Yes, several people have died from injecting air into their veins. He called it a mercy killing when arrested but on the stand improbably claimed that he thought the patient was already dead; at any rate he was acquitted. But people have also survived much larger amounts. French doctors reported in on an year old man scheduled for a CAT scan who was supposed to get 90 milliliters of contrast solution but instead got 90 milliliters of empty syringe.
Prompt treatment with pure oxygen saved him. Amount or size of air: according to Dr. However, when large amounts of air quickly enter the circulatory system it can be fatal.
The speed by which it enters body: The speed at which the air enters the blood system is also an important factor in determining whether an introduction of air into the body will be fatal or not. Patent foramen ovale : A patent foramen ovale PFO is a small opening between the 2 upper chambers of the heart, the right and the left atrium. Normally, a thin membranous wall made up of 2 connecting flaps separates these chambers. In some cases, the exact cause of air embolism may be difficult to ascertain, particularly when patients are undergoing invasive procedures, as it may not always be apparent whether the air entered the operative field or from a supporting intravenous line.
When there is clinical suspicion of air embolism, a number of initial steps should be taken quickly to manage the situation. The initial priority is to prevent further air embolism; if air is noted entering the arterial system, the flush should be stopped immediately and the rotating hemostatic valve RHV should be fully opened. The arterial pressure should be allowed to passively push the air back out. This can be enhanced by turning the system vertically, which will cause air bubbles to rise.
In the event of venous air embolism, the system should be dropped to minimize further entrainment of air. In the case of an unresponsive patient, the first priority is to address airway, breathing and circulation ABC , including cardiopulmonary resuscitation CPR when necessary.
Once the patient has been stabilized, only then should additional evaluation and management be undertaken. High flow oxygen may also aid the reabsorption of nitrogen gas from the bubble into the blood, reducing the size of the air embolus [ 12 ]. A year-old woman with encephalitis who suffered a respiratory arrest. Two images from axial CT brain a , b performed shortly afterward revealed extensive, serpiginous hypodensity in the sulcal distribution overlying the cerebral hemispheres bilaterally arrowheads , representing intravascular air embolization.
It is important to note that, in the case of arterial air embolism, patients should be kept in the flat supine position as the head-down position may worsen cerebral edema [ 20 ]. If clinically indicated, commencement of cardiopulmonary resuscitation is warranted. This will continue end-organ perfusion and may promote migration of the air embolus into the smaller pulmonary vessels [ 21 ].
Of note, cardiopulmonary resuscitation can be challenging if the patient is positioned decubitus, or if there are femoral access catheters and sheaths for example. Patients should be transferred to an Intensive Care Unit for careful monitoring and management, and consideration should be given to hyperbaric oxygen therapy, or other advanced treatments including Extracorporeal Membrane Oxygenation ECMO. The case in Figure 9 demonstrates the usefulness of quick and efficient initial management of air embolism.
Post procedure, she developed transient aphasia, right facial droop, and right arm brachyplegia likely secondary to air embolism. This was presumed to be related to faulty occlusion balloon. Hyperbaric chamber therapy was discussed but declined due to concerns about patient movement during transport. CT angiogram b,c was performed immediately. Post-procedure revealed air within the large left cavernous segment internal carotid artery aneurysm arrow.
A CT performed 2 days later d showed the embolism had resolved and this patient made a full recovery. Advanced hemodynamic support and monitoring requires the input of an anesthesiologist or rapid response team, who can perform advanced physiological monitoring and support such as the use of pressors and mechanical ventilation. This procedure tends to be difficult, perhaps related to the narrow luminal diameter, but offers the highest chance of success when there is already a catheter near the right atrium or ventricle.
In a case report, Garg et al. Typically, 15—20 cc of air may be aspirated using this technique. HBOT constricts pathologic air bubbles, provides oxygen to ischemic organs, and abets the conversion of nitrogen from gas to liquid phase, thereby reducing air bubble size; in essence, it diminishes gas volume, cerebral edema and enhances partial pressure of dissolved oxygen in the blood.
It is widely regarded as the gold standard for treatment [ 25 , 26 ]. A study by Blanc et al. The successful use of a hyperbaric oxygen therapy HBOT is outlined in this case, in which a year-old female with a history of suspected lung cancer underwent a CT-guided lung biopsy at an outside facility a. During the procedure, the patient suffered a cardiorespiratory arrest. An immediate CT b revealed a right pneumothorax arrow , together with air in the right pulmonary vein arrowhead.
Additional images from the CT scan c , d , revealed air in the right coronary artery black arrow , the ascending thoracic aorta white arrow and the epidural veins arrowhead. The patient was initially unresponsive and required cardiopulmonary resuscitation.
A non-contrast CT brain e was performed, revealing air scattered in the vessels overlying the right cerebral hemisphere arrowheads. Subsequent MRI of the brain confirmed multiple areas of acute infarction in the right cerebral and cerebellar hemispheres. Axial T2 f and DWI g images of the brain demonstrated acute areas of infarction in the right cerebellum. Air embolism is rare but can be fatal and can occur during a number of invasive procedures, thus it is important that physicians are prepared to deal with this complication.
Systematic planning, prompt recognition, and focused treatment offer the best chance of survival. Radiologists and other physicians alike, should maintain a high degree of suspicion for air emboli and consider advanced management, including hyperbaric oxygen therapy, at an early stage.
National Center for Biotechnology Information , U. Journal List J Clin Med v. J Clin Med. Published online Oct Colin J. Find articles by Sasan Behravesh. Sailendra G. Find articles by Sailendra G.
Find articles by Rahmi Oklu. Bernhard Rauch, Academic Editor. Author information Article notes Copyright and License information Disclaimer. Received Sep 18; Accepted Oct This article has been cited by other articles in PMC. Abstract Air embolism is a rarely encountered but much dreaded complication of surgical procedures that can cause serious harm, including death.
Keywords: Air embolism, endovascular, catheter, embolization. Introduction An intravascular air embolism VAE is a rare, preventable, but serious complication of endovascular procedures resulting in significant morbidity and mortality. Etiology of Air Embolism Air emboli exist only when there is a connection between air and the vascular system. Open in a separate window.
Figure 1. Figure 2. Figure 3. Clinical Presentation Following Air Embolus Symptoms and signs associated with serious air embolism are non-specific and can be difficult to diagnose. Figure 4. Figure 5. Figure 6. Placing and Removing Central Venous Catheters When placing catheters, the CVP should be raised to decrease the pressure gradient by placing the patient in the Trendelenburg position. During an Angiogram or Other Invasive Procedure When conducting invasive procedures including arteriography, it is important to identify high-risk cases in advance.
Figure 7. Air Embolism Management 5. Initial Management Techniques When there is clinical suspicion of air embolism, a number of initial steps should be taken quickly to manage the situation. Figure 8. Figure 9. Advanced Management Advanced hemodynamic support and monitoring requires the input of an anesthesiologist or rapid response team, who can perform advanced physiological monitoring and support such as the use of pressors and mechanical ventilation.
Figure Conclusions Air embolism is rare but can be fatal and can occur during a number of invasive procedures, thus it is important that physicians are prepared to deal with this complication. Acknowledgments R. Author Contributions R. Conflicts of Interest The authors declared no conflicts of interest and have no financial disclosures.
References 1. Mirski M. Just 0. These air bubbles can travel to your brain, heart, or lungs and cause a heart attack, stroke, or respiratory failure. A pulmonary embolism may dissolve on its own; it is seldom fatal when diagnosed and treated properly. However, if left untreated, it can be serious, leading to other medical complications, including death.
Overdistension of the right ventricle and obstruction to pulmonary blood flow are the primary pathophysiologic causes of death as a result of venous air embolism. It is possible that any impaired cardiac contractility in this patient may have decreased the volume of air necessary to produce cardiac arrest.
Thirteen patients had immediate cardiac arrest where mortality rate was Air emboli were mainly iatrogenic, primarily associated with endovascular procedures. They can develop within 10 to 20 minutes or sometimes even longer after surfacing. Do not ignore these symptoms — get medical help immediately.
Immediately place the patient in the left lateral decubitus Durant maneuver and Trendelenburg position.
This helps to prevent air from traveling through the right side of the heart into the pulmonary arteries, leading to right ventricular outflow obstruction air lock. Shortness of breath, coughing up blood and feeling faint or dizzy, or passing out are also common symptoms.
Deep vein thrombosis DVT is a blood clot in the deep veins of your leg. Recompression is the most effective, though slow, treatment of gas embolism in divers. Normally this is carried out in a recompression chamber. As pressure increases, the solubility of a gas increases, which reduces bubble size by accelerating absorption of the gas into the surrounding blood and tissues.
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