II. Definitions
- Air Embolism
- Rare but catastrophic obstruction of blood vessels due to introduction of air or gas into the venous circulation
III. Causes
- Central venous catheterization (may occur in up to 0.2% to 1%)
- More common with head and neck procedures
- Cardiac bypass
- Blunt or Penetrating Trauma
- Scuba Diving Injury (see Arterial Gas Embolism)
- Child birth
- Hemodialysis Emergency
IV. Findings
- Specific to site of embolism-related obstruction
- Pulmonary Air Embolism
- Presents similarly to Pulmonary Embolism (e.g. Chest Pain, Dyspnea)
- Cardiac Findings
- "Millwheel", machine-like Heart Murmur may be present
- Cerebral Air Embolism
- Altered Mental Status
- Focal Neurologic Deficits
- Seizure
V. Management
- ABC Management
- Apply 100% FIO2 to facilitate dissolving air in blood
- Consider early hyperbaric chamber (within 6 hours)
- Place patient in trendelenburg and left lateral recombent position (Durant's Maneuver)
- Postulated to keep air in right atrial apex and prevent passage into pulmonary circulation
- Advance central venous line into the right heart and ventricular outflow and attempt to aspirate air
VI. Prevention: Central Lines
- Flush Central Lines to remove air
- Apply Occlusive Dressing when changing Central Lines
- Patient should perform Valsalva Maneuver when the line is being removed
- Confirm caps on all intravenous lines
- Clamp any Central Line that is leaking
VII. References
- Guest and Sawyer in Swadron (2022) EM:Rap 22(7): 11-2
- Gordy (2013) Int J Crit Illn Inj Sci 3(1):73-6 +PMID: 23724390 [PubMed]