Thrombophlebitis Muskat Thrombophlebitis Muskat Hally-Project BBS
A Prospective Study of Venous Thromboembolism after Major Trauma — NEJM Thrombophlebitis Muskat
N Engl J Med ; Although deep-vein thrombosis and pulmonary embolism are considered common complications after major trauma, their frequency and the associated risk factors have not been carefully quantified. Full Text of Background We performed serial impedance plethysmography and Thrombophlebitis Muskat contrast venography to detect deep-vein thrombosis in a cohort of patients admitted to a regional trauma unit.
Prophylaxis against thromboembolism was not used. Full Text of Methods Deep-vein thrombosis in the lower extremities was found in of the patients 58 percent with adequate venographic studies, and proximal-vein thrombosis Thrombophlebitis Muskat found in 63 18 percent. Three patients died of massive pulmonary embolism before venography could be performed.
Before venography, only three of the patients with deep-vein thrombosis had clinical features suggestive of the condition. Deep-vein thrombosis was found in 65 of the patients with major injuries involving the face, chest, or abdomen 50 percent ; in 49 of the 91 patients with major head injuries 54 percent ; in 41 of the 66 Varizen Kreuzheben spinal injuries 62 percent ; and in of the with lower-extremity orthopedic injuries 69 percent.
Thrombi were detected in 61 of the patients with pelvic fractures 61 percentin 59 of the 74 with femoral fractures 80 percentand in 66 of the 86 with tibial fractures 77 percent, Thrombophlebitis Muskat. A multivariate analysis identified five independent risk factors for deep-vein thrombosis: Full Text of Results Venous thromboembolism is a common complication in patients with major trauma, and effective, safe prophylactic regimens are needed. Full Text of Discussion The care of patients with trauma places a large burden on the health care system 1,2.
Trauma is the leading cause of death in people under Thrombophlebitis Muskat age of 40 years, and the care of patients with trauma accounts for more hospital days per year than the care of patients with heart disease or cancer It is generally believed that deep-vein thrombosis and pulmonary embolism are common complications of major trauma 5,6.
However, there is a paucity of information on the epidemiology of venous thromboembolism in patients with trauma 5,6. An autopsy study found deep-vein thrombosis in 65 percent of fatally injured patients, Thrombophlebitis Muskat, and pulmonary embolism was the cause of death in 20 percent 7,8.
Several prospective studies have examined the risk of deep-vein thrombosis after trauma, although these studies have had limitations, including the Thrombophlebitis Muskat of highly selected groups of patients with trauma, failure to use a gold-standard diagnostic test for thrombosis, small samples, 10,13 and lack of detailed descriptions of patients 9,11, In view of the limited information available, our study had three objectives, Thrombophlebitis Muskat.
The first was to determine prospectively with contrast venography the frequency of deep-vein thrombosis in a broad spectrum of patients with trauma. The second objective was to determine the incidence of thrombosis in subgroups of patients according to the site of major injury or the presence of a specific injury. The third objective was to identify the characteristics of patients with trauma that may be associated with a Thrombophlebitis Muskat risk of thromboembolic complications.
The study was conducted in the Regional Trauma Unit of the Sunnybrook Health Science Centre, the largest level 1 trauma facility for adults in Canada 2, From January through Aprila cohort of patients with major trauma was prospectively evaluated with objective diagnostic testing for venous thromboembolism. The protocol was approved by the Research Ethics Board of the hospital, and patients or their surrogates were asked to provide consent for participation in the venographic component of the study.
Consecutive patients admitted to the trauma unit with an Injury Severity Score 15 of at least 9 were assessed for eligibility. A score of 9 was selected as the cutoff point to exclude patients who had only minor injuries or a moderately severe injury of a single system. Other criteria for exclusion were death or discharge Thrombophlebitis Muskat five days after the injury, a history of allergy to radiographic contrast agents, Thrombophlebitis Muskat, renal failure a serum creatinine concentration higher than 3.
The patients did not receive mechanical or pharmacologic antithrombotic prophylaxis during the study. The principal procedure used to determine the presence of thrombosis was bilateral contrast venography, Thrombophlebitis Muskat. Impedance plethysmography was performed every other day in the patients who were able to undergo the procedure 16, These patients underwent venography 14 to 21 days after admission, or earlier if the hospital stay was shorter than 14 days, Thrombophlebitis Muskat.
For reasons of safety, patients not able Thrombophlebitis Muskat undergo serial plethysmography because of lower-extremity injuries underwent venography on day 7 to Hemodynamically stable patients in the intensive care unit were transported to the radiology department for venography. Venography was performed according to the method of Rabinov and Paulin, 18 with the use of iohexol, a non-ionic contrast agent. Since a large proportion of patients with trauma have lower-extremity injuries that can affect the interpretation of venograms, Thrombophlebitis Muskat, we developed conservative criteria for coding the venograms before the study began, Thrombophlebitis Muskat.
The venogram of each leg was considered Thrombophlebitis Muskat if there was complete visualization of at least the proximal 75 percent of both posterior tibial and peroneal veins of the calf, as well as the popliteal, Thrombophlebitis Muskat, superficial femoral, common femoral, and external iliac veins.
Thrombophlebitis Muskat thrombosis was defined as a constant intraluminal filling defect in a deep leg vein seen on two or more views.
Proximal deep-vein thrombosis was defined as thrombosis involving the popliteal or more proximal veins with or without involvement of the calf veins. Venograms indicating persistent nonfilling of a deep venous segment were considered to be nondiagnostic unless deep-vein thrombosis was identified elsewhere.
Impedance plethysmography was performed in patients who had symptoms or signs suggestive of deep-vein thrombosis 16, All patients symptomatic or asymptomatic with abnormal plethysmograms underwent venography on the same day. Patients with clinical features suggestive of pulmonary embolism underwent ventilation-perfusion lung scanning 19, A normal perfusion scan was considered to rule out pulmonary embolism, Thrombophlebitis Muskat, whereas a scan indicating a high probability of embolism, defined as a scan revealing one or more perfusion defects, segmental or larger, with a ventilation mismatch, was considered to confirm the diagnosis, Thrombophlebitis Muskat.
Patients with nondiagnostic lung scans underwent pulmonary angiography, contrast venography, or both within 24 hours after scanning. The results of venography, lung scanning, and pulmonary angiography were evaluated by a panel of experts who were unaware of the clinical details and the original interpretation of the test, Thrombophlebitis Muskat.
The possible risk factors for venous thromboembolism that we assessed were age, sex, cause of the injury, Thrombophlebitis Muskat, Injury Severity Score, 15 score on the Abbreviated Injury Scale for each of the six body regions, 21 major sites of injury, specific injuries pelvic, femoral, or tibial fractures and spinal cord injuriesblood group, transfusion requirements, need for surgical procedures, cumulative time in the operating room, mobility, and length of Thrombophlebitis Muskat stay.
The primary analysis was a determination Thrombophlebitis Muskat the frequency of deep-vein thrombosis in the overall group of patients with trauma and in four clinical subgroups established on the basis of the body regions with predefined major injuries: Rates of thromboembolism were also assessed for several specific injuries, including spinal cord injuries and fractures of the pelvis, Thrombophlebitis Muskat, femur, tibia, and ankle, Thrombophlebitis Muskat.
Associations between potential risk factors and thrombosis were determined with chi-square statistics for categorical variables and t-tests for continuous variables. All reported P values are two-tailed, Thrombophlebitis Muskat. During the month study period, there were admissions to the Sunnybrook Regional Trauma Unit.
A total of patients were ineligible for the following reasons: The remaining patients underwent daily clinical surveillance and, Thrombophlebitis Muskat, if technically possible, serial impedance plethysmography. Venography was not attempted in 85 patients because informed consent was not provided 54 patientsdeath occurred after day 5 but before venography could be performed 29Thrombophlebitis Muskat, or symptomatic pulmonary embolism developed before venography could be performed 2.
Autopsies performed in 18 of the 29 patients who died after day 5 confirmed the cause of death as head injury in 8, sepsis with multisystem organ failure in 5, massive pulmonary embolism in 3, myocardial infarction in 1, and carcinomatosis in 1.
Autopsies were not performed in the other 11 patients, but the clinical cause of death was head injury in 7 and multisystem organ Thrombophlebitis Muskat associated with sepsis in 4. We were unable to arrange venography for an additional patients before their discharge home or transfer to another facility. Venography was attempted in the remaining patients, Thrombophlebitis Muskat.
In 56 patients The patients in whom Thrombophlebitis Muskat venography was adequate constituted the study cohort. The clinical characteristics of the initial cohort of patients who underwent surveillance for deep-vein thrombosis and those in whom venography was adequate are summarized in Table 1 Table Thrombophlebitis Muskat Characteristics of the Initial Cohort of Patients with Trauma and the Study Cohort Those in Whom Venography Was Adequate.
Of the patients with adequate venographic Diagnose von Arteriosklerose und Thrombose, Proximal deep-vein thrombosis was diagnosed in 63 patients Among the patients with adequate venographic studies in both legs, 18 percent had bilateral deep-vein thrombosis, Thrombophlebitis Muskat, and 3 percent had bilateral proximal deep-vein thrombosis.
Fourteen patients had isolated proximal deep-vein thrombosis calf veins not involvedrepresenting 22 percent of those with proximal deep-vein thrombosis and 4 percent of the overall cohort. Rates of proximal and distal deep-vein thrombosis were virtually identical for the left and right legs. The results in the 36 patients who underwent Thrombophlebitis Muskat venography because they could not be screened with serial plethysmography did not differ from the results in the patients who underwent delayed venography.
Deep-vein thrombosis was diagnosed in Only 3 of the patients with deep-vein thrombosis 1. None of the three patients with fatal pulmonary embolism had any clinical features suggestive of Thrombophlebitis Muskat thromboembolism before their sudden deaths on days 15, 16, and 18 after injury.
The frequencies of deep-vein thrombosis and proximal deep-vein thrombosis according to the site or sites Thrombophlebitis Muskat major injury are shown in Table 2 Table 2 Occurrence of Deep-Vein Thrombosis and Proximal Deep-Vein Thrombosis in the Cohort of Patients, According to the Site of Major Injury.
Many of the patients had injuries involving more than one site. The relation between the occurrence of deep-vein thrombosis and each possible pair of injury sites is shown in Figure 1 Figure 1 The Frequency of Deep-Vein Thrombosis among Patients with One or More Major Injuries. The white boxes indicate the frequencies of deep-vein thrombosis among the patients with injuries confined to a single region of the body, and the black boxes indicate the frequencies among the patients with injuries in two regions 87 patients or three regions 19 patients, Thrombophlebitis Muskat.
No Thrombophlebitis Muskat had major injuries in all four regions. For example, the incidence of deep-vein thrombosis was 39 percent among patients with head injuries alone; 50 percent among those with injuries of the head and spine; 69 percent among those with injuries of the head and face, chest, or abdomen; and 77 percent among those with head injuries and orthopedic injuries of the lower extremities.
These conditional probabilities suggest the strong influence of lower-extremity orthopedic injuries on the risk of thrombosis. Deep-vein thrombosis was diagnosed in 81 percent of the patients with spinal cord injuries. Among the patients with lower-extremity fractures, deep-vein thrombosis was diagnosed in 61 percent of those with pelvic fractures, Thrombophlebitis Muskat, in 80 percent of those with femoral tiefe Venenthrombose, in 77 percent of those with tibial fractures, Thrombophlebitis Muskat in 74 percent of those with ankle fractures.
During the surveillance period, Thrombophlebitis Muskat, 39 patients had clinically suspected pulmonary embolism before venography was performed. Pulmonary embolism was confirmed in seven in three at autopsy, in three by lung scanning, and in one by pulmonary angiography. The diagnosis of pulmonary embolism was ruled out in 22 patients in 17 by lung scanning, in 4 by angiography, Thrombophlebitis Muskat, and in 1 at autopsy. The diagnosis of embolism was neither confirmed nor ruled out in the remaining 10 patients with nondiagnostic lung scans, although in 8 of the 10, deep-vein thrombosis was confirmed by venography within 24 hours after scanning, and angiography was therefore not performed.
The other two Thrombophlebitis Muskat refused to undergo pulmonary angiography. Thus, Thrombophlebitis Muskat, the diagnosis of pulmonary embolism or deep-vein thrombosis was confirmed in fewer than half the patients with clinical features suggestive of pulmonary embolism.
The univariate analysis of potential factors for venous thrombosis identified significant associations between thrombosis and the following factors: Patients with deep-vein thrombosis were also significantly less mobile and had a longer mean hospital stay than those without thrombosis Thrombophlebitis Muskat that were not significantly associated with thrombosis included sex, the Thrombophlebitis Muskat of injury, the Injury Severity Score, major head injury or pelvic Thrombophlebitis Muskat, blood group, amount of blood transfused in the first 24 hours, and cumulative number of hours spent in the operating room from the time of admission until venography was performed.
Multiple logistic regression identified five statistically significant factors that were independent predictors of deep-vein thrombosis: We have confirmed that deep-vein thrombosis is Thrombophlebitis Muskat common complication after Thrombophlebitis Muskat trauma, with an overall incidence of 58 percent in our cohort.
Even Thrombophlebitis Muskat important, proximal deep-vein thrombosis was diagnosed in 18 percent of the patients, Thrombophlebitis Muskat, and three patients died of massive pulmonary embolism despite clinical and plethysmographic surveillance. Given the high Thrombophlebitis Muskat of proximal deep-vein thrombosis, we expect that the rate of fatal pulmonary embolism 0, Thrombophlebitis Muskat.
Two previous studies that used routine venography in patients with trauma also reported a high frequency of venous thrombosis 9, Thrombophlebitis Muskat, A study by Kudsk et al.
Our data are also consistent with the high frequency of thrombosis reported in other, somewhat analogous groups of patients, including those undergoing general surgical procedures 24,25 and those with spinal cord injuries 26 or fractures of the hip or tibia
Thrombophlebitis Muskat Physiotherapy 2 | Electric Current | Electromagnetic Radiation
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Acute phase of myocardial infarction. Acute phase of stroke. Severe arterial hypertension with systolic pressure more than mm Hg. Epilepsy with frequent seizures. Individual intolerance to this type of energy. Long professional contact with this type of energy. Electrical current is the flow of charged particles, such as electrons in metals or ions in ele ctr oly tes, Thrombophlebitis Muskat.
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