Monday, June 22, 2020

Lower limb edema

Mr. Fei has been engaged in office desk work for a long time, and often takes a meeting in Economy Class to become a "flying trapeze". A long-distance journey takes more than ten hours. After a long flight, I felt backache and right lower extremity swelling and pain. By the way, I massaged my lower extremities. During the massage, Mr. Fei suddenly felt suffocated, chest tightness, black eyes, and urgent medical treatment, only to find that deep vein thrombosis of the lower extremity caused pulmonary embolism.

We know that after the arteries send blood to the whole body, they go back to the heart through the venous system, then through the pulmonary arteries to reach the lungs, exchange gas, and then return to the left heart, and then sent to the whole body by the arteries to complete the blood circulation.

You are smart, you can see that the "deep vein thrombosis in the lower extremity caused a pulmonary embolism" means that the thrombus in the deep vein of the lower extremity fell off and followed the blood flow to the pulmonary artery and blocked the pulmonary artery. This is the lung. embolism. Deep vein thrombosis is the main source of thrombosis that causes pulmonary thromboembolism. Deep vein thrombosis mostly occurs in the lower extremities or deep pelvic veins. Fat embolism, amniotic fluid embolism, and air embolism are also caused by pulmonary embolism. For Fei, lower limb massage is an important trigger.

According to the above blood circulation pathway, once the pulmonary artery is blocked, the blood cannot or rarely pass through the lungs, and there is less blood for gas exchange, so that we feel chest tightness, breathing hard, and respiratory failure in severe cases. At the same time, the pulmonary artery is the outlet of the right ventricle. The outlet is blocked. Whether it is completely blocked or half blocked, the heart has to work hard to overcome this difficulty. The right ventricle of helplessness is "weak but can't help but wind". At this time, the small horse-drawn cart is very difficult. It is very likely to be involved in proneness (acute right heart failure), and the other half (acute left heart failure, cardiogenic) shock). Therefore, the consequences are still very serious. Serious cases may be too late to reach the hospital, or the diagnosis and start of treatment may have serious consequences.

There are many risk factors. Venous thrombosis is the result of the interaction between the patient's own risk factors and environmental risk factors. The patient's own risk factors usually exist for a long time, and the environmental risk factors are mostly temporary. Patient risk factors include age, previous history of venous thromboembolism, tumors, neurological diseases accompanied by limb paralysis, diseases causing long-term bed rest such as heart failure, respiratory failure, and primary or secondary thrombosis tendency, hormone replacement therapy , Oral contraceptives, etc. Environmentally relevant risk factors include fractures, hip or knee replacements, major surgical procedures, severe trauma, spinal cord injury, etc.

Examination of the lower extremities revealed that the circumference of one thigh or lower leg increased by more than 1 cm compared to the opposite side, or varicose veins of the lower extremities, and venous thrombosis of the lower extremities should be highly suspected. Pulmonary embolism is a common complication of venous thrombosis of the lower extremities. Larger emboli can stay at the bifurcation of the pulmonary aorta or lobe artery, leading to large-area pulmonary embolism, which can cause dyspnea, cyanosis, fainting, sudden death, etc. The condition is acute, severe, and the mortality rate is high. Smaller emboli can reach the distal end of pulmonary blood vessels, causing small areas of pulmonary embolism, which may be free of any clinical symptoms, and the condition is mild and hidden. Pulmonary embolism is lacking in specificity. Chest tightness, chest pain, palpitation, shortness of breath, difficulty breathing and other symptoms are extremely easy to miss or misdiagnose.

The contraction of the calf muscles of the elderly is weakened, and blood is easily stagnation in the veins of the lower extremities, so the incidence of venous thrombosis of the lower extremities is higher than that of the young. People who stay in bed for a long time, sit in the office or travel for a long time have varying degrees of venous blood flow in the lower extremities. When the blood flow of the lower extremities is slow, the blood is likely to coagulate in the blood vessels, forming venous thrombosis, and swelling and pain in the lower extremities . At this time, improper massage of the lower limbs may squeeze the blood clot formed in the veins of the lower limbs. The blood clot reaches the pulmonary artery with the blood flow, blocking the pulmonary artery and its branches, forming a pulmonary embolism. Because about 80% of the deep vein thrombosis has no obvious symptoms in the early stage of the onset, only the symptoms of lower extremity swelling, swelling, and pain will appear at the time of the attack, so it often fails to attract enough attention from the patient. Pay more attention in daily work and life. If you have to sit for a long time or lie down for a long time, try to do some leg exercises to keep blood circulation smooth and avoid thrombosis.

In addition, there are many causes of edema, such as physiological edema, pathological edema, and pathological edema can be divided into cardiogenic edema, renal edema, hepatic edema, etc. The pathogenesis of various edemas is different, and the performance is different. The treatment methods are not the same, it is recommended to go to the hospital for routine diagnosis of hematuria, B-ultrasound or CT.

It can be seen that the legs are swollen and can not be massaged casually. If swelling and pain in the lower extremities occur, blind massage should be avoided, otherwise the thrombus will loosen and fall off, causing disastrous consequences. Must be vigilant, go to the hospital to do the corresponding examination in time, and diagnose and treat as soon as possible.

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