Trent Brown's air embolism
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Las Vegas Raiders right tackle Trent Brown missed Sunday’s win over the Cleveland Browns with what head coach Jon Gruden classified as an illness.
It turns out that a pregame IV resulted in air being injected into Brown’s bloodstream, NFL Network reports. The injection required immediate medical attention and required Brown to be hospitalized, where he will remain overnight for testing.
Pro Football Talk’s Mike Florio reports that Brown’s representation is seeking a full investigation of the incident by the NFL Players Association.
Air injected into the bloodstream and causing an embolism can have serious consequences. According to Healthline, air bubbles that enter the brain, heart or lungs can cause a heart attack, a stroke or respiratory failure. A minor embolism can produce minor symptoms, according to the medical website.
The severity of Brown’s reported embolism is unclear.
I am at a loss to understand how this happened.
First of all, it takes A LOT of air to cause a problem. In a rabbit, if I recall, it takes about 7 cc of air per kilogram weight to be lethal. That's a lot. A simple air bubble in an IV would not cause this.
The article doesn't say what kind of procedure was being performed. A "pregame IV"? What is that all about?
There are some procedures which use an irrigation system to visualize structures. I imagine it's possible that this irrigation system was not properly primed and air was injected that way.
Edit to add: Wikipedia says, "The lethal dose for humans is considered theoretically between 3 and 5 ml per kg. It is estimated that 300-500 ml of gas introduced at a rate of 100 ml per sec would prove fatal."
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Air embolism used to be a big risk factor in certain types of neurosurgical (and other) procedures in which the patient was in a sitting position. The neurosurgeon would usually be working on the back of the skull, or the posterior cervical spine.
Bear with me here: physiology alert!
Because the patient is sitting, the pressure in the venous circulation at the head is lower than the pressure in the heart. When the surgeon is working on bone (as in the skull) it's possible to open a vein, and because the vein is encased in bone, the vein won't collapse. Air is sucked into the vein and can travel into the heart. If the amount is substantial, it can be enough air to obstruct the filling of the heart with blood, potentially causing a catastrophic cardiovascular collapse.
For these reasons, monitoring for air embolism during sitting neurosurgical cases is the standard of care - a doppler device is taped to the chest, over the heart, and if air is entrained, there's a distinct change in the sound of the doppler. The other thing is to have a method of getting the air out if it becomes hemodynamically significant. For that reason, one would place a catheter into the right atrium to enable one to get the air out.
I've seen a couple of air embolisms, but only one was significant. I aspirated (with a syringe) on that right atrial catheter and got about 30-50 cc of air. It came out like frothy blood. Scared the crap out of me, needless to say.
Today's neurosurgeons are trained to do cases in the prone position rather than sitting.
Air embolism can also occur during other procedures where there is a potential for air (or other gas) to enter the circulation, such as laparoscopic procedures (CO2 is used here because it's very soluble in blood) and, believe it or not, C-Sections.
ETA: Here's a site that shows an air embolism during a neurosurgical procedure:
Embolism occurs at about 7:00 into the video.
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Interesting stuff.
The things I learn here.
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IV hydration is common in football players. So are pre-game pain shots and therapies.
Is there something that can be given IV for pain, that doesn't effect reflexes or ability to think?
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IV hydration is common in football players. So are pre-game pain shots and therapies.
Is there something that can be given IV for pain, that doesn't effect reflexes or ability to think?
@Jolly said in Trent Brown's air embolism:
IV hydration is common in football players. So are pre-game pain shots and therapies.
Is there something that can be given IV for pain, that doesn't effect reflexes or ability to think?
Acetaminophen, 1000 mg.
Ketorolac, 30 mg.
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I know those guys used to live on Toradol...But that's a shot or by mouth only, correct?
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@George-K said in Trent Brown's air embolism:
Toradol...But that's a shot or by mouth only, correct?
When that stuff first came out, I used to give 60 mg IV. My former partner, who ended up as a pain doc, said, "That's bullshit."
The nurses in PACU said, "Dr. K, you patients need much less morphine/dilaudid than others we see. What are you doing different."
I LOVE toradol. Love, love, love...
