Intraoperative Circulatory Embolus - Guidelines for Crises in Anaesthesia 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. Box A: THROMBOEMBOLISM 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 Box B: FAT EMBOLISM • Petechial rash, desaturation, confusion/irritability if patient conscious • Supportive measures are mainstay of initial management Box C: AMNIOTIC FLUID EMBOLISM • Supportive measures are mainstay of initial management • Monitor the fetus, if undelivered • Treat coagulopathy (fresh frozen plasma, cryoprecipitate and/or platelets) • Consider plasmaphoresis Box D: AIR/GAS EMBOLISM • “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 By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Thromboembolism #Embolus #Embolism #VTE #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
