Venous Air Embolism

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Abstract
• Venous air embolism causes injury primarily by obstruction of blood flow from the right side of the heart to the left. This is due to mechanical obstruction of the right ventricular pulmonary outflow tract and pulmonary vasculature and to poorly understood pulmonary vasoconstrictive mechanisms. Venous air embolism can result in considerable hypoxemia from ventilation-perfusion maldistribution and shunt. With large emboli, systemic hypotension, myocardial ischemia, and arrhythmias can occur and result in death. One should be familiar with the clinical setting where embolism occurs, as prevention is the best treatment. When air embolism is suspected, placement of the patient in the left lateral decubitus position, initiating closed chest massage or, if possible, aspiration of air through a right atrial or Swan-Ganz catheter are all acceptable forms of treatment. The patient should also be given 100% oxygen. (Arch Intern Med 1982;142:2173-2176)