A mill-wheel type of murmur during laparoscopy suggests: (A) Tension pneumothorax, (B) intra-abdominal bleeding, (C) Gas embolism, (D) pre-existing valvular disease
Answer is C. The 'water-wheel' or 'mill-wheel' murmur is classically associated with large intracardiac air emboli and described as a "characteristic splashing auscultatory sound due to the presence of gas in the cardiac chambers." . Most venous air (gas) emboli are iatrogenic . Ref Davidson edition23rd pg 620