Arterial gas embolism: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Asymptomatic | *Asymptomatic | ||
*Mild: dyspnea, cough | *Mild: [[dyspnea]], [[cough]] | ||
*Cardiogenic shock: hypotension, oliguria, altered mental status, chest pain | *[[Cardiogenic shock]]: [[hypotension]], oliguria, [[altered mental status]], [[chest pain]] | ||
*Dialysis related | *[[Dialysis]] related | ||
**Acute dyspnea, chest tightness, LOC, cardiac arrest | **Acute [[dyspnea]], [[chest pain|chest tightness]], [[syncope|LOC]], [[cardiac arrest]] | ||
*Scuba related | *Scuba related | ||
**Symptoms develop during ascent or immediately upon surfacing | **Symptoms develop during ascent or immediately upon surfacing | ||
**Causes variety of stroke syndromes depending on part of brain affected | **Causes variety of [[stroke syndromes]] depending on part of brain affected | ||
***Immediate death, loss of consciousness, seizure, blindness, hemiplegia | ***Immediate [[cardiac arrest|death]], [[syncope|loss of consciousness]], [[seizure]], [[vision loss|blindness]], [[weakness|hemiplegia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Low ETCO2 in significant venous air embolism | *Low ETCO2 in significant venous air embolism | ||
*TEE: most sensitive, invasive not available in emergencies | *[[echocardiography|TEE]]: most sensitive, invasive not available in emergencies | ||
*Doppler US: noninvasive; air in chamber = high pitch sound | *Doppler US: noninvasive; air in chamber = high pitch sound | ||
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*Central line aspiration of air from right heart | *Central line aspiration of air from right heart | ||
*100% [[O2]] non-rebreather | *100% [[O2]] non-rebreather | ||
*Hemodynamic support with positive inotropes | *Hemodynamic support with positive [[vasopressors|inotropes]] | ||
*Rapid [[CPR]] in large air embolus | *Rapid [[CPR]] in large air embolus | ||
*Positioning | *Positioning | ||
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===Scuba Related=== | ===Scuba Related=== | ||
*IVF (increases tissue perfusion) | *[[IVF]] (increases tissue perfusion) | ||
*Rapid recompression | *Rapid recompression | ||
Revision as of 17:13, 28 September 2019
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)[1]
- 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
- Asymptomatic
- Mild: dyspnea, cough
- Cardiogenic shock: hypotension, oliguria, altered mental status, chest pain
- 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
Evaluation
- Low ETCO2 in significant venous air embolism
- TEE: most sensitive, invasive not available in emergencies
- Doppler US: noninvasive; air in chamber = high pitch sound
Management[2][3]
- Central line aspiration of air from right heart
- 100% O2 non-rebreather
- Hemodynamic support with positive inotropes
- Rapid CPR in large air embolus
- Positioning
- Durant's maneuver - left lateral decubitus and Trendelenburg
- Traps air in apex of RV, relieves obstruction of pulmonary outflow tract
- May require open surgical or angiography for recovery of residual intracardiac or intrapulmonary air
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
References
- ↑ Vascular Access. In: Marino, P. The ICU Book. 4th, North American Edition. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013
- ↑ *Shaikh N., Ummunisa F. Acute management of vascular air embolism. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 180–185.
- ↑ Gordy S and Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013 Jan-Mar; 3(1): 73–76.