Air embolism may follow acute blast injury if air enters the arterial circulation from a lacerated lung. Once air has entered the arterial system it tends to move upwards to the organ with the greatest blood flow. If lodged in the heart or brain, then it may be fatal, often shortly after the blast.

Site of Deposition

Signs or Symptom


focal neurological deficit

acute headache

altered level of consciousness



air in retinal blood vessels


cardiac arrhythmias

chest pain

ECG evidence of ischemia or infarct

peripheral distribution

livedo reticularis

blanching of the tongue and/or face


Management Issues:

(1) The head should be kept down and lower than the feet. If one lung is more severely injured than the other, then that side should be dependent. If uncertain, then the patient should be kept recumbent in the left lateral decubitus position.

(2) The patient should receive supplemental oxygen and be well but not excessively hydrated.

(3) Mechanical ventilation may increase the risk of fatal air embolism.

(4) Patients with cerebral symptoms may benefit from dexamethasone or other therapies to reduce cerebral edema.

(5) Cardiac arrhythmias can be treated with anti-arrhythmic agents.

(6) Hyperbaric therapy may be beneficial if available.


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