User talk:Ahmad raffa

V. Information for self-preparation of students to practical lesson. Pulmonary embolizm (PE) is occlusion of lumen of main trunk or branches of pulmonary artery by clot-embolus, origined from a blood clot which was formed in the veins of greater circle of blood circulation or right cavities of heart, and added to the lesser circle of blood circulation with the flow of blood. The mechanical blockade of trunk or branches of pulmonary artery by clot-embolus is accompanied with the generalized spasm of pulmonary arterioles, that results in acute limitation of blood flow in lungs. Physiopathology basis of PE is occlusion of pulmonary arteries by clot-embolus with subsequent development of hypoxemia and pulmonary hypertension. Blood circulation in lung is acutely violated, an overload of right half of heart with development of acute or subacute right ventricular insufficiency, vast neuro-reflectory violations develop. The clinical flow of PE depends on what vessel is occluded (basic trunk and main branches, or its middle and small branches), and also from completeness of occlusion. On clinical flow four forms of PE are distinguished (N.B.Rzaev, 1970): fulminant, at which death of patient occurs suddenly (during 10 minutes) from acute asphyxia or cardiac arrest; acute – with sudden appearance of severe pain behind breastbone, expressed shortness of breath, development of collapse; in absence of treatment patients die during 24 hours; subacute – develops more gradually and clinically presents as the lung infarction, the basic display of which is bloody expectorations; chronic – develops gradually and clinically presents as chronic pulmonary and heart insufficiency. Depending on the volume of lesion of lung vessels PE can be: — supermassive - lesion of more than 70% of vessels of lungs (sudden loss of consciousness, diffuse cyanosis of overhead half of body, arrest of blood circulation, cramps, stop of breathing); — massive - lesion of more than 50% of vessels of lungs (loss of consciousness, shock, hypotension, insufficiency of function of right ventricle); — submassive - lesion from 30 to 50 % of vessels of lungs (shortness of breath, normal arterial pressure, the function of right ventricle is disturbed in less degree); — unmassive - lesion less than 30% of vessels of lungs (shortness of breath, the function of right ventricle does not change). 2. Features of examination of patient with suspicion on PE. A clinical presentation depends on size and location of clot-embolus. General, cardio-vascular and pulmonary symptoms are defined. General symptoms: severe pain in thorax, anxiety caused by fear of death, fever (symptom of Michael), loss of consciousness, general weakness, decrease of diuresis. Cardio-vascular symptoms: increasing tachycardia (с-symptom of Mahler), hypotension (up to development of collapse), cyanosis of face, neck and overhead half of trunk, dilation of neck veins, increase of CVP, pain in area of heart and liver enlargement. Pulmonary symptoms: shortness of breath, cyanosis, cough, bloody expectorations, noise of friction of pleura. It is possible to select several clinical syndromes: 1. Pain in thorax at PE is observed at 52–86,9 % patients. Pain is localized behind breastbone, without irradiation, has angina character, is accompanied by fear of death. PE is shock, shock from the obstruction of vessels. Syndrome of «weir», which is conditioned by violation of hemodynamics in the lesser circle of blood circulation due to clotting and reflex spasm of vessels. ¬3 variants of pain syndrome at PE are distinguished: angina-like; pulmonary-pleura; mixed. 2. Syndrome of acute respiratory insufficiency. Sudden disorders of breathing are characteristic: from feeling of shortage of air to the acutely expressed shortness of breath with appearance of cyanosis, development of bronchospasm, senses of fear.

== V. Information for self-preparation of students to practical lesson. Pulmonary embolizm (PE) is occlusion of lumen of main trunk or branches of pulmonary artery by clot-embolus, origined from a blood clot which was formed in the veins of greater circ ==

V. Information for self-preparation of students to practical lesson. Pulmonary embolizm (PE) is occlusion of lumen of main trunk or branches of pulmonary artery by clot-embolus, origined from a blood clot which was formed in the veins of greater circle of blood circulation or right cavities of heart, and added to the lesser circle of blood circulation with the flow of blood. The mechanical blockade of trunk or branches of pulmonary artery by clot-embolus is accompanied with the generalized spasm of pulmonary arterioles, that results in acute limitation of blood flow in lungs. Physiopathology basis of PE is occlusion of pulmonary arteries by clot-embolus with subsequent development of hypoxemia and pulmonary hypertension. Blood circulation in lung is acutely violated, an overload of right half of heart with development of acute or subacute right ventricular insufficiency, vast neuro-reflectory violations develop. The clinical flow of PE depends on what vessel is occluded (basic trunk and main branches, or its middle and small branches), and also from completeness of occlusion. On clinical flow four forms of PE are distinguished (N.B.Rzaev, 1970): fulminant, at which death of patient occurs suddenly (during 10 minutes) from acute asphyxia or cardiac arrest; acute – with sudden appearance of severe pain behind breastbone, expressed shortness of breath, development of collapse; in absence of treatment patients die during 24 hours; subacute – develops more gradually and clinically presents as the lung infarction, the basic display of which is bloody expectorations; chronic – develops gradually and clinically presents as chronic pulmonary and heart insufficiency. Depending on the volume of lesion of lung vessels PE can be: — supermassive - lesion of more than 70% of vessels of lungs (sudden loss of consciousness, diffuse cyanosis of overhead half of body, arrest of blood circulation, cramps, stop of breathing); — massive - lesion of more than 50% of vessels of lungs (loss of consciousness, shock, hypotension, insufficiency of function of right ventricle); — submassive - lesion from 30 to 50 % of vessels of lungs (shortness of breath, normal arterial pressure, the function of right ventricle is disturbed in less degree); — unmassive - lesion less than 30% of vessels of lungs (shortness of breath, the function of right ventricle does not change). 2. Features of examination of patient with suspicion on PE. A clinical presentation depends on size and location of clot-embolus. General, cardio-vascular and pulmonary symptoms are defined. General symptoms: severe pain in thorax, anxiety caused by fear of death, fever (symptom of Michael), loss of consciousness, general weakness, decrease of diuresis. Cardio-vascular symptoms: increasing tachycardia (с-symptom of Mahler), hypotension (up to development of collapse), cyanosis of face, neck and overhead half of trunk, dilation of neck veins, increase of CVP, pain in area of heart and liver enlargement. Pulmonary symptoms: shortness of breath, cyanosis, cough, bloody expectorations, noise of friction of pleura. It is possible to select several clinical syndromes: 1. Pain in thorax at PE is observed at 52–86,9 % patients. Pain is localized behind breastbone, without irradiation, has angina character, is accompanied by fear of death. PE is shock, shock from the obstruction of vessels. Syndrome of «weir», which is conditioned by violation of hemodynamics in the lesser circle of blood circulation due to clotting and reflex spasm of vessels. ¬3 variants of pain syndrome at PE are distinguished: angina-like; pulmonary-pleura; mixed. 2. Syndrome of acute respiratory insufficiency. Sudden disorders of breathing are characteristic: from feeling of shortage of air to the acutely expressed shortness of breath with appearance of cyanosis, development of bronchospasm, senses of fear.