• CPR, if required
• Open airway; prevent aspiration.
• Intubation for somnolent or comatose patient; highest possible concentration of oxygen; eliminates gas in the bubbles by establishing diffusion gradient that favors egress of gas from bubbles
• When air transport is required, helicopter transport should be at an altitude < 1,000 feet, and fixed-wing transfer should be limited to an aircraft that can maintain cabin pressure at 1 atm.

Medication (Drugs)

First Line
Oxygen:

• Concentration as high as possible
• Immediate transport to a suitable hyperbaric chamber for recompression

• Aspirin
• Adjunctive therapy with glucocorticoids, lidocaine, heparin, or indomethacin: Efficacy unclear

Additional Treatment

General Measures

• Lifesaving measures must take precedence to sustain life.
• Keep patient recumbent while maintaining patent airway. Place patient in flat supine position (head-down position may aggravate cerebral edema that develops).
• Maintain hydration with IV fluids.
• Hyperbaric oxygen:
  • 1st-line treatment of choice for arterial gas embolism; immediate transport to a suitable hyperbaric chamber for recompression as soon as possible; do not delay because of nonessential procedures.
  • 100% oxygen at pressure above that of the atmosphere at sea level
  • Decreases bubble size
  • Prevents cerebral edema
  • For assistance and advice on locating the nearest treatment chamber in your area, call Divers Alert Network (DAN) at any hour (919) 684-8111. Worldwide contact information available at http://www.diversalertnetwork.org.

In-Patient Consideratons

IV Fluids
Achieve normovolemia.