Air Embolism Flashcards
What is considered a significant air entrainment?
1-2mLs/kg upto 20mLs
What signs may be present to indicate a possible air embolism?
Resp: Dec SpO2 (due to V/Q mismatch), Dec EtCO2, Bronchospasm
CVS: Hypotension (impaired VR), tachycardia, elevated CVP, elevated PA pressure, full cardiovascular collapse
CNS: Confusion, followed by acute deterioration in LOC
Outline immediate management if air entrainment is surgical
- Notify surgeons and ask them to flood the field with saline and compress bleeding points with wet sponges
- Call for help
- If laparoscopy - get surgeons to decompress and disconnect gas
- Ventilate with high FiO2, TURN OFF N2O
- Position pt so that operation site is below level of the heart - increase venous pressure and helps prevent further entrainment of air
- Aggressive treatment of hypotension - fluids, pressors (Metaraminol, Phenylephrine, Adrenaline)
- If loss of cardiac output - commence CPR
- If CVL insitu - aspirate distal lumen
Outline immediate management if air entrainment is via a CVL
- Prevent further entrainment
- Call for help
- Aspirate the CVL with the largest syringe available
- Ventilate pt with 100% O2 and avoid N2O
- Place the patient head down and (L) lateral position
- Aggressively treat hypotension with pressors (Metaraminol, Phenylephrine, Adrenaline)
Should PEEP be used to prevent further venous air entrainment?
Controversial. PEEP will increase CVP and may limit the progression of embolus, but it also increases risk of paradoxical embolus
What management should be considered if the patient is slow to wake post event?
Delayed emergence can be due to cerebral embolism. Hyperbaric oxygen therapy is effective, and the pt should be given Dexamethasone 10mg
What differential diagnoses should be considered for a patient with sudden drop in SpO2, EtCO2 and BP?
- Anaphylaxis - look for rash, and consider temporal relationship
- Pulmonary thromboembolism - slow/partial response to therapy. CTPA is diagnostic
- Pneumothorax - Chest signs present
- Hypovolaemia - Assess for signs of massive blood loss
- PEA cardiac arrest
