What lying position should be taken for air embolism?

Many people have never heard of the disease of air embolism, but if it is serious, it can cause a person to fall into a coma and even pose a certain threat to life. Air embolism means that air enters the blood vessels. It usually occurs after a woman gives birth. Therefore, pregnant women should make all kinds of preparations during pregnancy and before giving birth. Once air embolism occurs, rescue measures should be taken in time to avoid causing greater harm to life and to recover as soon as possible.

What lying position should be adopted for air embolism?

Place the patient in the left lateral position. This position helps the gas float to the apex of the right ventricle, avoiding blocking the pulmonary artery orifice and thus preventing embolism. As the heart beats, the air is mixed into foam and enters the pulmonary artery in small amounts.

What is air embolism?

Air embolism is a disease caused by gas emboli originating from the lungs that block cerebral blood vessels. It is usually caused by excessive expansion of the lungs due to expanding lung gas when the surrounding pressure decreases (such as when ascending from deep water to shallow water). It is often characterized by pain and/or neurological symptoms. Air embolism refers to air entering the blood circulation to the lungs, blocking the main pathway of the pulmonary artery and causing severe shock. This disease is extremely rare and can occur during delivery or postpartum (including miscarriage) in the field of obstetrics and gynecology.

Symptoms and signs of air embolism:

Patients may complain of chest discomfort, difficulty breathing, coughing, irritability, and coma. In severe cases, cardiac arrest or even sudden death may occur.

Air embolism occurs within 10 minutes, and more than 5 ml can lead to pulmonary embolism.

Pathological causes of air embolism:

Common causes of air embolism: Air entering the blood vessels can cause gas embolism, but it depends on the amount of gas entering. If the amount of air is small, it can be dispersed into the alveolar capillaries and combine with hemoglobin. Or it diffuses into the alveoli and is expelled from the body with breathing, thus causing no harm. However, if the amount of air entering is large and rapid, the beating of the heart will mix the air and blood in the heart cavity to form a large amount of foam. If this foam is not discharged when the heart contracts or blocks the pulmonary artery, it may cause sudden death. Generally, when the amount of air that quickly enters the blood circulation is around 100 ml, it can lead to heart failure, which is manifested as abnormal discomfort in the chest, followed by difficulty breathing and cyanosis. At this time, rescue should be organized immediately.

Pathogenesis of air embolism:

When chest injury causes rupture of bronchoalveoli and blood vessels, allowing communication between the trachea and pulmonary veins, and when the tracheal pressure exceeds the venous pressure, air embolism may occur. The gas that enters the pulmonary vein flows with the blood through the left atrium and left ventricle, and finally flows into the systemic arterial branches, blocking the arterial branches and causing ischemia of the corresponding organs, especially the brain and myocardium. In severe cases, it can hinder the blood flow back to the left heart, causing serious circulatory failure, and the patient can die immediately.

Air embolism in the pulmonary circulation or right side of the heart is iatrogenic. When doing central venous puncture, if the needle or catheter lumen is not blocked in time, the negative pressure in the pleural cavity will continue to increase with inhalation, and atmospheric air can easily enter the central vein. When puncturing the subclavian vein or internal jugular vein for catheter examination or pacemaker placement, when the needle is pulled out or the catheter is replaced, air may also be sucked into the vein, flow into the right atrium, and enter the pulmonary artery through the right ventricle, causing pulmonary artery air embolism, which can lead to pulmonary infarction. Due to the combination of extensive spasm of the pulmonary artery system and severe hypoxia, if rescue is not timely, it is usually fatal.

Risk plan for air embolism:

1. Expel all air before infusion. During the infusion, the nurse on duty should patrol and observe closely in time, even when changing the liquid, to prevent air from entering the vein and forming embolism.

2. When air is found to have entered the anus, clamp the intravenous line immediately to prevent further entry of air.

3. Let the patient lie in the left side decubitus position with the head low and the feet high, so that air can enter the right ventricle and avoid the entrance of the pulmonary artery. Due to the beating of the heart, the air is mixed into foam and enters the pulmonary artery in small amounts at a time. At the same time, notify the doctor and cooperate with the doctor to make emergency treatment.

4. Immediately give the patient pure oxygen, and if conditions permit, perform hyperbaric oxygen therapy.

5. If there is cerebral convulsion, diazepam can be used. Hormones can also be used to reduce cerebral edema, and heparin and small molecule dextran can be used to improve circulation.

6. After the patient's condition stabilizes, record the cause of air entry, air volume and treatment process in detail and truthfully.

7. Continue to observe and record until it is proven that the patient is completely out of danger.