.initials: A
authors.lastname: Fock
authors.forename: Shalini
authors.initials: S
authors.lastname: Arulanandam
mesh_terms: D000293:Adolescent; D001926:Brain Death; D003560:Cysts / Q000150:complications* / Q000000981:diagnostic imaging; D003665:Decompression Sickness / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D057210:Delayed Diagnosis; D004242:Diving / Q000009:adverse effects*; D004618:Embolism, Air / Q000209:etiology*; D017809:Fatal Outcome; D015600:Glasgow Coma Scale; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D020766:Intracranial Embolism / Q000209:etiology*; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods; D010360:Patient Transfer / Q000592:standards; D011859:Radiography; D012640:Seizures / Q000209:etiology