Air embolism is the entry of gas into vascular structures. It is a rare life-threatening complication of several medical procedures, in particular lung biopsy and central catheter insertion. The prevalence is 0.06%, but may be underestimated. It can have an asymptomatic course. Symptomatic air embolism can be accompanied by respiratory insufficiency and myocardial or cerebral infarction. We present a 78-year-old woman with acute hypotension and unconsciousness after lung biopsy. A CT scan showed air embolism in both the pulmonary and systemic circulation, followed by myocardial infarction and stroke. She was admitted to the intensive care unit for stabilisation and hyperbaric oxygen therapy. The patient improved, but a hemi-paralysis remained. Recognising air embolism is important to prevent further embolisation and to start treatment. Treatment is mostly supportive. In severe cases, 100% oxygen is supplied to expel air, thereby limiting permanent injury. In case of neurological and cardiac complications, hyperbaric oxygen is indicated. © 2023, Netherlands Society of Intensive Care. All rights reserved.