1.41 Venous Air Embolism Flashcards
Clinical Features of VAE
symptoms
Symptoms - awake patient:
1 Dizziness / light head / vertigo
2 Nausea
3 Agitation
4 SOB + Cough
(pulmonary oedema ft pink frothy sputum
5 Gasp reflex
bolus air entering pulmonary circ = hypoxaemia
6 Substernal chest pain
Signs CVS
- Dysrhythmias
Tachy>brady - Mill Wheel Murmur
- Pulmonary Artery HTN
- Myocardial ischaemia
Non specific ST T changes
evidence RH Strain +/- jugular distension - Circulatory shock
Collapse
Hypotension
Sx Respiratory
Tachypnoea
Haemoptysis
Wheeze
Cyanosis
Abnormal capnography
EtCo2 low
Paco2 high
Pao2 low
Pulmonary Oedema
Neurological
Owning to shock or in presence of PFO
Gas bubbles enter arterial inflow in cerebral circulation
causes
1 acute confusion
2 Seizures
3 Transient / permanent focal deficits
4 Coma
Initial Management
Recognise + Diagnose
ABC 100% O2 call for help
Inform Surgeon
- attempt to decrease volume and rate of gas entrainment:
Deflating pneumoperitoneum immed.
+
Flood field with saline
Switch N2O off to air
expansion bubbles
PEEP and IV fluid admin
increase venous pressure and reduce entrainment
Head down position
Mx
Cardiac arrest
CPR
(massage may help bubbles break into smaller fragments)
Turning patient to left lateral - Durant manoeuvre:
Decrease blood accumulating RV
Decrease Air ejected in pulmonary circulation
Increase RV SV
Allow air accumulate in apex of RV to aid aspiration
Insert RIJ attempt aspirate air present
Continue fluid insert a line consider inotropes
Mx
Terminate surgery
t/f ICU
stabilisation + investigation
Assess severity
?hyperbaric O2 chamber:
1 Decrease size bubbles present
2 speeds resolution of bubbles in circulation (high diffusion gradient)
3 Increases dissolved O2 content to improve DO2
4 Shown reduced mortality in patient with cerebral air emboli
Perfluorocarbons FP43 aids dissolution in animal experiments
