Treatment embolism

Treatment of thromboembolism not depend on localization in the first hours of the disease, when the clinical picture is largely determined by the concomitant reflex arterial spasm, and must start with a complex conservative therapy. The latter is aimed at the elimination of pain, and reduction of arterial spasm, halting continued clot, lizirovania (if possible) of the pitch and already formed a secondary clot, improving metabolic processes in ischemic tissues. This is achieved by using a combination analgesics, vasodilators (papaverine, no-Spa, Penywern, bevelen), various types of procaine blockades (mostly sympathetic, direct action anticoagulant (heparin) and fibrinolytic drugs. The effect of conservative treatment depends in most cases from the General condition of the patient, old embolism, the nature of the pitch, its localization and adequacy of therapy.
The maximum therapeutic effect was possible only at early stages of treatment (the first minutes and hours of the disease) and optimal dose of anticoagulant and fibrinolytic drugs (heparin 40 000-120 000 IU a day, fibrinolizin 30 000-60 000 UNITS, streptokinase 250 000-750 000 UNITS, thrombolysis 350-450 mg).
In each case, in violation of the General condition of the patient is appropriate symptomatic therapy.
Successive conservative treatment is the method of choice when embolic stroke (embolectomy possible only in case of acute occlusion of the common carotid artery and domestic branches in extracranial of the last), splenic embolization, liver and in most cases, the renal arteries. Reconstructive surgery with the defeat of arteries of the kidney shown only in the absence of the effect of conservative treatment against uncompensated forms hypertensive syndrome or growing renal failure (with bilateral lesions).
When embolism mezenterialnah arteries and the absence of bowel necrosis shows embolectomy, when conducting operations in the stage of peritonitis and segmental osteonecrosis of the intestine produces a wide resection last in healthy tissues.
Treatment of fat embolism has goals: cessation of the further receipt of fat from hematoma, dissolution of fat droplets, caught in the vessels, the prevention of the spread of fat emboli in the systemic circulation. Accordingly shown: strict calm, careful (but without attempts reposition!) immobilization of fractures, with a large hematoma - emptying her puncture, subcutaneous injection of ethyl ether (2-3 ml 3-4 times per day), drugs (for the suppression kashlevogo reflex). In addition, when the pulmonary form recommended bloodletting (500 ml), inhalation of oxygen. According to testimony - heart funds.
Treatment of air embolism. In a massive flow of air in a large vein of gaping combat or accidental wounds wounded usually die before they have assistance. Effective measures, as a rule, is only possible with the entry of air into the vein on the operating table. In these cases, barely heard the distinctive sound of suction, need, without hesitating a second, hold the wounded finger vein and immediately impose elastic clip on her discharge end. Recommend then compress the chest of the patient on the exhale and avoid inhalation, remove the clip, enter veins aspirator tip in the direction of the heart, to suck out the air and foam blood, and put the clip. This recommendation justified only in the case if the surgeon will have time to do it at the first after sucked in a breath.
Later the reception becomes useless as air manages to move far and either determined that the occurrence did not cause immediate threatening disorders or severe pattern of obstruction of the right heart and pulmonary trunk.
Another recommendation is immediately simultaneously with pressing Vienna, put the patient in the Trendelenburg position is not applicable when the injured system top Vena cava, as of or jugular, subclavian vein air position will "float" in the direction of the heart, and not Vice versa; but for the prevention of air embolism during operations on the neck and to the supraclavicular area Trendelenburg position is reasonable, because when it increased venous pressure. If the air entrainment discontinued, and serious disorders not followed, continue the operation, leaving Vienna soft clip to the imposition on it of ligatures or vascular suture. Otherwise, trying to suck air through a puncture of the right ventricle or by catheterization (see Heart, functional diagnostics).
Shows your open heart massage, blood transfusions, with simultaneous introduction it directly into the left ventricle. Apparently, in appropriate cases and in the presence of the laboratory of artificial blood circulation in the clinic in air embolism can be used AIK. Data of this kind are known cardiac surgeons.
All this with a massive embolism may not give effect. When as if successfully held the air entrainment the patient shows strictest peace; intravenous transfusion of blood in the first day is highly undesirable - only at an alarming degree of bleeding it can be applied drip method.