Arterial gas embolism: Difference between revisions
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Revision as of 23:29, 10 February 2015
Background
- Also known as "air embolism"
- Due to negative intrathoracic pressure from spontaneous breathing
- 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 is most important
- Positive pressure mechanical ventilation reduces positive pressure gradient
- Trendelenburg for insertion/removal of IJV and subclav lines
- Reverse Trendelenburg for femoral
Clinical Features
- Acute dyspnea, chest tightness, LOC, cardiac arrest
- Decompression syndrome - see SCUBA Diving Emergencies
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
- Prevent any further air entry
- Immediately cover puncture site with saline soaked gauze
- Treat w/ 100% NRB
- Hemodynamic support with positive inotropes
- Rapid CPR in large air embolus
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.