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Reading more about venous air embolism after putting in/removing ~10 CVCs in last 2 weeks is kind of freaking me out so I decided to do a deeper dive

#FOAMed #FOAMcc #EmergencyMedicine
🔺Symptoms: acute onset dyspnea, cough, syncope, AMS, “mill wheel murmur" (specific but not sensitive)

🔺Clinical manifestation: acute R-heart failure, cardiogenic shock (hypotension, oliguria, JVD), acute embolic stroke (air bubbles pass thru patent foramen ovale)
🔺Clinical Dx but can use:
🔹EtCO2: decreased due to increase physio dead space & worsening V/Q mismatch
🔹EKG: signs of R-heart strain (R axis deviation, RBBB, peaked P waves), non-specific ST changes
🔹TTE/TEE: Air in cardiac chambers, RV dilation
🔹CXR: pulmonary edema
🔺Prevention:
🔹Trendelenburg position for insertion & removal of IJ/subclavian, supine for femoral
🔹Positive-pressure mechanical ventilation reduces risk
🔹Removal: if Pt following command, valsalva timed w/ expiration during removal. Firm pressure >1min, w/out massaging site
🔺Management:
🔹attempt aspirate air from bloodstream
🔹place in left lateral decub to prevent air blocking RV outflow track (unproven benefit)
🔹chest compressions (unproven)
🔹100%O2 on vent or NRB may speed air resorption (unproven)
🔹Inotropic support: Levo, Epi, Dobutamine
🔑 take home points:

❗️Prevention, prevention, prevention

‼️Its a clinical diagnosis: Sudden neurologic deterioration ➕ hypotension ➕hypoxia ➡️ high index of suspicion

#FOAMcc #FOAMed
📚Sources:
- Marino’s ICU book Ch.2
- UpToDate “Air Embolism”
- “Accidental Air Embolism” by Chuang et al, AHA, 2019
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