Thursday, March 26, 2009

Tales from the Trauma Service XVIII

Patient comes in after a motor vehicle collision, intubated in the field for combativeness. Undergoes the Full Body Irradiation WorkupTM. Images and unpleasant surprise follows:

You can see the contrast within the subclavian vein.

Contrast and air within the superior vena cava.

Contrast and air within the right ventricle.

Contrast and air within the pulmonary outflow tract.

The patient experienced an air embolism, apparently from the power injector. The usual treatment is to insert a central line to extract the air as well as trendelenberg and left lateral decubitus position. Unfortunately the air had already passed into the pulmonary artery. The patient was placed on 100 percent oxygen. The classic exam finding of the "mill-wheel" murmur was absent. Sometimes a pulmonary artery catheter can be used to extract the air. The patient was asymptomatic, and was extubated the next day.

What amazes me is that according to this, air embolism occurs in about 12-23 percent of patients.


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