Embolism by Dr.AmrithaAnilkumar
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Embolism is due to a solid, liquid or gaseous, material which is floating and travelling in the bloodstream, eventually blocking the vessel on its pathway
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Embolism by Dr.AmrithaAnilkumar
- 1. en love da Homoeopathy EMBOLISM
- 2. EMBOLISM
- 3. EMBOLISM Definition It is due to a solid, liquidor gaseous, material whichis floating and travelling in the bloodstream, eventuallyblocking the vessel on its pathway
- 4. CLASSIFICATION DEPENDINGUPONTHE MATTER IN THE EMBOLI 1.Solid 2.Liquid 3.Gaseous DEPENDINGUPONWHETHER INFECTEDOR NOT 1.Sterile 2.Septic DEPENDINGUPONTHE SOURCEOF THE EMBOLI 1. Arterial emboli 2. Venous emboli 3.Venous-arterial paradoxical emboli 4.Fat embolism. 5. Air embolism
- 5. SOURCES 1. Cardiac source (80%): – Due to mural thrombus following 2.mitral stenosis 3.atrial fibrillation (50%) 4.myocardial infarction (25%) 5.Idiopathic is 10% ™ EFECTS OF ARTERIAL EMBOLISM 1.Blockageat middle cerebral artery– hemiplegia 2.Blockage at central retinal artery– permanentblindness 3.Blockageat mesenteric vessels - intestinal gangrene ™ 4.Blockageat renal artery – haematuria 5.Blockageat limb vessels- pain, pallor, pulse less, paraesthesia, paresis, ulceration, gangrene™
- 6. COMMONSITE • lower limbs • brain • upper limb • superior mesentericand renal arteries. • commonfemoral artery • popliteal artery CLINICALFEATURES • Sudden, dramatic, rapid development of pain with numbness. • Loss of sensation and movements. • Collapsedveins, cold limb distal to the level of block, oedema and presence of blebs distally.
- 7. INVESTIGATION • ECGand echocardiography. • Angiogramis gold standardin all acute limb ischaemia • Prothrombin time, APTT, BT, CT, plateletcount should be done TREATMENT • Embolectomy • Intra-arterial thrombolysis using fibrinolysins • Endovascular therapy
- 8. SADDLE EMBOLUS Definition • It is an embolus blocking a bifurcation of aorta CAUSES • Mural thrombus after myocardial infarction • Mitral stenosis with atrial fibrillation • Aortic aneurysm
- 9. CLINICALFEATURES • Sudden,Rapidlyprogressive ischaemiain bothlower limbs • Gangrene of both lower limbs • Features of associated infection INVESTIGATION • Arterial Doppler • Aortic Angiogram • Ultrasound-Abdomen TREATMENT • Embolectomy by using Fogarty’s Catheter • Open arteriotomy& embolectomy can be tried • AntibioticProphylaxis – to prevent infection
- 10. EMBOLECTOMY 1.INTERVENTIONAL METHOD by using Fogarty’s Catheter Intraoperative arteriogramafter embolectomy to confirmadequacy of blood flow 2.OPENARTERIOTOMY METHOD – done directlyover the arteryfollowedby suturing the artery COMPLICATIONS • Bleeding • Sepsis • Thrombosis • Narrowing • Incomplete removal
- 11. FAT EMBOLISM • It is observedafter intramedullarynailing, liposuction, joint reconstruction, parenteral lipid infusion, cardiopulmonary bypass, and pathological fractures. • Fat globules release fatty acids whichact as toxins. CLINICALFEATURES • PULMONARY • Cyanosis, • tachypnoea, • rightheart failure, • froth in mouthand nostrils, • CUTANEOUS • Petechial haemorrhages • Cerebral • Drowsy, restlessness& coma. • KIDNEY • fat droplets in urine.
- 12. INVESTIGATION • Presence of fat lobules in pulmonary capillary • Chest Xray shows snow stormappearance. • Transesophageal echocardiography TREATMENT • Adequate oxygenation with ventilator support (ICUcare). • Hydration, • nutrition, • prevention of DVT AIR/GASEMBOLISM CAUSES • venous access likeIV cannula • artificial pneumothorax. • surgeries of neck and axilla. • Traumatic opening of major veins causing embolism. • During fallopian tube insufflation • laparoscopic surgeries. • During illegal abortion.
- 13. Pathogenesis • amount of air requiredto cause air embolismis 50ml • When air enters the right atrium ↓ gets churnedup forming a foam ↓ whichenters rightventricle - & blocks pulmonaryartery • Mill –Wheel Murmur heardover the precordium through a stethescope CLINICALFEATURES • respiratory distress, • Haemoptysis • Convulsions • unconsciousness, • visual and hearing disturbances, • fatigue and numbness, • paralysis, • coma
- 14. TREAMENT • Patient is placed in Trendelenburg position • By placing a needle, the air has to be aspiratedfromthe rightventricle • Thoracotomy is requiredto aspiratethe excess air causing the block REFERENCE 1. SRB's Manual of Surgery by SriramBhatM 2. A Manual on Clinical Surgeryby Das 3. A Concise textbookof Surgeryby Das
- 15. A Special Thanks To A Very Special Doctor