Clinical findings in air embolism

Symptoms	Physical findings
Pulmonary
Dyspnea (100 percent incidence) "Gasp reflex"* "Sucking sound"^¶	Tachypnea Wheeze Rales Respiratory failure
Cardiac
Substernal chest pain	Hypotension Tachycardia Mill wheel murmur^Δ Signs of right heart failure (eg, elevated JVD) Shock
Neurologic
Sense of doom Dizziness/lightheadedness	Change in mental status Focal neurological deficits
Skin
	Crepitus over superficial vessels (seen rarely in setting of massive air embolus) Livedo reticularis
Ocular
	Bubbles within the retinal arteries

JVD: jugular venous distension.
* A gasp or cough is at times reported when a bolus of air enters the pulmonary circulation.
¶ A sucking noise can be heard on occasion when air is sucked into the intravascular space, such as when air embolism occurs as a complication of a central line.
Δ The mill wheel murmur is a relatively specific sign classically associated with venous air embolism but only rarely heard. It is a churning sound heard throughout the entire cardiac cycle and is caused by the movement of air bubbles in the right ventricle.

Graphic 76772 Version 3.0

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Clinical findings in air embolism