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Fat, air, pulmonary and gas embolism

What is embolism?

Embolism – pathology exclusively, arterial vasculature, which is based on the overlap of its lumen at a certain level with partial or complete cessation of blood flow caused by factors not related to pathology of the affected vessel. The emboli are those substances in the internal environment of the organism or the environment that block the vascular lumen. This means that:

  1. Embolism caused by penetration or migration of emboli in the artery is large or small circle of blood circulation from other areas of the vascular channel;

  2. Emboli can be of different nature: blood clots, thrombus, detached atherosclerotic plaque, fat cells and oily solutions, air;

  3. Sources of emboli can be arterial and venous vessels of any localization, as well as the heart;

  4. The diameter of the embolus determines the caliber of the artery, which it overlaps;

  5. To predict what pool of arterial vasculature fall embolus, impossible.

Pathogenesis of embolism can take place in three ways:

  1. Source of emboli are blood vessels. In this case, it affected the pool, which was broken. The clot or atherosclerotic plaque, breaking away from its place in the vessel of large diameter, become an embolus and migrates to smaller vessels in the pool of his branch;

  2. Source of emboli are venous vessels. In their role there may be a thrombus, air, fat cells. Their migration is a bit more complicated, as they first fall from the veins into the heart, whence are emitted in all directions (brain, limbs, intestines, kidneys, etc.);

  3. Source of emboli is the heart. It is usually small blood clots that are formed against the background of arrhythmia. After they break away from the usual place of localization, they migrate to any blood vessels.

Embolism is always an acute condition that requires urgent measures. The penetration of emboli in arterial vessels leads to cessation of blood flow. This can result in ischemia, which can turn into gangrene or infarction of the authority (within 6-12 hours). This feature distinguishes it fromthrombosis arteries, which is a chronic process that is compensated for the lost blood flow due to collateral (extra) vessels.


Types of embolism

The classification of the emboli based on the form of the embolus and its final localization after the cessation of migration. Principal embolism in the table.

View of the embolic origin of embolus

View of embolism on the localization of the embolus

Pulmonary embolism (embolus are blood clots in the arteries, veins and heart)

  1. Pulmonary embolism;

  2. Thromboembolism carotid arteries and their branches;

  3. Thrombosis of the subclavian arteries and its branches (upper limbs);

  4. Thrombosis of the visceral branches of the aorta (mesenteric and renal arteries);

  5. Thromboembolism of the iliac, femoral arteries and their branches (lower limbs);

  6. Concomitant multiple lesions of the arterial bed in several basins.

Air and gas embolism (emboli are formed by the ingress of air into the veins, or from the bubbles of blood gases)

Fat embolism (fat emboli are cells or substances)

From the table it becomes apparent that whatever the nature of the embolus, its final localization may be any of the blood vessels.

Fat embolism

Fat embolism occurs as a result of the penetration of the fat droplets of melted or destroyed fat cells of the body into the venous bed. This is possible with massive injuries (injuries to bones and soft tissues of the extremities, necrosis). Another source of fat embolism can be introduced intravenous fat solutions that are not designed for such mode of administration. Once in the bloodstream, fat is not able to dissolve in the blood. Post these around the arterial bed leads to accumulation of fat particles in certain places. If they become larger than the diameter of the vessel, this causes signs of impaired blood flow. Typically, fat embolism occurs relatively not difficult, as it affects the small vessels.

Air and gas embolism

Represents the overlap of the lumen of blood vessels by air bubbles or gas. This is possible with the injuries to major veins, especially in the neck. If the wound will not be closed on time, and Vienna compressed, you could end up sucked in her clearance of air, which flow of blood gets into the heart and spread all the blood pools. As for the possibility of occurrence of air embolism from entry of air into the syringe or system when performing intravenous manipulations, it is virtually not possible. For the occurrence of clinical manifestations of air embolism, its quantity should be about 20 ml.

Gas embolism occurs without violation of integrity of the blood vessels. Its origin is guilty of sharp changes in atmospheric pressure. This is possible from divers called Quezon disease. If a diver rises rapidly from a great depth, they inhaled the gas mixture does not have time to be absorbed as fast as it was at high depths. As a result, undissolved air bubbles that block the small blood vessels throughout the body.

Pulmonary embolism

One of the most frequent and formidable of embolism is pulmonary embolism. In most cases it is presented with thromboembolism. Regardless of the specific nature of the embolus, the manifestations of the disease with the defeat of vessels of a certain diameter will be identical. On this basis, pulmonary embolism klassificeret:

  1. Embolism of the Central trunk of the pulmonary artery;

  2. Embolism larger branches of the pulmonary artery;

  3. Embolism small branches of the pulmonary artery.

The most formidable is considered as the first appearance of the disease. It is connected with the possibility of reflex cardiac arrest at the time of the occurrence of embolism in the result polnocennogo reflex. This is possible only when embolism, when blood clots heart become emboli and fixed in the mouth of the pulmonary artery. Air and fat embolism lead to the defeat of only small branches of the pulmonary arteries and cause severe manifestations. With the exception of cases of massive release of small clots with a new permanent ejection from the heart. The defeat of the large branches of the pulmonary artery is often fatal due to the development of acute cardiopulmonary failure or pulmonary infarction.

Embolism of the arteries and blood vessels

The most dangerous of its species are considered to be thromboembolic diseases of arteries of the brain, intestines and kidneys. In all cases, lesions of great vessels during the short time therenecrosis of the appropriate organ (kidney infarction, gangrene of the intestine, a stroke of the brain). This will lead either to severe disability or death. Much easier flow of embolism of peripheral arteries of the limbs. Usually, they are easy to diagnose because the condition will occur very acutely and are accompanied by bright clinical picture. Timely, rapid intervention to prevent serious consequences. Otherwise, there is a gangrene of the limb.


The causes of embolism

Each of the types of embolism has its causes.

If thromboembolism:

  1. Atrial fibrillation and other cardiac arrhythmias;

  2. Myocardial infarction;

  3. Endocarditis;

  4. Aneurysm of the left ventricle;

  5. Hypercoagulability of blood;

  6. Diseases of the venous system of the pelvis and extremities (thrombophlebitis, varicose veins, post-thrombotic syndrome);

  7. Large operations on the organs of the pelvis, abdomen and limbs;

When air embolism:

  1. Traumatic injury to major veins;

  2. The bends;

  3. Gross violations equipment intravenous manipulations;

  4. Surgical intervention in gynecology breaches of their conduct, abortion, and difficult labor.

When fat embolism:

  1. Massive trauma to the extremities;

  2. Intravenous administration of fat-containing of prohibited drugs;

  3. Severe pancreatic necrosis.

The symptoms of embolism

The symptoms of embolism are well described in the table below:

Localization of embolism

Symptoms

Pulmonary artery

  1. Sudden pain behind the breastbone or in one of the halves of the thorax;

  2. Profuse sweating;

  3. A drop in blood pressure (90/50 and below);

  4. Shortness of breath and rapid breathing (more than 20);

  5. Tachycardia (more than 100) and cardiac arrhythmia;

  6. Severe weakness;

  7. Cough and hemoptysis (join later).

Carotid artery

  1. Headache;

  2. Dizziness;

  3. Violation of coordination of movements;

  4. Movement disorders by type of paresis and paralysis;

  5. Speech disorders;

  6. Dizziness.

Mesenteric artery

  1. The strongest burning pain in the abdomen;

  2. Bloody liquid stool;

  3. Bloating;

  4. Tachycardia and decrease of blood pressure;

  5. The lack of rumbling and peristalsis of the intestine;

Renal artery

  1. Pain in the projection of the affected kidney;

  2. Red color of urine;

  3. Oliguria (amount of urine below normal).

The arteries of the extremities

  1. Sudden pain at the site of localization of the embolus, which then spreads to the entire limb;

  2. The pale skin of extremities;

  3. Cold the affected segment and numbness;

  4. The impossibility of active and passive movements;

  5. Signs of gangrene (bubbles with a dark liquid, black spots).


Treatment of embolism

Because embolism refers to acute diseases, its treatment requires urgent measures. The earlier they are given, the better the prognosis. Differential treatment strategy is given in the table.

View of embolism

The complex of therapeutic measures

Thromboembolism

  1. Emergency surgery – thromboembolectomy. Shown in the early period after the occurrence of the disease (preferably 6 hours). Runs on all arteries of large and medium calibers, including the arteries of the intestine and brain. On the pulmonary and renal arteries, thromboembolectomy is almost not carried out due to technical difficulties and severity of the patients (high surgical risk). On the limbs the intervention is performed under local anesthesia and presents no difficulty. The main criterion is whether the absence of contractures of the limbs. During the procedure, the thromboembolism is extracted from the artery with a special probe Fogarty;

  2. Emergency fibrinolysis. The most common type of treatment in case of impossibility of execution of thromboembolectomy. Its focus is the dissolution of thromboembolism. For these purposes, used farmakonisi, alteplase, Arixtra;

  3. Anticoagulation – blood thinners. It is best to use regular heparin, which is later replaced by its analogs (fraksiparinom, Clexane);

  4. Improvement of rheological properties of blood and metabolic therapy for the affected tissues (reosorbilakt, refortan, trental, Actovegin, corvitin, metamax, ascorbic acid);

  5. Symptomatic events. They are aimed at maintaining the basic parameters of homeostasis – hemodynamic parameters and respiration. This introduces cardiac glycosides (strofantin, korglikon), glucocorticoid hormones (prednisone, dexamethasone), diuretics (furosemide), nitrates (nitro-MIK, isocat), aminophylline, instalatii oxygen cerebroprotector (ceraxon, piracetam, tocitem);

  6. After the relief of the critical state is assigned an adequate amount of nutrition (including parenteral), antibiotic prophylaxis of complications of an infectious nature, stress ulcers and bleeding;

Air embolism

  1. Give the lower end of the body elevated position. The head is a bit lowered;

  2. If you have installed a Central venous catheter, you should try to aspirate air with a syringe;

  3. When a progressive deteriorationthe state recommended the transfer of patients on artificial respiration and performing resuscitation;

  4. Treatment in a hyperbaric chamber and hyperbaric oxygen;

  5. Instilljatsii of oxygen;

  6. Stabilization of hemodynamic parameters and infusion therapy.

Fat embolism

  1. Stabilization of vital parameters when they are disturbed (ventilation, resuscitation);

  2. Instalatii oxygen mixture;

  3. Medications to help dissolve fat emboli (Essentiale, LIPOSTABIL, decalin);

  4. Glucocorticoid hormones (dexamethasone, hydrocortisone, prednisone);

  5. Anticoagulants (heparin, Clexane);

  6. Cardiac glycosides and other symptomatic medications, depending on the predominant clinical picture.


Prevention of embolism

Preventive measures consist of several sections.

Prevention of thromboembolism:

  1. taking anticoagulants (aspirin cardiomagnyl, warfarin);

  2. Monitoring of indicators of blood coagulation (APTT, INR, PTI), especially in patients at risk for thromboembolic complications;

  3. Timely and adequate treatment of cardiac arrhythmias;

  4. The removal of the venous pathology of the lower extremities;

  5. The installation of Vena cava filters in patients from risk groups;

  6. Elastic compression of the legs and prophylactic doses of anticoagulants in individuals at-risk who need surgical intervention;

  7. Physical and mental stress.

Prevention of air embolism:

  1. Compliance with the rules of soft lifting from high depths by divers;

  2. Correct and rapid treatment of wounds with damage to the venous vessels;

  3. Proper installation of women on the operating table during gynecologic operations, a thorough and rapid ligation of the damaged veins;

  4. Clearcompliance with technique of intravenous injection;

Prevention of fat embolism:

  1. Injury prevention;

  2. Fast and stable immobilization of the injured extremity;

  3. Early surgical intervention or other methods of reduction, leading to stabilization of the bone fragments;

  4. Compliance with the rules of intravenous drugs.