Episode 132.0 – Air Embolism

Air embolism is a rare but potentially fatal complication involving the entrapment of air in the vascular system, most commonly occurring in the emergency department during central venous catheter placement or traumatic injury. While the exact volume of air required to cause harm is debated, clinical significance typically arises when gas exceeding 50 mL obstructs the pulmonary outflow tract, leading to obstructive shock, chest pain, or hemodynamic collapse. Diagnosis relies on clinical suspicion following line placement and can be supported by CT imaging or echocardiography. Management prioritizes high-flow oxygen, placing the patient in the left lateral decubitus and Trendelenburg positions to trap air in the right atrium, and considering hyperbaric oxygen therapy within six hours of symptom onset. In extreme cases of cardiac arrest, aspiration of air through an existing central line or emergent cardiopulmonary bypass may be necessary interventions.