Pediatrics

Air Embolism

Diagnosis

Clinical diagnosis, may have:

  • ↓ EtCO2
  • ↓ SaO2
  • ↓ BP
  • mill-wheel murmur

More likely if surgical site above heart or air in IV line

Diagnosis

Clinical diagnosis, may have:

  • ↓ EtCO2
  • ↓ SaO2
  • ↓ BP
  • mill-wheel murmur

More likely if surgical site above heart or air in IV line

  1. Notify team

  2. Stop nitrous oxide and volatile agents

  3. Increase O2 to 100%

  4. Stop air entrainment: find air entry point, stop source, and limit further entry

    • Flood wound with irrigation/soaked saline dressing
    • Turn off all pressurized gas sources: laparoscope, endoscope
    • Place bone wax or cement on exposed bone edges

  5. Check for open venous lines or air in IV tubing

  6. Position surgical site below heart, head down, lateral if possible

  7. Consider:

    • Compress jugular veins intermittently if head or cranial case

  8. Hemodynamic support if hypotensive:

    • Give epinephrine 1-10 MICROgrams/kg, followed by infusion of epinephrine 0.02-1 MICROgrams/kg/min or norepinephrine 0.05-2 MICROgrams/kg/min
    • Chest compressions: 100-120/min to force air through lock, even if not in cardiac arrest
    • If available, call for Transesophageal Echocardiography/US
    • Consider ECMO
    • 1-10 MICROgrams/kg IV/IO
    • Consider infusion 0.02-1 MICROgrams/kg/min IV
    • Infusion 0.05-2 MICROgrams/kg/min IV

  9. Consider DDx

  10. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  11. Call for Transesophageal Echocardiography

  12. Start chest compressions

  13. Give epinephrine 10 MICROgrams/kg IV/IO

    • 1-10 MICROgrams/kg IV/IO
    • Consider infusion 0.02-1 MICROgrams/kg/min IV

  14. If cardiac arrest, go to CARDIAC ARREST

  15. Consider ECMO

Patient weight

Between 0.5 kg and 120 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.