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We answer all types of Neurology/Neurological questions about the brain, spinal cord, and peripheral nerves. Include your age, sex, current meds, and known diagnoses, upcoming/completed appointments, tests, or procedures. We are not physicians. We help explain medical terminology and give support.
Air bubble in the brain?
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Thatieta posted:
What is this? my cousin had a baby bout 5 days ago and had complications with the epidural. went to the doctors 2days ago with pain in her head that hasnt gone away since she had the epidural. since then she had been admitted and placed in a medically induced coma due to the siezures which the doctors say are because of the air bubble in her brain. What are the side effects? what can happen to her because of this? She is only 25 yrs young, anything can help.
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Lifes responded:
Dear Thatieta,

I'm sorry your 25-year old cousin has had this adverse event. You are correct in calling this a "complication".

Let me explain the process that creates an "air embolism" (air bubble).

Anytime a nurse penetrates the vein for an IV, or a anesthetist or anesthesiologist (highly trained physician or nurse) penetrates the spinal column to remove spinal fluid / or remove spinal fluid to insert medication such as in an epidural, the number one risk is air embolism.

Before inserting drugs via a needle (or needle and tubing), professionals must take care to remove all "air" from the syringe and IV tubing. Some tiny bubbles can be expected in either syringe or IV tubing; these tiny bubbles are usually absorbed by the patient's body. However, in some cases, more air bubbles are in the tubing and either go unnoticed by any professional, or the body is unable to absorb the introduction of air. This is a more common risk during labor and delivery, where professionals are hurrying to complete tasks, when there is more chaos and many tasks to complete, etc. HOWEVER, the rule to remove air bubbles is a basic, elementary task all professionals learn! To ignore the presence of air is plain negligence. It IS easy, though, to overlook in situations where there is fast-paced, stressful, chaotic medical situations-- Labor and Delivery is one of those situations.

Let's say you are admitted for surgery tomorrow. You haven't needed IVs, but prior to surgery you need one so a nurse prepares the equipment and inserts the IV into your arm. The unit is not very busy; the nurse is not rushing. She carefully checks each of her steps; no excess air is introduced; you go through surgery without incident. Versus---- A woman comes to the ER in labor. She's often hurried through ER Triage to be admitted to the Unit. An IV can be started in the ER or Unit. Once in the Unit, many types of "prep" begin (many nursing tasks). In the midst, Drs are in and out. A laboring mother only has a certain window of time to ask for an epidural or it can't be done. If she's waited long to decide, things can get rushed. Or there can be any number of reasons that the professional can feel rushed. But, whether from rushing-- or just not paying attention -- or from minimizing the potential risk if a Dr/nurse saw air in the syringe, the air is somehow allowed to enter the body.

Once in the body, an air bubble acts similarly to a "smoke ring", meaning, it is lighter than fluid, it travels fast through blood or cerebral spinal fluid. From a spinal epidural, it has a straight shot to the brain. If it had been in the blood, an embolism can travel to the heart or brain. An air embolism to the brain causes headache. They should have had her laid flat. They shouldn't have released a post-delivery woman who complained of severe headache.

Once an air embolism is identified in the brain, the best medical protocol is to place the patient into a medically induced coma and to support the breathing and heart with a ventilator. Air can be absorbed by the body and some medications can assist the body. Being mostly flat (flat, no pillow) keeps the air bubble in one spot, which is best so it doesn't travel more and damage the brain.

If they caught it quickly enough, damage can be controlled. However, anything to do with the brain is uncertain. Every patient recovers differently, and no doctor can predict the outcome with certainty. They can assess, go from prior experiences, along with typical recovery of patients with similar events.

see post 2
 
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Lifes replied to Lifes's response:
Her immediate next of kin should ask the doctor for his best guess about prognosis. How long the patient will be kept in a coma (usually, they try to remove the vent as quickly as they can medically). Do they think she'll have damage (best guess). Will she likely need other services (PT, OT, ST). Note that anytime a person has had a brain "assault", it is normal to need additional services after they reduce the sedative meds and allow her to wake up. Just being in bed a few days to a week can leave a patient feeling weak and unable to do tasks independently at first. Additionally, ask if she'll now be prone to seizures. This aspect will be important for child care and mom's safety.

As far as the baby, there are two things family can do to help during this absence of the mother: Take a light-weight receiving blanket to the hospital and gently rub it over mom's skin (face, arms, chest) and put it in a plastic bag to take back to baby. Even putting the blanket in the crib will leave Mom's "scent". A new blanket can be re-freshed with mom's scent every few days. Obviously, make sure not to get bodily fluids (ex. blood) onto the blanket. For mom, record her baby's sounds, even whimpering or baby-noises (don't make long recordings of distressed crying). Talk to the mom when you visit (she may hear you, at least somewhat). Tell her, in positive words and with a positive tone of voice, baby (name) is waiting for you to get better and then play a short bit of the baby's noises. Just 30-seconds or so. If you have any home movies or recordings of mom's voice, play those for the baby to hear. (Babies can't see well or focus well, but they hear! )Both will need that connection to each other, especially in this immediate birth-bonding period.

Hope for the best with your cousin, but as well, balance that hope with knowing the outcomes of brain injury are unclear right now. The docs will know more once they wake her up. Baby's Dad or Next of Kin should make temporary arrangements for who will care for Baby. Plan on at least 1 to 3 months for this initial period. Limit the number of people who care for Baby-- the baby NEEDS to bond with ONE or TWO people in place of Mom, and one of the substitutes should be a female. At the same time, the adults need to understand that once Mom is back home, Baby and Mom will need to bond.

I hope Mom's time in ICU is short and that she won't have any brain damage.

As a personal note, if your family intends to consult a lawyer, this is as good a time as any to do that. Most cases have a one year statue of limitations.

Lifes

* Disclaimer: Although I am familiar with medical conditions, I am not a doctor. Only a doctor can diagnose or give prognosis on a specific patient. My reply here is mainly to explain how these situations typically occur, but without knowing specifics in this case. Family should sit down with the patient's doctor and ask their questions directly.


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