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©2013 UpToDate ® Print Email 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 murmurΔ 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 * 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.