Air Embolism

(Review in Anesthesiology 1999;90(2):564)

if patient decompensates just after being placed on mech vent, consider this dx

caused by gradient of low pressure pulmonary venous system (hypovolemia) and/or increased airway pressure (PPV, cough, tension pneumo)

2 cc of air injected into the cerebral circ can be fatal

1 cc of air in the pulm vein can cause cardiac arrest

injuries close to the hilium yield the highest risk b/c the pulm vein (low pressure) is close to the large airways

Probe positive PFO can allow conduit from venous air embolism

paradoxical embolism can also occur in ARDS, pulm htn,

ability of lungs to function as filter is exceeded at 0.35 cc of air per kg per minute

blast injury can cause massive air embolism

hemoptysis with circulatory and CNS dysfunction is sufficient for provisional diagnosis

fundoscopic exam may reveal air in retinal vessels

TEE can detect extremely small bubbles

tympanic membrane should rupture if lung ruptures in blast injury

spont vent is preferred, lung isolation if only one lung injured and ppv is necessary

thoracotmy with hilar clamping has been used

hyperbarics for SAE

HFOV is preferred mode if there is bronchopleural fistula

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