Chest
Volume 116, Issue 1, July 1999, Pages 234-237
Journal home page for Chest

Opinions/Hypotheses
Is Emergency Thoracotomy Always the Most Appropriate Immediate Intervention for Systemic Air Embolism After Lung Trauma?

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      When an arterial air embolus progresses to the coronary or cerebral arteries, the situation become extremely dangerous. The lethal volume of an air embolus in the coronary arteries and cerebral arteries is much smaller than that in general: the lethal volume in the cerebral vessels is 2–3 ml, and that in the coronary arteries is 0.5–1 ml.10 The air accumulates in the right ventricle to form an airlock after entering the vessels.

    • Crisis Management of Air Embolism in the OR

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      For example, during surgery, the major cerebral venous sinuses do not collapse and may remain open, thus creating a pathway for air movement. Even 2 mL to 3 mL of air injected into the cerebral circulation can be lethal in a surgical field with an open venous system (eg, craniotomy performed in the sitting position).6 In general, symptoms of a cerebral air embolism correlate with the absolute amount of embolic air or gas and the affected area of the brain.5

    • Fatal systemic air embolism after blunt chest trauma: Postmortem computed-tomography findings

      2011, European Journal of Radiology Extra
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      In case of chest trauma the injured lung must be isolated by selective lung ventilation and possibly by thoracotomy with hilum clamping. Placement of the patient in Trendelenburg position and right lateral decubitus may cause the air bubble to migrate towards hearts apex [5]. Thus, bubbles could aspirated if central venous catheterization has been made.

    • Timing of tracheal intubation in traumatic cardiac tamponade: A word of caution

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      Meanwhile, administer 100% O2, gentle bag-valve-mask ventilation if required, minimal IV fluids, and immediately transfer the patient to the OR. If rapid deterioration quickly follows intubation and PPV, the differential diagnoses include: tamponade, hypovolaemia, air embolism, and tension pneumothorax or haemothorax.20,21 Note that major blood loss is not a prerequisite for hypotension due to tamponade, air embolism, or tension pneumothorax.20,21

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