Venous Air Embolism

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Venous air embolism (VAE), a subset of gas embolism, is an entity with the potential for severe morbidity and mortality. Venous air embolism is a predominantly iatrogenic complication that occurs when atmospheric gas is introduced into the systemic venous system. 

Pathophysiology

Two preconditions must exist for venous air embolism to occur: (1) a direct communication between a source of air and the vasculature and (2) a pressure gradient favoring the passage of air into the circulation.  

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The potentially life-threatening and catastrophic consequences of venous air embolism (VAE) are directly related to its effects on the affected organ system where the embolus lodges. 

Mortality/ Morbidity

Clinical Presentation

However, severe cases are characterized by cardiovascular collapse and/or acute vascular insufficiency of several specific organs, including, but not limited to, the brain, spinal cord, heart, and skin. 

Symptoms 

1. Nausea 2. Acute dyspnea 3. Agitation/disorientation/sense of "impending doom" 4. Continuous cough 5. Substernal chest pain

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1. Transient/permanent focal deficits (weakness, paresthesias, paralysis of extremities) 2. Loss of consciousness, collapse 3. Acute altered mental statu 4. Seizure 5. Coma (secondary to cerebral edema)

Neurological

Skin

1. Livedo reticulari 2. Crepitus over superficial vessels (rarely seen in setting of massive air embolus)

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Ophthalmologic

The above hemodynamic, pulmonary, and neurologic complications primarily result from gas gaining entry into the systemic circulation, occluding the microcirculation and causing ischemic damage to these end organs. 

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