Interesting case from my MICU month.  Pt is a middle aged  WM with hx of HIV, CVA presented to the ED with hypoxic respiratory failure and sepsis. Intubated in the ED and admitted to the unit. Pt self extubated few hours later in the MICU. Responded well to fluids, antibiotics and O2 nasal cannula.  Few days later, nurse d/c’ed his RIJ central line.

Within minutes,  pt became severely altered, O2 sats plummeted to the 60s and  bedside ultrasound showed significant air bubbles in the cardiac chambers.

What happened? When central line was removed, the wound site was not immediately occluded (with fingers, dressing with tape, etc). As pt inhaled, air traveled through the communicating conduit into the central blood vessel.

What to do now? Intubate for severe respiratory distress. Place pt in left lateral decubitus position and Trendelenburg position–prevents air from traveling to the pulmonary arteries causing airflow obstruction. Hyperbaric oxygen therapy, if you suspect cerebral embolism, as it decreases mortality.

The pt was intubated, placed on his side with bed tilted down. Did fine and transferred to floor the next day.