II. Definitions

  1. Air Embolism
    1. Rare but catastrophic obstruction of blood vessels due to introduction of air or gas into the venous circulation

III. Causes

  1. Central venous catheterization (may occur in up to 0.2% to 1%)
    1. More common with head and neck procedures
  2. Cardiac bypass
  3. Blunt or Penetrating Trauma
  4. Scuba Diving Injury (see Arterial Gas Embolism)
  5. Child birth
  6. Hemodialysis Emergency

IV. Findings

  1. Specific to site of embolism-related obstruction
  2. Pulmonary Air Embolism
    1. Presents similarly to Pulmonary Embolism (e.g. Chest Pain, Dyspnea)
  3. Cardiac Findings
    1. "Millwheel" Heart Murmur may be present
  4. Cerebral Air Embolism
    1. Altered Mental Status
    2. Focal Neurologic Deficits
    3. Seizure

V. Management

  1. ABC Management
  2. Apply 100% FIO2 to facilitate dissolving air in blood
  3. Consider early hyperbaric chamber (within 6 hours)
  4. Place patient in trendelenburg and left lateral recombent position (Durant's Maneuver)
    1. Postulated to keep air in right atrial apex and prevent passage into pulmonary circulation
  5. Advance central venous line into the right heart and ventricular outflow and attempt to aspirate air

VI. Prevention: Central Lines

  1. Flush Central Lines to remove air
  2. Apply Occlusive Dressing when changing Central Lines
  3. Patient should perform Valsalva Maneuver when the line is being removed
  4. Confirm caps on all intravenous lines
  5. Clamp any Central Line that is leaking

VII. References

  1. Guest and Sawyer in Swadron (2022) EM:Rap 22(7): 11-2
  2. Gordy (2013) Int J Crit Illn Inj Sci 3(1):73-6 +PMID: 23724390 [PubMed]

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Ontology: Air Embolism (C0013926)

Definition (NCI_FDA) The presence of bubbles of gas in the vascular system; occurrence is related to the entry of air into the venous circulation following trauma or surgery.
Definition (NCI) The presence of bubbles of gas in the vascular system; occurrence is related to the entry of air into the venous circulation following trauma or surgery.
Definition (CSP) embolism due to air bubbles entering the blood vessels after trauma, surgical procedures, or changes in atmospheric pressure.
Definition (MSH) Blocking of a blood vessel by air bubbles that enter the circulatory system, usually after TRAUMA; surgical procedures, or changes in atmospheric pressure.
Concepts Injury or Poisoning (T037)
MSH D004618
SnomedCT 157661009, 212371006, 271376002, 36207003
English Air Embolisms, Embolism, Air, Embolism, Gas, Embolisms, Air, Embolisms, Gas, Gas Embolism, Gas Embolisms, Aeroembolism, Air Embolism, Embolism, Air [Disease/Finding], gas embolisms, air embolus, embolus air, gas embolism, air embolisms, embolism air, air embolism, air embolism (diagnosis), Gas embolism, AIR EMBOLISM, Air embolism, Air embolus, Air embolism (disorder), Air embolus (morphologic abnormality), embolism; air, aeroembolism
French EMBOLIE GAZEUSE, Embolie gazeuse
Swedish Luftemboli
Japanese クウキソクセンショウ, ガス塞栓症, 空気塞栓症, 空気栓塞, 塞栓症-ガス, 塞栓症-空気, 空気塞栓
Finnish Ilmaembolia
Portuguese EMBOLIA GASOSA, Embolia Gasosa, Embolia de Ar, Embolia gasosa, Embolia Aérea
Czech Vzduchová embolie, vzduchová embolie, plynová embolie, embolie vzduchová
Polish Zator powietrzny
Hungarian Légembolia
Norwegian Luftembolisme, Luftemboli
Dutch embolie; lucht, luchtembolie, Embolie, gas-, Embolie, lucht-, Luchtembolie
Spanish aeroembolia, embolia gaseosa (trastorno), embolia gaseosa, émbolo gaseoso (anomalía morfológica), émbolo gaseoso, Embolia gaseosa, Embolia Aérea, Embolia de Aire, Embolia Gaseosa
German Embolie, Gas-, Embolie, Luft-, Luftembolie
Italian Embolia gassosa