Air embolism in chest trauma

Abstract

Air embolism is a recognized complication of penetrating chest trauma. A case of fatal air embolism is presented and the pathophysiology of both venous and arterial air embolism is described. Air embolism can be precipitated by positive intrathoracic pressure in the presence of open vascular injury and can present as unexpected cardiovascular collapse following intubation and positive pressure ventilation. Strategies for preventing air embolism include minimum airway pressures during ventilation, single lung ventilation via a double lumen tube and maintenance of adequate pulmonary venous pressure with intravenous fluids. Established air embolism is managed by patient positioning to direct air bubbles away from vital organs, aspiration of intravascular air, minimizing air bubble size and repairing the underlying injury.