Arterial gas embolism
Background
- 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)
Workup
Management
- Prevent any further air entry
- Immediately cover puncture site with saline soaked gauze
- 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.