[penguin2]

I like the explanation I heard a cardiologist give to a patient once, who was stressing over a few air bubbles: It would take a whole IV tubing full of air w/a great force behind it pushing it thru to cause any harm.

[jojotoo]

Originally Posted by Daytonite

You should know the immediate first aid for a large amount of air that enters the blood stream: turn the patient onto their left side with the head of the bed elevated to trap the air bubble in the upper right atrium of the heart.

So once you put the pt in this position and the air is "trapped" - then what?

[Balder_LPN]

Originally Posted by anc33

Insults secondary to decompression are very different from the ones we generally see in a hospital setting. In diving situations, depressurization causes nitrogen in the body to come out of solution. The gas bubbles formed can be found throughout the body unlike insults where we know where the air entered the body (ie. while removing a central line). That may be the reason why the head down position is not advised after diving injuries.

Note too that the presence of nitrogen bubbles in the blood is termed DCS (decompression sickness), and most of the nitorgen will initially be found in the veins as the pressure is slightly lower than the arteries. A diver may also suffer AGE (arterial gas embolism) when holding their breath on ascent, forcing air through the membrane of the alveoli and therefore placing the embolism into the artery. AGE is usually a more immediate threat to life than DCS. We are reccomended not to use trendelenberg for either with divers.

What about clots formed around the gas bubbles, this is not addressed either by trandelenberg?

I still dont get why you do it in the hospital, but not for divers with the same type of injury.

Also did you know that the divemaster/instructor is taught to accompany the injured diver to the hospital to (attempt to) ensure such things as ; medivac maintains lowest possible altitude, administration of 100% O2, no trandelenberg, and immediate recompression therapy? This may be old fashioned, but the dive industry doesnt think that healthcare teams know how to properly treat a diving injury.

[MurseNeutron]

how many licks does it take to get to the center of a tootsie pop? my standpoint would probably be to just not put any air in the patient, lol.

im at work right now so i asked one of the high speed ICU docs i work with how they would remove air from the patient after you caught the embolism in the right atrium of the heart. he stated that you should actually put the patient in trandelenberg position on the right side with the chest slightly up catching the embolism on the apex of the heart, which still allows blood to flow normally through.

He mentioned that if held in that position long enough, eventually most amounts would be broken down; considering a main reason of blood is to carry oxygen. If they had to remove the embolism it would be pulled out with a longer triple lumen. say a 30 cm cath, which actually is used for nothing impaticular, but removing air due to its length. they would thread the catheter through and pull the air out. pretty cool. he also said that 10ccs of air really wouldnt do anything, which is the basic length of an IV line.

Now if you were to inject it arterially you probably would want to start looking for another profession or a good lawyer.

[Mulan]

Originally Posted by Balder

Note too that the presence of nitrogen bubbles in the blood is termed DCS (decompression sickness), and most of the nitorgen will initially be found in the veins as the pressure is slightly lower than the arteries. A diver may also suffer AGE (arterial gas embolism) when holding their breath on ascent, forcing air through the membrane of the alveoli and therefore placing the embolism into the artery. AGE is usually a more immediate threat to life than DCS. We are reccomended not to use trendelenberg for either with divers.

What about clots formed around the gas bubbles, this is not addressed either by trandelenberg?

I still dont get why you do it in the hospital, but not for divers with the same type of injury.

Also did you know that the divemaster/instructor is taught to accompany the injured diver to the hospital to (attempt to) ensure such things as ; medivac maintains lowest possible altitude, administration of 100% O2, no trandelenberg, and immediate recompression therapy? This may be old fashioned, but the dive industry doesnt think that healthcare teams know how to properly treat a diving injury.

Venous Air Embolism

[MurseNeutron]

Doses of air greater than 50 ml (1 ml/kg) cause hypotension and dysrhythmias. 300 ml of air entrained rapidly can be lethal.

copied from above link. you would have to try way to hard. i would worry more about taking half a shift to get the IV pump to actually run more than 5 minutes without beeping before air injury to a patient

unless..... your a baaaaaad person.

to answer the question "why would divers be put supine instead of trandelenburg?"

Emergency treatment of arterial gas embolism includes the immediate administration of 100 percent oxygen to widen the pressure gradient for nitrogen between the bubble and the circulation and thus accelerate reabsorption of gas bubbles, and hydration to decrease vascular obstruction and augment collateral flow. The Trendelenburg position decreases the risk of additional cerebral emboli, but may increase cerebral edema; thus, the supine position is the best compromise for transportation

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boyles law might also help: that at a constant temperature, the volume of a gas varies inversely with the pressure to which it is subjected. This law helps to explain the principles behind diving-related barotrauma and air embolism. Henry's law states that at a constant temperature, the amount of a gas that is dissolved in a liquid is directly proportional to the partial pressure of that gas. This law provides the explanation for decompression sickness and nitrogen narcosis.

watch the movie Man of Honor with cuba gooding JR. entertaining way to learn about it.

[ceecel.dee]

Originally Posted by MurseNeutron

you would have to try way to hard.

Measurable?
I would just be careful to check all lines of an alarming IV pump, and not allow more than an inch or so of air into any patient.
Central line extractractions need special site care (the "sucking hole" theory).

[malamarn06]

The horrer of being told in nursing school that the slightest speck of air must be retrieved from regular IV tubing stuck with me for the first 3 years of my nursing career.
then in a recent critical care course... this question was answered.... according to a HD RN she said an arm's length of Dialysis tubing would be long enough to cause a problem.... i was skeptical so i inquired further...

I am careful enough not to let that happen...

[Hellllllo Nurse]

Originally Posted by Daytonite

Those bubbles that you see in the IV tubings that enter the vein make their way to the chambers of the heart (remember that the veins carry blood heading back to the heart) where the turbulence causes them to break apart into even smaller bubbles. Those miniscule bubbles of air are too small to do any occlusion or occlusive damage in the body. They eventually get absorbed into the tissues of the body.

Now, having said that doesn't give nurses free rein to permit this to happen. Efforts should be taken to prevent air from getting into the IV line and the patient's vein. You should know the immediate first aid for a large amount of air that enters the blood stream: turn the patient onto their left side with the head of the bed elevated to trap the air bubble in the upper right atrium of the heart.

Great explanation, Daytonite.

[catwoman1]

I work in a Cardiology office where we do testing. When we need to do echocardiograms specifically on patients who may have a septal defect, we inject air bubbles on purpose to better trace the blood flow. there are no adverse effects to the patient. You need to inject a large amount of air (more than 25 cc's) before you see adverse reactions.