What action is most appropriate when an air embolism is suspected during IV therapy?

Hypernatremia occurs when serum sodium levels are elevated, typically above 145 mEq/L. Treatment focuses on gradual correction of sodium levels and rehydration using hypotonic solutions, which promote a shift of water into cells and help dilute serum sodium.

Rationale for correct answer:

3. D5W (5% Dextrose in Water):
Although D5W is technically isotonic in the bag, it behaves as a hypotonic solution once the dextrose is metabolized. It provides free water, which helps dilute elevated serum sodium levels, making it appropriate for gradual correction of hypernatremia.

Rationale for incorrect answer:

1. 0.9% Normal Saline:
This isotonic solution contains sodium and chloride concentrations close to plasma levels. Administering it to a patient with hypernatremia could exacerbate the elevated serum sodium levels rather than dilute them.

2. 3% Hypertonic Saline:
This solution contains a high concentration of sodium and is typically used for hyponatremia, not hypernatremia. Administering it to a hypernatremic patient would dangerously increase serum sodium levels and worsen the condition.

4. Lactated Ringer’s:
While this isotonic fluid contains electrolytes, including sodium, it is not ideal for treating hypernatremia. It can maintain or even raise serum sodium concentrations, depending on the patient's fluid and electrolyte status.

Take-home points:

• D5W provides free water that helps dilute elevated serum sodium in hypernatremia.
• Avoid isotonic or hypertonic saline when sodium levels are already high.
• Always correct hypernatremia gradually to prevent cerebral edema and neurologic complications.

An air embolism during IV therapy is a medical emergency caused by air entering the venous circulation, potentially blocking blood flow to vital organs. The left lateral Trendelenburg position helps trap air in the right atrium, preventing it from entering the pulmonary circulation and causing respiratory or cardiac complications.

Rationale for correct answer:

3. Position the patient in left lateral Trendelenburg:
This position helps trap the air in the right atrium and prevents it from reaching the pulmonary arteries, minimizing the risk of a fatal embolism. It's the most effective initial action.

Rationale for incorrect answer:

1. Place the patient in a supine position with head elevated:
This position does not effectively trap air in the heart and may allow air to move into the pulmonary circulation, increasing the risk of embolism.

2. Elevate the legs and apply oxygen:
While oxygen is appropriate, elevating the legs can worsen the embolism by facilitating air movement toward the heart or lungs. It’s not the primary positioning intervention.

4. Flush the line and resume infusion:
Flushing the IV line can force more air into the circulation, worsening the situation. The infusion should be immediately stopped, not resumed.

Take-home points:

• Air embolism requires immediate positioning in left lateral Trendelenburg.
• Stop the infusion immediately and notify the provider—do not flush the line.
• Air embolism signs may include dyspnea, chest pain, tachycardia, or hypotension.