Monday, March 14, 2011

Fowl Play

You are the anesthesiologist for a neurosurgery for a patient with cranial synostosis. The patient is in Fowler's position. You DJ the iPad music, glance at the news of the day, and listen to blips of the heart (you can YouTube this). Suddenly the patient becomes immediately hypotensive and tachycardic. You note the patient's JVP suddenly rises. You turn down the music and hear a sucking noise. You send a stat ABG from the radial art line which showed hypoxemia and hypercarbia. The EKG on the monitor shows peaked p waves, non-specific ST changes, and sinus tachycardia. You start fluids wide open, prepare vasopressor support, and ask the neurosurgeon to place the patient into Tredelenberg.

Challenge: What happened?

Image from, shown under Fair Use.

1 comment:

Craig Chen said...

Fowl Play

In venous air embolism, there must be a direct communication between air and the vasculature as well as a pressure gradient favoring the passage of air into the circulation rather than bleeding from the vessel. This is a common complication in ENT and neurosurgery cases because they occur above the heart (and above the JVP); it is also more common in the Fowler's position.

Source: UpToDate.