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-
1. It is the mass
detached from the
origin.
2. Lodging in some other
area of the part.
THROMBUS-
I. It is solid mass
formed in the
circulation.
II. It blocks that part were
formed.
5.
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 thrombus 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
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.ECGmost 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.
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.
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.
