Bismillahirahmanirahim , Today I have
been asked by one of my patient , he is worried regarding his fracture can
cause Pulmonary embolism , I have explain to him it is prevented case if we
take it seriously and understand our body condition.
·
Pulmonary embolism is a condition that occurs
when an artery in lung becomes blocked. In most cases, the blockage is caused
by one or more blood clots that travel to lungs from another part of your body.
·
Most clots originate in legs, but they can also
form in arm veins, the right side of your heart or even at the tip of a
catheter placed in a vein.
·
In most cases, a pulmonary embolism isn't fatal.
Still, pulmonary embolism is a leading cause of hospital deaths and an
increasing threat to passengers on long airplane flights. when pulmonary
embolism does occur, treatment with anti-clotting medications can greatly
reduce the risk of death
CAUSES
·
Human body have two lungs, one on each side of
heart. Blood is constantly being pumped from the right side of heart to the
lungs and back to the left side of your heart. In lungs, blood picks up oxygen
and releases carbon dioxide, a waste product of metabolism. Blood vessels
called arteries take the oxygen-rich blood to tissues throughout body, and
veins bring oxygen-poor blood back to the heart. Capillaries — the smallest
blood vessels — connect the veins and arteries.
·
Clots that form in the veins throughout body can
dislodge, travel through the bloodstream to the right side of the heart, and
then enter the pulmonary arteries, where they may cause a blockage. A blockage
can occur in any small artery. Most often, a number of clots will shower your
lungs during an episode of pulmonary embolism; it's unusual for just one clot
to take place
UNDERSTANDING BLOOD CLOT
·
A blood clot is a plug of platelets — colorless
blood cells that repair injured blood vessels — enmeshed in a network of red
blood cells and fibrin, a type of protein. Clots normally develop to help stop
bleeding after being cut or injured, but sometimes clots form for no apparent
reason
·
A blood clot that forms and remains in a vein is
called a thrombus. A clot that travels to another part of your body is an
embolus. Occasionally other substances, such as pieces of a tumor, globules of
fat from fractured bones or air bubbles, may enter the bloodstream and become
an embolus that blocks arteries
·
Most clots that cause problems originate in a
vein in leg or pelvis. The affected vein may be near the surface of skin
(superficial thrombosis) or deep within a muscle (deep vein thrombosis, or
DVT). Clots in superficial veins usually aren't serious and often clear on
their own. But clots in the deep veins may detach and migrate through bloodstream to lungs
Illustration of Blood clot for example review |
FACTOR INVOLVE IN CLOT FORMATION
SURGERY.
·
especially operations to replace major joints,
such as the hip and knee.
LONG PERIODS OF INACTIVITY.
·
Inactivity caused by prolonged bed rest (exp
after surgery, heart attack or serious injury) or long plane or car trips that
decreases blood flow in veins, making clots more likely.
·
In recent years, attention has also focused on
the increasing incidence of deep vein thrombosis and pulmonary embolism among
otherwise healthy travelers on long plane trips. Cramped seats with little
legroom have contributed to the problem - deep vein thrombosis and is sometimes
referred as "economy class syndrome." Not everyone who has DVT goes
on to develop pulmonary embolism, however. For many people, the DVT causes few
symptoms and is diagnosed long after the episode has passed.
INCREASED LEVELS OF CLOTTING FACTORS IN THE BLOOD
·
-Some types of cancer, especially pancreatic,
lung and ovarian cancers, cause increased blood levels of procoagulants —
substances that contribute to blood clotting. The female hormone estrogen found
in birth control pills and hormone therapy (HT) also increases the amount of
clotting factors in the blood
CERTAIN MEDICAL CONDITIONS
·
-People who have cardiovascular disease
associated with clot formation, such as heart attack (myocardial infarction) or
stroke, are more likely to develop blood clots in their veins
INJURY TO THE VEINS.
·
-occur during certain surgical procedures,
especially hip surgery or knee replacement. It may also result from direct
injuries to the legs or from leg or pelvic fractures.
SIGNS AND SYMPTOMS
·
Common signs and symptoms include:
·
Sudden shortness of breath, either when in
active or at rest.
·
Chest pain that often mimics a heart attack. The
pain can occur anywhere in chest and may radiate to shoulder, arm, neck or jaw.
It may be sharp and stabbing or aching and dull and may become worse when you
breathe deeply (pleurisy), cough, eat and bend. The pain will get worse with
exertion but won't go away when you rest.
·
cough that produces bloody or blood-streaked
sputum.
·
Rapid heartbeat (tachycardia).
·
Pt may have stable vital signs (BP, HR, RR,
SPO²) but frequently present with elevated HR. Severe PE can present with shock
( low BP) or cardiac arrest, particularly when large clot blocks blood outflow
from Rt side of the heart to lungs. In many case, HR and RR elevated to
compensate.
·
SPO² may decreased
OTHER SIGNS AND SYMPTOMS THAT CAN
OCCUR WITH PE INCLUDE
·
Wheezing
·
Leg swelling
·
Clammy or bluish-colored skin
·
Excessive sweating
·
Anxiety
·
Weak pulse
·
Light headedness or fainting (syncope)
·
Fever
IN COME CASES, PE PRESENT WITH
·
Sudden death, where pt collapse, stops breathing
and heart stop beating (cardiac arrest).
RISK FACTOR
1.
Inactivity
- prolonged sitting in a cramped position during lengthy plane or car trips
increase risk.
2.
Prolonged
bed rest-Being confined to bed for an extended period after surgery, a
heart attack, leg fracture or any serious illness makes it more vulnerable to
blood clots.
3.
Certain
surgical procedures-Especially likely to cause blood clots are hip, pelvic
and knee surgeries as well as some obstetric or gynecologic procedures
4.
Some
medical conditions- - Certain cancers, especially pancreatic, ovarian and
lung cancers can increase levels of substances that help blood clot, and
chemotherapy further increases the risk. Women with a history of breast cancer
who are taking tamoxifen or raloxifene also are at risk. High blood pressure
and cardiovascular disease make clot formation more likely, as does having an
inflammatory bowel disease such as ulcerative colitis or Crohn's disease.
5.
Being
overweight-- one theory links the formation of clots to leptin, a hormone
produced by fat cells in the body. People who are overweight have more leptin-
so may be more prone to develop clots
6.
Pacemakers
or venous catheters- Having a
pacemaker or catheter — a soft, flexible tube — in a central vein makes the
formation of clots more likely in that vein.
7.
Pregnancy
and childbirth
- Some women who have pregnancy-related venous thromboembolism also have
an inherited clotting disorder.
8.
Supplemental
estrogen. - The estrogen in
birth control and in hormone replacement therapy can increase clotting factors
in blood, especially if smoking or overweight
9.
Family
history.
- Having a personal or family history of venous thromboembolism increases
the risk of blood clots.
10.
Smoking
tobacco use predisposes some people to blood clot formation, especially
when combined with other risk factors.
COMPLICATION
High blood pressure in your lungs
(pulmonary hypertension)
- occurs when a large number of clots obstruct blood flow in the blood
vessels in lungs for months or years, making the right side of heart work hard
against great resistance.
- most common symptoms of
pulmonary hypertension are breathlessness (dyspnea) when you exert yourself and
general fatigue. Fainting, dizziness, swollen legs or ankles, and pressure or
pain in chest also are common when pulmonary hypertension becomes severe.
Heart damage.
In a condition called cor pulmonale, the lower right pumping chamber of
heart (right ventricle) becomes enlarged and eventually fails as a result of
problems in your lungs.
So this is the info regarding a pulmonary embolisme , the cause , effect
and what is the symptom of this problem I have explain in this blog , insha
Allah for my next entry I will share with all og you how to diagnoses and
prevention measurement for this problem .Wallahuaklam.
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