AIR EMBOLUS
AIR EMBOLUS
 |
| Air Embolus |
HISTORY
(What Are The Most Common Causes Of Air Embolism) ?
¤ Most common during operative procedures involving major veins or cardiopulmonary bypass.
¤ Penetrating trauma to chest (air from lung)
¤ Insertion or removal of large bore venous lines Carbon dioxide embolus from laparoscopic insufflation.
¤ Can occur with right to left shunt (VSD).
¤ Source of air usually massive.
SIGNS & SYMPTOMS
¤ Most common during operative procedures involving major veins or cardiopulmonary bypass.
¤ Penetrating trauma to chest (air from lung)
¤ Insertion or removal of large bore venous lines Carbon dioxide embolus from laparoscopic insufflation.
¤ Can occur with right to left shunt (VSD).
¤ Source of air usually massive.
SIGNS & SYMPTOMS
(What Hsppens If Air Gets Into "IV") ?
¤ Cardiovascular collapse
¤ Failure to respond to usual resuscitation.
¤ Failure to respond to usual resuscitation.
TESTS
SPECIFIC TESTS
(How Do You Know If A Patient Has An Air Embolism) ?
¤ EKG may show ischemic changes with coronary air embolus.
¤ If intraoperative TEE is in use, intracardiac air will be seen differential diagnosis.
¤ Pulmonary embolism
° Usually in ward patient with DVT
° Rarely occurs intraoperatively
¤ Stroke
° Intraoperative embolic stroke rarely causes cardiovascular collapse.
¤ Myocardial Infarction
° Severe ischemia seen on EKG
¤ Traumatic cardiac tamponade
° Echocardiogram or surgical exploration
¤ Tension pneumothorax
° Hyper-resonant breath sounds
° Diagnose + treat with needle thoracostomy.
MANAGEMENT
FIRST TO DO
¤ Position patient head down, left side down
° Keeps air in apex of right ventricle where slow reabsorption occurs
¤ Cardiorespiratory support
° Intubation + mechanical ventilation
° 100% FiO2 to help reabsorption
(creates nitrogen gradient)
° Volume + pressors as needed
¤ Find and correct source of air embolism
° Close hole in vein
° Flush all lines
° Check bypass machine and connections.
FIRST TO DO
¤ Position patient head down, left side down
° Keeps air in apex of right ventricle where slow reabsorption occurs
¤ Cardiorespiratory support
° Intubation + mechanical ventilation
° 100% FiO2 to help reabsorption
(creates nitrogen gradient)
° Volume + pressors as needed
¤ Find and correct source of air embolism
° Close hole in vein
° Flush all lines
° Check bypass machine and connections.
GENERAL MEASURES
¤ Avoid air embolism
° Backbleed or aspirate all venous lines during insertion
° Flush or vent any potential air sources prior to unclamping
° Check and tap all bypass lines prior to instituting flow
SPECIFIC THERAPY
¤ If venous lines are in RA or RV, aspirate out the air
¤ If chest is open, aspirate RV apex with needle after positioning
¤ If chest is open, cardiac massage to relieve RV outflow obstruction.
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FOLLOW _ UP
¤ Treat survivors as status-post myocardial infarction complications and prognosis.
COMPLICATIONS
¤ Myocardial Infarction
° Secondary to air embolus entering coronary artery
¤ Anoxic brain injury
° Secondary to prolonged cerebral hypoperfusion.
FOLLOW _ UP
¤ Treat survivors as status-post myocardial infarction complications and prognosis.
COMPLICATIONS
¤ Myocardial Infarction
° Secondary to air embolus entering coronary artery
¤ Anoxic brain injury
° Secondary to prolonged cerebral hypoperfusion.
PROGNOSIS
¤ If patient presents with cardiovascular collapse, most do not survive
¤ If air is noticed during embolization (i.e. line placement) and aspirated, prognosis is good
¤ Air embolism in trauma (penetrating lung injury) is usually lethal.
