- Gas Embolism
- ~ 1ml/kg can be fatal
- Venous air embolism (VAE), arterial air embolism (AAE) and paradoxical air embolism (PAE) can occur.
- Pathophysiology
- CVS function
- Obstruction to RVOT if bolus VAE
- Slower infusions cause PAH and RVF
- Neutrophils attracted to RBC/plt that form around the bubble
- Paradoxical (due to PFO/transpulmonary shunt)
- Effect of VAE is greater in children
- Seen in most areas of medicine
- Venous
- Neurosurgery
- Craniotomy, sitting position, spinal surgery, ACDF.
- Ortho
- Obstetrics
- Head/neck
- Including laser procedures
- IV catheters
- CVC insertion, air in giving sets
- Arterial
- Direct entry
- CPB
- Angiography
- CEA
- Laparoscopy
- PAE
- Intracardiac shunt
- Transpulmonary shunt
- Detection
- TOE best
- Precordial doppler
- Precordial stethoscope
- TCD
- PAC
- CVC
- Treatment
- 100% O2
- Prevent further air entry
- Flood site
- Compress wound
- IV fluids
- Increase intra-thoracic pressure
- Decrease size
- Turn N₂O off
- Aspirate via CVC
- Consider hyperbaric O₂
- Overcome mechanical obstruction
- L lateral decubitus position
- CPB if available
- CPR
- Arterial
- Prevention
- Communication is key
- Screen for PFO
- Raise CVP
- Peep increases risk of PAE
- Presentation
- Venous
- CV collapse
- Tachypnoea
- Tachycardia
- Apnoea
- Chest pain/SOB
- Pulmonary oedema
- Mill wheel murmur
- Gasp reflex
- Tachyarrhythmias
- Low SpO₂
- CVP high
- Arterial
- Angina
- Hypotension
- Dysrhythmias
- RVF
- LOC/convulsions/coma
- CEACCP
Link:ceaccp.oxfordjournals.org/content/2/2/53.full.pdf?frame=sidebar