Circulatory embolus
Causes: thrombus, fat, amniotic fluid, air/gas. Signs: hypotension, tachycardia, hypoxemia, decreased ETCO2. Symptoms: dyspnoea, anxiety, tachypnoea. Also consider if sudden unexplained loss of cardiac output.
Consider thrombolysis e.g. alteplase 10 mg i.v. then 90 mg over 2 h (>65 kg).
Consider surgical removal – consult vascular surgeon.
Consider percutaneous removal – consult radiologist.
Petechial rash, desaturation, confusion/irritability if patient conscious.
Supportive measures are mainstay of initial management.
Supportive measures are mainstay of initial management.
Monitor the fetus, if undelivered.
Treat coagulopathy (fresh frozen plasma, cryoprecipitate and/or platelets).
Consider plasmaphoresis.
"Mill wheel" murmur may be present.
Discontinue source of air/gas if applicable and discontinue N2O.
Tell surgeon to flood wound with saline and cover with wet packs.
Lower surgical field to below level of heart if possible.
Place patient in left lateral position if possible.
If central venous catheter in situ, attempt to aspirate air.
Volume loading and Valsalva manoeuvre may help.
Pneumothorax (+/- tension)
Bronchospasm (→ 3-4)
Pulmonary oedema
Cardiogenic shock
Hypovolaemia
Myocardial failure
Sepsis (→ 3-14)
Bone cement implantation syndrome
Anaphylaxis (→ 3-1)