Does this sound like an air embolism?

[raindrop]

I checked platelets with the RN that had this patient. The patient was extremely agitated and wanted his platelts pronto because afterwards he was going to be able to go home.

Anyhow, he was sitting on the side of the bed while we were doing the check, she flushed his Hickman, and 10 seconds or so, he said he wanted to lay down - and he just sort of fell back slowly. His breathing wasn't labored, but he looked more gray that what I remember, his pulse was tachy, B/P 170's/80's, RR even. And then he started complaning of abdomen pain and some chest pain - with slurred speech. His hands were shaking.

Patient was places on his left side, but not in Trendelenburg b/c the bed wasn't working properly. By the time she got doc on the phone (promptly) his condition was much improved. Doctor said he thought it was anxiety and that this is nothing new for the patient.

Anout 20 minutes passed and the patient had 3 large continent BM's. His gait was normal, shaking stopped, VSS.

He went home about an hour after this happened, and he seemed fine.

Does it sound like a air embolism? Why was he fine afterwards if that was it, or do you think it will take longer for complications to come forward? I have never been in this situaton and I want to learn from it, so that I can recognize the sx. I hope he is okay. The cna said he got into his car without any problems and he was asking his wife about his daughter a lot (who was in the ER suffering from a PE).

[TiredMD]

I'm not too clear on where the air would have come from? Assuming the Hickman wasn't new and no one was injecting air directly into it, it doesn't seem too likely to me that you managed to get 20cc of air (pretty much the minimum you need to produce a symptomatic air embolism) into the port.

Personally, what you described sounded to me a lot more like a TIA.

[Wise Woman RN]

perhaps vaso-vagal?? Considering the 3 large BMs... maybe there was some pressure on the nerve??

[Valerie Salva, BSN, RN]

perhaps vaso-vagal?? Considering the 3 large BMs... maybe there was some pressure on the nerve??

This is exactly what I was thinking- also a vaso -vagal response can stimulate the urge to defacate- really sounds like vaso-vagal to me (check out my name lol!)

http://www.mayoclinic.com/health/vasovagal-syncope/DS00806/DSECTION=3

Causes of vaso-vagal response include:

• Emotional distress, including panic attacks, anxiety attacks or fear
  
• Standing in a hot, crowded area
  
• Having a bowel movement (especially if straining)
  
• Coughing strenuously
  
• Unpleasant situations, such as the sight of blood
  
• Urinating
  
• Standing in one place too long
  
• Breathing too fast (hyperventilation)
  
• Severe dehydration
  
• Severe pain
  
• Heat exposure

You said the guy was agitated- maybe that was it.

Since the guy was waiting to get platelets, his count was probably low, so that would lead me away from thinking TIA.

[TiredMD]

perhaps vaso-vagal?? Considering the 3 large BMs... maybe there was some pressure on the nerve??

Likely, but man that part about the slurred speech really sent my antenna up . . .

[EricJRN, MSN, RN]

How long was the speech slurred? Speech can be kind of garbled in any vasovagal syncope patient right before or after the syncope.

[EmmaG, RN]

Anyhow, he was sitting on the side of the bed while we were doing the check, she flushed his Hickman, and 10 seconds or so, he said he wanted to lay down - and he just sort of fell back slowly.

Are you certain she flushed with saline? Did it flush easily? What was the last medication to go through that line? Had he already received any type of transfusion through the line?

[chadash]

How long was the speech slurred? Speech can be kind of garbled in any vasovagal syncope patient right before or after the syncope.

ahhh yes. poo and vaso vagal, like love and marriage, horse and carraige...

but actually, you CAN have one without the other. Hmmm.

Might be it, though.

[MoopleRN]

I don't think it was something vasovagal related; his pulse and BP were up, not down. Maybe the doctor was right!