Pulmonary embolism (pulmonary embolism) is an acute blockage of the main trunk or branches of the pulmonary artery with an embolus (thrombus) or other objects (fat droplets, bone marrow particles, tumor cells, air, catheter fragments), leading to a sharp decrease in pulmonary blood flow.
Pulmonary thromboembolism, causes, symptoms, first aid for pulmonary thromboembolism.
It has been established that the source of venous embolus in 85% of cases is the system of the superior vena cava and the veins of the lower extremities and the pelvis, and much less often the right heart and veins of the upper extremities. In 80–90% of cases, hereditary and acquired factors predisposing to pulmonary embolism are revealed in patients. Hereditary predisposing factors are associated with a mutation in a particular chromosome locus. Congenital predisposition may be suspected if unexplained thrombosis occurs before the age of 40 years in the presence of a similar situation in close relatives.
bones, paralyzed limbs.
3. Prolonged bed rest, for example, with myocardial infarction, stroke.
4. Malignant neoplasms. Most often, pulmonary embolism occurs with cancer of the pancreas, lungs, stomach.
5. Surgical interventions on the organs of the abdominal cavity and pelvis, lower limbs. The postoperative period is especially insidious with its thromboembolic complications due to the use of a permanent catheter in the central vein.
6. Taking certain medications: oral contraceptives, diuretics in high doses, hormone replacement therapy. Uncontrolled use of diuretics and laxatives causes dehydration, blood clotting and significantly increases the risk of thrombosis.
7. Pregnancy, operative delivery.
9. Thrombophilic conditions are pathological conditions associated with the tendency of the body to form blood clots inside the vessels, which is caused by disorders of the coagulation system of the blood. There are congenital and acquired thrombophilic conditions.
10. Antiphospholipid syndrome is a symptom complex characterized by the appearance in the body of specific antibodies to phospholipids, which are an integral part of cell membranes, their own platelets, endothelial cells, and nervous tissue. As a result of the cascade of autoimmune reactions, these cells are destroyed and biologically active agents are released, which, in turn, is the basis of pathological thrombosis of various localization.
12. Systemic diseases of the connective tissue: systemic vasculitis, systemic lupus erythematosus and others.
Symptoms of Pulmonary Thromboembolism.
Acute shortness of breath, rapid heartbeat, drop in blood pressure, chest pain in people with risk factors for thromboembolism and manifestations of venous thrombosis of the lower extremities make TEL suspect. The main sign of pulmonary embolism is shortness of breath. It is characterized by a sudden onset and a varying degree of severity: from lack of air to noticeable suffocation with a blue skin. In most cases, this is a “quiet” shortness of breath without noisy breathing. Patients prefer to be in a horizontal position, do not look for a comfortable position.
Pain in the chest is the second most common symptom of pulmonary embolism. The duration of an attack of pain can be from several minutes to several hours. With embolism of small branches of the pulmonary artery, the pain syndrome can be absent or not expressed. Nevertheless, the dependence of the intensity of the pain syndrome on the caliber of the clogged vessel is not always traced. Sometimes small vessel thrombosis can produce a heart attack pain syndrome. If pleura is involved in the pathological process, pleural pain occurs: stitching associated with breathing, coughing, body movements.
Often there is an abdominal syndrome, caused, on the one hand, by right ventricular heart failure, and on the other, by reflex irritation of the peritoneum with the involvement of the phrenic nerve. Abdominal syndrome is manifested by diffuse or clearly defined pains in the liver area (in the right hypochondrium), nausea, vomiting, belching, bloating.
A cough appears 2-3 days after the occurrence of pulmonary embolism. It is a sign of heart attack pneumonia. In 25-30% of patients, bloody sputum discharge is observed. Important is the increase in body temperature. Usually it grows from the first hours of the disease and reaches subfebrile numbers (up to 38 degrees). When examining a patient, the cyanosis of the skin is evident.
Most often, cyanotic skin has an ashy shade, but with massive PE, the effect of a “cast-iron” color appears on the face, neck, and upper body. In addition, pulmonary thromboembolism is always accompanied by cardiac abnormalities. In addition to increased heart rate, signs of right ventricular heart failure appear: swelling and pulsation of the cervical veins, heaviness and pain in the right hypochondrium, pulsation in the epigastric region.
With previous pulmonary embolism, thrombosis of the veins of the lower extremities, pain in the foot and lower leg areas first appears, increasing with movement in the ankle joint and walking, pain in the calf muscles with dorsiflexion of the foot. Pain is noted when palpating the tibia along the affected vein, visible edema or asymmetry of the circumference of the tibia (more than 1 cm) or hips (more than 1.5 cm) at a level of 15 cm above the patella.
First aid for pulmonary embolism.
It is necessary to call an ambulance. It is necessary to help the patient to take a sitting position or lay him with his head raised, loosen tight clothing, remove dentures, provide access to fresh air. If possible, the patient should be reassured, not allowed to eat or drink, not left alone. With severe pain, narcotic analgesics are shown, which also further reduce shortness of breath.
The optimal drug is a 1% solution of morphine hydrochloride. 1 ml should be diluted to 20 ml with isotonic sodium chloride solution. With this dilution, 1 ml of the resulting solution contains 0.5 mg of the active substance. The drug is administered at 2–5 mg with an interval of 5–15 minutes. If intense pain syndrome is combined with severe psychoemotional agitation of the patient, then neuroleptanalgesia can be used – 1-2 ml of a 0.005% solution of fentanyl is administered in combination with 2 ml of a 0.25% droperidol solution.
A contraindication to antipsychotics is a decrease in blood pressure. If the pain syndrome is not expressed and the pain is associated with breathing, coughing, changes in body position, which is a sign of infarction pneumonia, then it is more advisable to use non-narcotic analgesics: 2 ml of a 50% solution of sodium metamizole or 1 ml (30 mg) of ketorolac.
If pulmonary embolism is suspected, anticoagulant therapy should be started as soon as possible, since the patient’s life directly depends on this. At the prehospital stage, 10,000–15,000 units of heparin are simultaneously administered intravenously. Contraindications for the appointment of anticoagulant therapy for pulmonary embolism are active bleeding, the risk of life-threatening bleeding, the presence of complications of anticoagulant therapy, the planned intensive chemotherapy. With a decrease in blood pressure, a drop infusion of reopoliglukin is indicated (400.0 ml intravenously slowly).
In the event of a shock condition, pressor amines (1 ml of a 0.2% solution of norepinephrine bitartrate) are necessary under the control of blood pressure every minute. With severe right ventricular heart failure, dopamine is prescribed intravenously at a dosage of 100–250 mg / kg body weight / min. With severe acute respiratory failure, oxygen therapy, bronchodilators are required.
5 ml of a 2.4% solution of aminophylline intravenously slowly, carefully prescribed at an arterial pressure below 100 mm Hg. Art. Antiarrhythmic drugs are administered as indicated. In the event of cardiac arrest and breathing, immediately proceed with creation measures..
Based on the book “Quick help in emergency situations”.