Air Embolism: Endovascular System

The procedure was done emergently because of the patient’s critical condition. His right IJ area was prepped in the usual fashion. It was very difficult to visualize his right IJ vein, even though his habitus should have allowed us to do so, but the patient was, I believe, severely intravascularly volume depleted, and his vein was collapsing. I have attempted to access the right internal jugular vein multiple times, both under real-time ultrasound guidance and even later on blindly. I was able to get blood return and hit the vein; however, I was not able to advance the guidewire. I was able to advance it one time and put the catheter in, and it was nonfunctioning. I had to take the catheter out and tried multiple other times on the right IJ vein without success. That procedure was terminated. Pressure was applied. There was no cervical hematoma whatsoever. The patient was uncomfortable because of the length of the procedure but did well otherwise. Hemodynamically, he was unchanged, and his oxygen saturations remained stable.I prepped the IJ vein area in the usual fashion. One percent lidocaine was used for local anesthesia. Again, the left IJ vein was collapsing. With deep inspiration, the vein could be well visualized on the real-time and ultrasound guidance, after which I could get access to the left IJ vein. A wire was advanced without difficulty while the

Subcutaneous emphysema (SE) is when there is air trapped under the skin, and then goes into the tissues surround that area. The fifty year old patient in the journal article I chose was undergoing laparoscopy surgery for his diverticular disease when the SE was found (other complications that can be associated with SE are pneumothorax and pneumomediastinum. Pneumothorax is a collapsed lung and pneumomediastinum is when there is an abnormal amount of air in the mediastinum.)

Pulmonary Enema can be identified in a PA and lateral chest radiograph, using a horizontal beam which is critical for the projection of air-fluid levels. It appears an increasingly diffuse in radiodensity in the hilar regions, interstitial spaces and the interlobar septa. Clinical indications or signs of the condition (pulmonary edema) include Signs of the condition include a rapid respiratory rate, heaving of the chest and abdomen, intercostal muscle retractions, and cyanosis. To improve the movement of air into and out of the chest, the patient will often sit upright to breathe and resist laying down. (Venes, D, 2005 p. 666 )

A tension pneumothorax occurs when the lung is punctured, but there is no outside opening for air to escape. The pressure that builds is put on internal organs, which decreases cardiac output and the lungs’

Venous thromboembolism (VTE), including both deep venous thrombosis (DVT) and pulmonary embolism (PE), is reognised as the leading cause of preventable in-hospital mortality. DVT is the formation of blood clots in a deep vein- usually the large veins in the leg or pelvis. The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, becoming a life-threatening blood clot in the lungs, pulmonary embolism. When a blood clot breaks loose and travels in the blood, this is called a venous thromboembolism. An inflammatory reaction is usually present mainly in the superficial veins and, for this reason this pathology is often called thrombophlebitis. It is a disorder that can occur in all races and ethnicities, all age groups, and both genders. Despite a marked increase in federal and national efforts to raise awareness and acknowledge the need for VTE prevention, VTE continues to remain as an important and growing public health problem. Unfortunately, VTE recurs frequently and is commonly overlooked, affects both hospitalized and non-hospitalized patients, and results in long-term complications including chronic thromboembolic pulmonary hypertension (CTPH) and the post-thrombotic syndrome (PTS).

During mechanical ventilation, patients are at risk of injuries to their lungs caused by improper settings on ventilators. Mechanical ventilator induced lung injury (VILI) can affect the lung in several ways. Some of the ways the lung become affected is by excessive pressure, excessive volume, and not enough volume. When the lungs are affected by excessive pressure its termed pulmonary barotrauma. On the other hand, if the lungs receive too much volume it’s called volutrauma. However, when the lungs don’t receive enough volume its termed atelectrauma. This paper describes how pulmonary barotrauma, pulmonary volutrauma, and pulmonary atelectrauma affects the lungs during mechanical ventilation and ways to prevent them from happening.

A Deep Venous Thrombosis (DVT) will propagate when there is either stasis of blood flow, endothelial injury, or if the patient is in a hypercoagulable state. Under physiological conditions, a dislodged DVT can predictably settle in the pulmonary arteries causing a pulmonary embolism. However, a DVT in the presence of a intracardiac shunt or PAVM can paradoxically cause an embolism in branches of the aorta. The pathophysiological mechanism varies depending on the etiology of the paradoxical embolism. For instance, in a paradoxical embolism due to a PFO, a DVT gets dislodged and enters the right atrium where a transient increase in right atrial pressure during a Valsalva maneuver can force the embolism through the PFO and into the left atrium

It is usually presented by a classic triad of symptoms: 1.) respiratory changes; 2.) neurological abnormalities; 3.) petechial rash. The client will normally present first with respiratory changes such as dyspnoea, tachypnoea, and hypoxemia and can progress to respiratory failure. One half of the clients with a fat embolism caused by a long bone fracture will develop severe hypoxaemia and respiratory insufficiency and will require mechanical ventilation. Neurological changes resulting from cerebral embolism produces signs in 86% of cases and often occur after respiratory distress. The changes vary from mild confusion to severe seizures. The most common being confusion with focal neurological signs such as hemiplegia, aphasia, apraxia, and anisocoria. The third in the triad the petechial rash will be the last to develop and it occurs in 60% of the cases. The rash is due to embolization of small dermal capillaries leading to extravasation of erythrocytes. The rash is in the conjunctiva, oral mucous membranes, and skin folds of the upper body. The rash appears within the first 36 hours and disappears completely within 7

One day post op Ms Smith had clinical indications of a large flank hematoma and pelvic swelling. An abdominal ultrasound was ordered to check for possible internal bleeding. The ultrasound probe was placed on Ms. Smith and her entire abdomen appeared as nothing but dark shadow no matter what probe, frequency, or pressure was applied. To a new sonographer or someone who hasn’t seen this before it could be quite puzzling. Apparently during Ms. Smiths extended surgery the air that was put into her abdomen to for better visualization had not been completely removed. It is a rare complication of surgery, and is called subcutaneous emphysema. It additionally can be caused by a collapsed lung, blunt force trauma, and scuba diving. The air usually

Air embolism is a rare but potentially fatal consequence of air entering the vascular system. It can result from a wide range of procedures, including those related to vascular access in interventional radiology, in addition to open surgical procedures. We set out to review all cases of air embolism at our institution over a 25-year period, including analysis of cause, clinical signs and symptoms, treatment and prognosis.

Background: Occult Pneumothoraxes (OPTX) represents air within the pleural space that is not visible on conventional chest radiographs, but ultimately detected with CT . In a study comparing differences in pneumothoraces, while similar in size, patients significantly underwent tube thoracostomy compared with patients who had overt pneumothoraces1. While optimal management of occult pneumothoraxes has not been identified, the increased use of computed tomography has led to a rise in detection. Occult OPTX Extended focused assessment with sonography for Trauma, also known as eFAST, is screening test that has been shown to useful in identifying OPTX. Our aim of the present study is to identify if there are any differences in OPTX detections between

Because patients who often have right ventricular hypertrophy and large pulmonary arteries, they’re at elevated risk for blood clots, especially if immobilized, polycythemic, or dehydrated-all of which can occur during an exacerbation. I start the client’s intravenous, using a #20 gauge needleless system, to his non-dominant left median cubital vein. I hung D5.45NS infusing via Alaris pump at 75cc/hr. And, also administered Solu Medrol (Methylprednisolone sodium succinate) via IVP. Nafcillin intravenous antibiotic therapy was also ordered and started as well. About 0300, I am doing my patient rounding, to check vital signs, change positioning, pain management, bowel/bladder needs and etc. I walk into the client’s room to find him waving his hand, extinguishing a match after lighting up a cigarette. He takes a puff of the cigarette with his oxygen at 2 liters/minute via nasal cannula still attached on his face. I approached him fast and request that he extinguish it, immediately! He does not and becomes verbally combative, “ No f-bomb blank, blank, blank is going to take my cigarette away!” He reaches to throw his box of tissues at me, that’s when his cigarette falls out of his mouth and onto the tile floor. And, yes, I step on it, and the cigarette extinguishes. I was fortunate to arrive early enough so that the room did not fill with

According to new research by Japan's Osaka University, binge watching sessions increase a person's chance of receiving a fatal pulmonary embolism.

Capnography is the most feasible and safer method to monitor venous air embolism in children.

The clinical picture of acute pulmonary embolism (PE) is not similar from various aspect of its pathophysiological course presenting from minimal symptoms to variety of severity of disease like severe hypoxia, hypotension, right heart failure and death1. Massive pulmonary embolism is defined as obstruction of blood flow to a lobe or multiple segments of the lung, or for unstable hemodynamics, i.e. failure to maintain blood pressure without supportive measures.” This case highlights about aggressiveness of treatment and role of thrombolytic therapy for a severely hemodynamic unstable patient2.