Arterial gas embolism: Difference between revisions
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==Background== | ==Background== | ||
*Also known as "air embolism" | *Also known as "air embolism" | ||
*May be fatal when air entry reaches 200-300 mL (pressure gradient of 5 mmHg across 14 ga catheter entrains air at 100 mL/sec) | *May be fatal when air entry reaches 200-300 mL (pressure gradient of 5 mmHg across 14 ga catheter entrains air at 100 mL/sec) | ||
*Prevention | *Dialysis related | ||
**Due to negative intrathoracic pressure from spontaneous breathing | |||
*Scuba related | |||
**Results from pulmonary barotrauma (most common) and decompression sickness | |||
===Prevention=== | |||
*Positive pressure mechanical ventilation reduces positive pressure gradient | |||
*Trendelenburg for insertion/removal of IJV and subclav lines | |||
*Reverse Trendelenburg for femoral | |||
==Clinical Features== | ==Clinical Features== | ||
*Acute dyspnea, chest tightness, LOC, cardiac arrest | *Dialysis related | ||
* | **Acute dyspnea, chest tightness, LOC, cardiac arrest | ||
*Scuba related | |||
**Symptoms develop during ascent or immediately upon surfacing | |||
**Causes variety of stroke syndromes depending on part of brain affected | |||
***Immediate death, loss of consciousness, seizure, blindness, hemiplegia | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 21: | Line 29: | ||
==Management== | ==Management== | ||
* | *Place in supine position | ||
* | *100% O2 NRB | ||
*Hemodynamic support with positive inotropes | *Hemodynamic support with positive inotropes | ||
*Rapid CPR in large air embolus | *Rapid CPR in large air embolus | ||
===Dialysis Related=== | |||
*Prevent any further air entry | |||
**Immediately cover puncture site with saline soaked gauze | |||
===Scuba Related=== | |||
*IVF (increases tissue perfusion) | |||
*Rapid recompression | |||
==See Also== | ==See Also== | ||
Revision as of 23:33, 10 February 2015
Background
- Also known as "air embolism"
- May be fatal when air entry reaches 200-300 mL (pressure gradient of 5 mmHg across 14 ga catheter entrains air at 100 mL/sec)
- Dialysis related
- Due to negative intrathoracic pressure from spontaneous breathing
- Scuba related
- Results from pulmonary barotrauma (most common) and decompression sickness
Prevention
- Positive pressure mechanical ventilation reduces positive pressure gradient
- Trendelenburg for insertion/removal of IJV and subclav lines
- Reverse Trendelenburg for femoral
Clinical Features
- Dialysis related
- Acute dyspnea, chest tightness, LOC, cardiac arrest
- Scuba related
- Symptoms develop during ascent or immediately upon surfacing
- Causes variety of stroke syndromes depending on part of brain affected
- Immediate death, loss of consciousness, seizure, blindness, hemiplegia
Differential Diagnosis
Dialysis Complications
- Dialysis-associated hypotension
- Dialysis disequilibrium syndrome
- Air embolism
- Missed dialysis (pulmonary edema)
Diving Emergencies
- Barotrauma of descent
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
- Barotrauma of ascent
- Pulmonary barotrauma (pulmonary overpressurization syndrome)
- Decompression sickness (DCS)
- Arterial gas embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- At depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
- Caustic cocktail from rebreathing circuit
Workup
- Low ETCO2 in significant venous air embolism
Management
- Place in supine position
- 100% O2 NRB
- Hemodynamic support with positive inotropes
- Rapid CPR in large air embolus
Dialysis Related
- Prevent any further air entry
- Immediately cover puncture site with saline soaked gauze
Scuba Related
- IVF (increases tissue perfusion)
- Rapid recompression
See Also
External Links
Sources
- The ICU book, 4th edition
- Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.