Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

Air Embolus Alcohol Abuse, Dependence, and Withdrawal 85

General Measures

■Avoid air embolism

➣Backbleed or aspirate all venous lines during insertion

➣Flush or vent any potential air sources prior to unclamping

➣Check and tap all bypass lines prior to instituting flow

specific therapy

■If venous lines are in RA or RV, aspirate out the air

■If chest is open, aspirate RV apex with needle after positioning

■If chest is open, cardiac massage to relieve RV outflow obstruction

follow-up

■Treat survivors as status-post myocardial infarction

complications and prognosis

Complications

■Myocardial Infarction

➣Secondary to air embolus entering coronary artery

■Anoxic brain injury

➣Secondary to prolonged cerebral hypoperfusion

Prognosis

■If patient presents with cardiovascular collapse, most do not survive

■If air is noticed during embolization (i.e. line placement) and aspi-

rated, prognosis is good

■Air embolism in trauma (penetrating lung injury) is usually lethal

Alcohol Abuse, Dependence, and Withdrawal................

JOSE R. MALDONADO, MD

history & physical

History

■Lifetime prevalence of alcohol abuse or dependence 14%

■Family history increases risk of alcoholism 4–5 fold

■Metabolism:

■90–98% via hepatic oxidation

■Slow rate (10 mL/h or 1.0 oz liquor/1.5 h)

■CNS depressant effects proportional to blood concentration