Arterial Gas Embolism (Age)

Arterial Gas Embolism (Age) is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Results when air bubbles enter the pulmonary venous return from ruptured alveoli, then propagate through the systemic vasculature:
    • Clinical manifestations depend on location of air bubbles in systemic vasculature system.
  • Also known as dysbaric air embolism or cerebral air embolism
  • Caused by overpressurization of lung tissue, causing pleural tear with air entering the vascular circulation:
    • Trapped air (in lungs with closed glottis) expands on diver ascent.
    • Boyle law: At a constant temperature, pressure (P) is inversely related to volume (V):
      • PV = K (constant) or P1V1 = P2V2
    • As pressure increases/decreases, volume decreases/increases.

Etiology

  • Pulmonary atrioventricular (AV) shunts, or as paradoxical embolism via a patent foramen ovale
  • Breath holding during ascent:
    • Symptoms attributable to a shower of bubbles and multiple blood vessel involvement
  • Iatrogenically during placement of central venous pressure (CVP) lines, cardiothoracic surgery, or hemodialysis
  • Penetrating injuries to heart, with emergent repair of cardiac wound

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