EMBOLISM.pptx

EMBOLISM

1. EMBOLISM BY- SYED MASOOD

2. DEFINATION Embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body. OR IN OTHER WORDS Embolism is the process of partial or complete obstruction of the cardiovascular system by any mass carried in the circulation. Mass or Embolus : it is mass(such as air, fat etc) detached from the site of origin is called an embolus.

3. Embolism,  obstruction of the flow of blood by an embolus , a particle or aggregate of substance that is abnormally present in the bloodstream. The substance may be a blood clot that has broken loose from its point of formation (while it is still adherent to the vessel at the point where it was formed, the clot is called a thrombus ); It may be a drop of soluble fat from a crushing injury of fatty tissue; it may be a clump of tumor cells, bacteria, or detached tissue cells; it may be a foreign body such as a bullet, which has penetrated a vessel wall; it may be a drop of amniotic fluid that has entered the maternal circulation during childbirth; or it may be an air bubble (called an air embolism ) or a bubble of some other gas—e.g., nitrogen in decompression sickness

4. EMBOLUS VS THROMBUS EMBOLUS- It is the mass detached from the origin. Lodging in some other area of the part. THROMBUS- It is solid mass formed in the circulation. It blocks that part were formed.

5. TYPES OF EMBOLI

6. Depending upon the matter: Solid- eg thromboemboli, pulmonary thromboli Liquid- eg fat globules Gaseous- eg air

7. Depending upon the source of emboli 1.Cardiac orign- thrombus formation orignates from Atrium and Atrial appendages Infarct Valvular disease 2.Arterial orign- Eg. In systemic arteries such as Brain,Spleen,Kidney. 3.Venous orign- Eg . In Pulmonary arteries. 4. Lymphatic orign-

8. Depending upon the flow of blood Paradoxical orign – an embolus which is carried from the venous side to the arterial side or vice-versa. Also known crossed embolus Retrograde orign- an embolus which travels against the flow blood

9. What causes an embolism? Primary cause of embolism Deep vein thrombosis, a condition in which blood clots form in the large veins of the lower extremities, such as in the thigh or lower leg. If the blood clot breaks free from the wall of the vein, it can travel through the bloodstream and cause an embolism by blocking an artery. Other causes of embolism Atherosclerosis (buildup of plaque on the walls of the coronary arteries; atherosclerosis is a type of arteriosclerosis Atrial fibrillation Endocarditis (inflammation of the lining and valves of the heart) Mitral stenosis

10. Risk factors!!!! Advanced age Atrial fibrillation Cancer Central venous catheters Deep vein thrombosis (blood clot in the leg that can break loose from the leg and cause a pulmonary embolism in the lung, a heart attack, or stroke) Long periods of immobility, such as bed rest or prolonged travel Obesity Oral contraceptives or hormone therapy Pregnancy Previous heart attack, embolism, or stroke Recent surgery or broken bone .

11. Pathology A thrombus separated from its site of origin travels circulation where the thrombus finally lodges to occlude the major branches of a vessel

12. Pulmonary embolism A pulmonary embolism most commonly occurs when a thrombus (a circulating blood clot) lodges in the pulmonary vascular bed and restricts circulation to the corresponding part of lung vasculature. PEs are generally classified (based of the size of the obstruction.) as: * Small- affect a fraction of a lung lobe * Medium-affect 1 lung lobe. * Large - affect 2 or more lung lobes, medium PE

13. Pathology A thrombus travels to the circulation & then Inferior vena cava The right ventricle pumps t hrombus to the pulmonary arteries where it lodges. PE may occur singly or multiply. They can be microscopic in size or be big enough to occlude the major branches of the pulmonary artery

14. Cont….

15. Clinical Features Symptoms of an embolism It vary with the severity and location of the embolism. asymptomatic or can be severe (life-threatening condition, such as pulmonary embolism) Symptoms of an embolism in an extremity such as the hands, arms, legs or feet include: Coldness in the extremity Decreased or absent pulse in the extremity Muscle twitching, spasms or seizures Muscle weakness Numbness or tingling in arms or legs Pale skin ( pallor)

16. In case severe condition(PE): Chest pain or pressure Coughing up blood (hemoptysis) Fainting or change in level of consciousness or lethargy Impaired balance and coordination Loss of bladder or bowel control Loss of vision or changes in vision Numbness or tingling in the arms or legs Rapid breathing ( tachypnea) or shortness of breath Rapid heart rate (tachycardia) Severe or sudden Headache Sharp pain in the lungs Sudden muscle weakness

17. Diagnosis of PE 1. ABG : PaO2 (hypoxia) and PaCO2 (hyperventilation) is usually decreased. Low PCO2 Slightly increased pH indicate mild acute respiratory alkalosis. 2. CXR is frequently normal but may see evidence of atelectasis/infarction or oligemia/decreased vascular markings . 3. ECG most commonly shows sinus tachycardia but may produce S1Q3flippedT3 with a large PE. It is not a specific test for PE but may help to rule out myocardial infarction from the differential diagnosis. 4.V/Q scan : reveals areas that are well ventilated but poorly per fused . 5. Pulmonary angiography , although the gold standard for diagnosis of PE, is invasive and should only be considered if surgery is planned or if the risks of long-term anticoagulation are higher than normal. 6. Venous duplex ultrasound or Doppler of the lower extremities is non-invasive and may provide corroborative evidence of PE but can produce false positive results. 7. Spinal cT scan- reveals presence of emboli.

18. cT scan & X Ray of pulmonary emboli

19. TREATMENT Initial treatment ; Administration of oxygen to aid respiration. Prophylactic anticoagulation therapy with IV heparin proceeding to warfarin to prevent further emboli. An inferior vena cava filter can also be used if anticoagulation is contraindicated or unsuccessful or if another PE would be fatal. Embolectomy is an alternative treatment for patients who cannot maintain effective cardiac output . survival rate following this procedure is only 10%. Best treatment PREVENTION. During any surgery leg elevation must!!!!!

20. POST OPERATIVE COMPLICATION One of its effects is Mucus Secretion in respiratory tract. Post operative Atelectasis- it is due to the blockage of a bronchus or bronchiole causing collapse of a segment or lobe of the lung. basal lobes are most commonly affected as the pt is nursed in half line position. It usually occurs between the first & third day after operation. Deep vein thrombosis General muscle wasting and immobility Pressure sores Wound infection Hemorrhage

21. PHYSIOTHERAPY manual techniques are generally contraindicated until anti-coagulants have been started and reached 'therapeutic' range, but things like ACBT are continued. Pre operative care Before surgery physiotherapist may Clear the secretion and Ensure good respiratory movements Explain why treatment is necessary Teach the pt the ex. which will be required after surgery Respiratory movements-mainly lower costal & posterior basal movements Teach coughing

22. Post Operative care Check : Temperature Pulse rate Blood pressure Respiration Careful observation of the pt may indicate whether He has pain Amount & rate of resp mvt General posture Amount of secretion Degree of awareness

23. Rx to prevent chest complications Breathing ex to all parts of the chest but mainly lower costal & post basal area. breathing should be Deep & emphasize on expiratory movements to loosen the secretions & stimulate cough reflex. Encourage coughing to try to clear the secretion. the pt sits forward and the therapist supports him in this position. Patient places his hand over or around the wound to prevent stretching of the wound as the pt coughs.

24. In abdominal surgery pt should bend his knees as this relaxes the abdominal wall and decreases the stretch. If secretion are very sticky use techniques postural drainage & vibrations Chest complications mostly occur in first 48hrs so Rx should be given during this time.

25. Postural Drainage

26. Prevention of Thrombosis While the pt is in Bed Encourage to move about. Leg ex particularly full range Dorsi- Plantar flexion to improve venous return to LL Hip and knee ex & Quards contraction

27. Prevention of muscle wasting &Jt immobility Done particularly in elderly & pt immobilized for longer periods General mobilization ex Grade 1,2-for pain relief Grade 3,4-for mobility Strengthening ex.

28. 7.yard standing: arms circling backwards. 8.yard standing: trunk bending and turning to touch left knee. 9. sitting:throwing and catching ball. 10.standing:arms bending and stretching. 11.wing stride standing, trunk bending side to side. 12.standing:stepping up and down. 1 .lying: alternate hip and knee bending and stretching. 2. crook lying -pelvis raising and lowering. 3.sitting ,standing up and sitting down. 4..stride standing: bouncing ball. 5.stride standing: throwing ball. 6.sitting:trunk turning side to side. EXERCISES::

29. Instruct the leg ex.- 1.half yard grasp standing-one leg swinging forward and backwards then repeat with other leg. 2.half yard grasp standing: knees and hip bending and stretching. Progression: 1.increase no. of repetitions. 2.increase the length of time for each exercise. 3.increase speed. 4.add weights. 5.alter range.