Embolism

Description:

Embolism — acute obstruction of a vessel with disturbance of blood supply of fabric or body as a result of transfer by a blood flow of various substrates (emboluses) which are not found normal. The thromboembolism which usually arises at venous thrombosis is more often noted. The come-off part of blood clot (mainly from veins of the lower extremity, a basin) is carried away through the right half of heart in pulmonary vessels. Depending on caliber of an obturirovanny vessel and local conditions of blood circulation formation of a heart attack of a lung is possible, and at obstruction of a pulmonary trunk or the main pulmonary arteries quickly (in a few minutes) there comes death (see the Thromboembolism of pulmonary arteries). Besides, the bacterial, air, fatty embolism and some other can be observed. Distinguish a vascular embolism of a small and big circle of blood circulation.

Embolism symptoms:

Bacterial embolism — a heavy complication of purulent inflammatory process of any localization. As a result of obstruction of vessels microorganisms or fragments of the blood clot which underwent purulent fusion form metastatic suppurative focuses in various bodies). The air embolism (aeroembolism) develops as a result of hit in an air blood stream at wounds of jugular or subclavial veins, accidental hit of air in a vein at non-compliance with rules of intravenous injections, an open injury of sine of a firm meninx, injury of a lung by a blast shock wave. A fatty embolism — obturation of small vessels of internals drops of neutral fat; meets mainly at the closed fractures of long tubular bones, multiple fractures of edges and pelvic bones, heavy burns, an electric trauma and extensive damages of soft tissues crush of hypodermic cellulose. The fatty embolism at osteomyelitis, acute pancreatitis, a diabetes mellitus, fatty dystrophy of a liver, injections of Solutio oleosa of medicines is possible or in cases of non-compliance with rules of introduction of the fatty emulsions applied to parenteral food.

At an arterial embolism there is an obstruction of vessels of various internals. The blood clots formed on shutters of mitral or aortal valves of heart at an endocarditis are the main source of arterial emboluses. The arterial embolus can obturirovat. brain vessels, coronal arteries of heart, upper mesenteric, ileal or femoral arteries that is shown respectively by symptoms of disturbance of cerebral circulation, a myocardial infarction, acute impassability of intestines, disturbance of blood supply of the lower extremity (pains, blanching, disappearance of pulse and other symptoms of ischemia up to a gangrenosis).

The massive air embolism constitutes serious danger — filling of the right half of heart air and the made foam blood causes an acute hypoxia and can lead to a lethal outcome. At receipt the multiple embolism of small pulmonary vessels with short wind, cyanosis, an acute heart failure develops in a blood stream of smaller amount of air. A part of vials of air can pass through vessels of lungs in a big circle of blood circulation and cause an embolism of coronal arteries of heart or vessels of a brain. Acute management consists in the termination of access of air to a vein.

The clinical picture of a fatty embolism of pulmonary arteries is characterized by short wind, cough, cyanosis, a resistant hyperthermia with the increased sweating, dot hemorrhages on skin, most often at the neck basis, in axillary poles, on a conjunctiva of a lower eyelid and mucous membrane of a mouth; the progressing decrease in level of hemoglobin, number of erythrocytes and thrombocytes expressed by a leukocytosis with a deviation to the left and increase in SOE, a hamaturia. Special value in diagnosis of a fatty embolism has existence of a so-called light interval. At the same time symptoms of an embolism can be found only in several hours and even days after an injury. The massive fatty embolism of pulmonary arteries can lead to death. At a small fatty embolism the forecast in most cases favorable. Prevention of a fatty embolism is the careful immobilization at changes.

Embolism reasons:

The embolism on character of the object causing it is subdivided as follows:
embolism solid particles (fabrics, microbes, parasites, foreign bodys);
fabric and fatty embolism meet preferential at extensive and severe injuries, fractures of long tubular bones etc.;
embolism liquids (amniotic waters, fat);
the embolism gases (in more special case an air embolism) occurs at open heart operations, wounds of large veins of a neck and thorax, and also decompressive diseases;
the bacterial embolism is connected by obstruction of vessels accumulations of microbes;
the embolism foreign bodys, generally small splinters at gunshot wounds, quite often has retrograde character;
the embolism caused by the come-off blood clot or its part — a clotting disease — has the greatest practical value. Blood clots or their parts (tromboembola) from peripheral veins settle, as a rule, in the pool of a pulmonary artery. In arteries of a big circle the embolism is usually caused by a separation of trombotichesky imposings on valves or walls of the left half of heart (at endocarditises, heart diseases, aneurism of a left ventricle);
the medicamentous embolism can occur at an injection of Solutio oleosa subcutaneously or intramusculary at accidental hit of a needle in a vessel. The oil which appeared in an artery corks it that leads to disturbance of food of surrounding fabrics and a necrosis.

Treatment of the Embolism:

Having heard a prisasyvayushchy sound in a wound, it is necessary to clamp immediately it fingers, to low lower an upper half of a body of the wounded, to apply a dense compressing bandage and to bring the victim in a hospital on a stretcher with the lifted foot end. If the air embolism occurred in the operating room, the patient is immediately transferred to the provision of Trendelenburga. Further treatment includes ensuring the most strict rest, oxygen inhalation. The major action at an air embolism is aspiration of air from a right ventricle (by means of its puncture) or the right auricle (through the catheter entered into a vein) in the conditions of artificial ventilation of the lungs. At all types of an air embolism hyperbaric oxygenation is shown. The air embolism which did not cause bystry death to a thicket terminates in recovery as gases of air are gradually dissolved in blood. Special type of an air embolism — the gas embolism caused by vesiculation of gas in the blood under the influence of considerable sudden decrease in atmospheric pressure.