Adults

Air Embolism - Venous

Diagnosis

Decreased end-tidal CO2, decreased oxygen saturation, hypotension

Diagnosis

Decreased end-tidal CO2, decreased oxygen saturation, hypotension

  1. Call for help

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Turn FiO2 to 100%

    • Turn off nitrous oxide

  3. Stop source of gas entry

    • Fill wound with irrigation and/or apply bone wax to bone edges
    • Lower surgical site below level of heart if possible
    • Search for entry point (including open venous lines)
    • Desufflate if concern for CO2 embolism

  4. Support hemodynamics

    • Escalate vasopressor support as needed
    • Turn down anesthetic agents

  5. Consider...

    • Positioning patient with left side down
      • Continue monitoring during positioning
    • Removing PEEP in patients with PFO at risk for paradoxical embolism
    • Avoid spontaneous ventilation; paralyze as needed
    • Using ETCO2 to monitor progression and resolution of embolism or for assessment of cardiac output
    • If diagnosis is unclear, call for TEE
    • If ongoing hemodynamic instability, call for ECMO or cardiopulmonary bypass

  6. Continuing care

    • Consider hyperbaric oxygen treatment within 6 hours for evidence of paradoxical embolism

Critical CHANGES

If PEA develops, go to Cardiac Arrest – Asystole/PEA

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.