BMJ Case Reports 2013; doi:10.1136/bcr-2012-008343

Systemic arterial air embolism: positive pressure ventilation can be fatal in a patient with blunt trauma

  1. Ritu Gupta4
  1. 1Department of Surgery, VMMC & Safdarjung Hospital, New Delhi, India
  2. 2Department of Radiodiagnosis, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
  3. 3Department of Internal Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
  4. 4Department of Otorhinolaryngology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
  1. Correspondence to Dr Puneet Aggarwal, puneetaggarwal4u{at}


Systemic air embolism is a potentially fatal condition. Although venous embolism is commonly reported after deep sea diving or neurosurgical procedures, arterial embolism is rare. It usually occurs because of lung trauma after biopsy or lung resection but can rarely affect patients of blunt or penetrating trauma to chest managed on positive pressure ventilation. We report a case of road traffic accident with head injury, with normal primary survey of chest and abdomen who developed fatal systemic arterial air embolism immediately after intubation. Postmortem CT scan revealed huge amounts of air in left side of the heart, ascending aorta, arch of aorta, bilateral internal carotids and all right-sided intracranial arteries. In emergency departments of non-specialised centres, such complications are universally fatal. Thus, extreme caution needs to be exercised while managing patients of blunt trauma on mechanical ventilation even if the chest and abdominal examinations are normal.

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