Arterial Gas Embolism
28/2/11
FANZCA Notes
PY Mindmaps
= ingress of gas into the arterial circulation -> embolism into distal capillary beds -> ischaemia
PATHOPHYSIOLOGY
(1) Paradoxical embolism
- entrainment into the venous circulation -> enters arterial circulation causing end-artery
obstruction.
- patent foramen ovale
(2) Overwhelming venous embolism
- in the lungs with subsequent arterial embolism
(3) Overexpansion of the lung through decompression barotraumas in diving, pulmonary
barotraumas in ventilated and paradoxical embolism.
(4) All bypass patients
AETIOLOGY
- entry of gas into aorta with distribution to organs
- small emboli to skeletal muscle and viscera tolerated well
- cerebral and coronary embolisation can result in severe morbidity
CLINICAL FEATURES
- cerebral: delayed recovery from anaesthesia
- other end organ dysfunction
INVESTIGATIONS
- as indicated
MANAGEMENT
Jeremy Fernando (2011)
-
resuscitate: intubate, ventilate, CPR may be required
identify and disable entry of gas
hyperbaric oxygen
high flow O2
volume expansion
anti-epileptics (barbiturates)
Jeremy Fernando (2011)