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EMBOLISM
EMBOLISM is a very common cause of sudden death that is misdiagnosed. Embolus is a free mass in the
blood which can occlude any vessel at any time. The mass which is called a thrombus may be column of
air or foreign body or fat globule...Etc. If it occludes an artery it will lead to tissue necrosis. If occlude a
vein leading to tissue congestion and disturbance in organ function. Death occur suddenly due to right
sided heart failure in general venous air embolism in arterial air embolism death due to migration of
embolus to left ventricle to many organs (brain is fatal).diagnosis in most cases is lost. But we have
certain investigation that is should be done e.g. ECG. Lines of treatment depend on the nature of the
embolus but always thrombolytic embolus is the only one under control.
Pa g e 2 o f 6 EMBOLISM Mohammed A. Ghanem
INTRODUCTION
Embolism: an embolism occurs when an object migrates from one part of the body and causes
a blockage of a blood vessel in another part of the body. We will discuss its causes &
Pathophysiology then its treatment & investigation. But unfortunately it is always fatal.
CLASSIFICATION
MA T E RI A L :
P A T H WA Y :
This is when a part of a blood clot (thrombus) blocks blood flow to a major organ such as
the heart or lungs. It’s the most common type of embolism.
Pa g e 3 o f 6 EMBOLISM Mohammed A. Ghanem
Endogenous :
1. The fracture of tubular bones (such as the femur), which will lead to the
leakage of fat tissue within the bone marrow into ruptured vessels.
2. Trauma of burns of a fatty area.
Exogenous: (from sources of external origin) causes such as intravenous
injection of emulsions.
the rupture of alveoli, and inhaled air can be leaked into the blood vessels.
the puncture of the subclavian vein by accident or during operation where there
is negative pressure.
Air is then sucked into the veins by the negative pressure caused by thoracic
expansion during the inhalation phase of respiration.
Intravenous therapy, when air is leaked into the system (however this iatrogenic
error in modern medicine is extremely rare).
Gas embolism is a common concern for deep-sea divers because the gases
in our blood (usually nitrogen and helium) can be easily dissolved at higher
amounts during the descent into deep sea. However, when the diver ascends to
the normal atmospheric pressure, the gases become insoluble, causing the
formation of small bubbles in the blood. This is also known as decompression
sickness or the Bends.
D. Septic embolism happens when a purulent tissue (pus-containing tissue) is dislodged from
its original focus.
B. Brain embolism : Cerebral embolism (intracranial embolism). One of the most common causes
of a stroke. It occurs when an embolus (usually a blood clot) becomes lodged in an artery in the
brain, blocking oxygen-rich blood from nourishing the portion of the brain beyond the blocked artery.
Without adequate oxygen, that area of the brain suffers tissue damage or death, causing typical
stroke symptoms such as speech impairment, one-sided paralysis, or problems with comprehension
or vision (depending on which portion of the brain was damaged).
C. Therapeutic embolism (embolization ): The deliberate creation of an embolus to
obstruct a blood vessel in order to stop internal bleeding or to cut off the blood supply to a tumor.
Pa g e 5 o f 6 EMBOLISM Mohammed A. Ghanem
These man-made emboli can be made of many different materials, such as fibrin, metal coils,
silicone balloons, wool or medicinal glue.
D. Paradoxical embolism . The result of an embolus that has traveled from the veins to the
arteries to the brain (where it blocks a cerebral artery), or any other systemic artery. The embolism is
“paradoxical” (contrary to the usual) because normally blood cannot travel from a vein into an artery.
The condition can occur when an embolus crosses from the right side of the heart to the left side
through a hole in the septum (the muscular wall that separates the left and right sides of the heart).
The hole is usually the result of an unrepaired congenital heart defect (e.g., patent foramen ovale,
atrial septal defect, ventricular septal defect).
E. Fat embolism , which can occur around 48 hours after a major bone fracture, include:
Confusion, rash, sleepiness, rapid heart beat, breathlessness, and bluish tint to the skin (cyanosis).
F. Air embolism is a life-threatening emergency that will lead to the heart’s stopping (cardiac
arrest) and sudden cardiac death if not treated immediately. A major cause of air embolisms are
rapid ascents during deep-water dives. Symptoms usually appear very quickly after the ascent and
may include: Dizziness Bloody froth from nose or mouth Paralysis Convulsions
TREATMENT OF EMBOLISM
Arterial embolism requires prompt treatment at a hospital. The goals of treatment are to control
symptoms and to improve the interrupted blood flow to the affected area of the body. The cause
of the clot, if found, should be treated to prevent further problems.
Medications include:
Anticoagulants (such as warfarin or heparin) can prevent new clots from forming
Antiplatelet medications (such as aspirin, ticlopidine, and clopidogrel) can prevent
new clots from forming
Painkillers given through a vein (by IV)
Thrombolytics (such as streptokinase) can dissolve clots
EMBOLISM is a very common cause of sudden death that is misdiagnosed. Embolus is a free mass in the
blood which can occlude any vessel at any time. The mass which is called a thrombus may be column of
air or foreign body or fat globule...Etc. If it occludes an artery it will lead to tissue necrosis. If occlude a
vein leading to tissue congestion and disturbance in organ function. Death occur suddenly due to right
sided heart failure in general venous air embolism in arterial air embolism death due to migration of
embolus to left ventricle to many organs (brain is fatal).diagnosis in most cases is lost. But we have
certain investigation that is should be done e.g. ECG. Lines of treatment depend on the nature of the
embolus but always thrombolytic embolus is the only one under control.
REFERENCES
1. NHS. http://www.nhsdirect.nhs.uk/index.aspx?WT.svl=nav Title: Embolism
2. Principles of forensic medicine stuff members of forensic medicine & clinical toxicology
department Ain Shams University.