Killing a Patient Using an Air Embolism

My villain approaches a patient in the hospital and injects a syringeful of air, killing the patient. How would this be done, and how much air would it take?

An air embolism is a quantity of air traveling as a single mass within the vascular system.
There are several factors at work when writing your scenario.

The first is whether it’s a venous air embolism, an arterial air embolism, or a paradoxical air embolism:

Venous air embolism: An IV (intravenous) line in a peripheral vein—like an arm vein—is unlikely to accommodate enough air in a rapid enough fashion to cause much trouble. Air bubbles that go in through such an IV are filtered out by the lungs, and generally cause no problems.

You’d need a very large syringe—fifty cc’s—and need to blow in several boluses of air in quick succession. The air takes up space in the right side of the heart, and restricts blood flow to the lungs.

If the patient has a large IV line in the internal jugular vein (called a central venous line), it’d be fairly easy to blow in a lot of air quickly and within a few centimeters of the heart. This is your best bet for this scenario. Patients with central lines aren’t necessarily confined to ICU. Temporary dialysis catheters are placed in the internal jugular, for instance.

Arterial air embolism: Access to an artery would be necessary. An artery is under pressure, and the air injected will meet more resistance than on the venous side. A few cc’s of air in the carotid artery can cause a stroke. The drawback is as soon as the killer pulls the needle out of the carotid artery, it’ll bleed profusely as the blood is under pressure. The killer’s method would be obvious right away if he left the bedside. Air to the brain isn’t uniformly fatal.

Paradoxical embolism: Air injected into the right sided venous circulation travels to the arterial left side of the heart without going through the lungs. This occurs via a hole between the right (venous) and left (arterial) sides of the heart, usually between the top two chambers (the atria), but can be between the bottom two chambers (the ventricles).

For a paradoxical embolism to work, the killer would need knowledge beforehand that the patient had such a hole, or he’d have to be very lucky to have selected a victim with an undiagnosed defect.

Since the arteries that supply blood to the heart originate where the arterial blood leaves the heart, air can travel down these coronary arteries and cause a heart attack and/or cardiac arrest.

The air can travel straight up into the carotid arteries (that supply the blood to the brain) and cause a stroke.

Hope this helps!

Cheers, Kelly

Diagram: Dr. R. Singer, heartlungdoc.com

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Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find Kelly’s fiction at www.kellywhitley.com.

 

 

Writing A Child With Fragile Bones

I have a character who is a young child with a broken bone. When the parents take her to the ER, they’re accused of child abuse, but they’re not abusive. They claim the kid’s leg broke as they changed her diaper. What kind of disease might a kid have that would lead to easy fracture without abuse?

I'd suggest Osteogenesis Imperfecta, or brittle bone disease.

This genetic disorder affects boys and girls equally; it is generally inherited as a dominant trait (at least one parent has the disease) although a few are the result of both parents having a recessive gene (they don’t exhibit the characteristics of the disease). Regardless of the origin, the disease is caused by abnormal collagen.

Bones are initially formed of collagen. Crystals of calcium hydroxyapatite are deposited on the collagen framework, giving the bones strength. An abnormal framework leads to “imperfect” deposition of calcium, and the bones are weak. Although this is an inherited disease, about one third of patients have no family history of the disease, and represent new genetic mutations.

There are several different types of Osteogenesis Imperfecta. The first three are the most common and would be the options for your scenario.

**In Type I, the collagen is normal but isn’t produced in enough quantity. Bones break easily. The patient may have increased joint flexibility, ie, “double-jointed.” The whites of the eyes may be bluish gray in color due to thin collagen. The teeth may or may not be abnormal. Hearing loss is common.

**Type II victims have very abnormal collagen and usually die within the first year of life. Death is due to respiratory failure (due to chest wall deformity) or bleeding inside the head.

**In Type III, the collagen is insufficient in quantity and abnormal. Fractures before birth can be detected, and the bones fracture easily with minimal stress. The affected kids are often short, with wide ribcages and the abnormal blue-gray color of the whites of the eyes. Frequent hearing loss.

Type III would be the most likely type to fit your scenario.

For more information, I suggest the Osteogenesis Imperfecta Foundation: http://www.oif.org/site/PageServer/

Hope this helps.
Cheers, Kelly

~*~

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at www.kellywhitley.com.