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ʻO ka thrombosis hohonu hohonu (DVT) a me ka pulmonary embolism kōkua mua

He ʻokoʻa nā helu ulia pōpilikia ma ka ʻāina. Hoʻohana kēia ʻaoʻao i ka 911, ka helu no ʻAmelika a me Kanada. Nui nā ʻāina ʻē aʻe i hoʻohana i ka 112, 999, a i ʻole ka helu ʻē aʻe. E huli i ka helu no kou ʻāina.

Venous thromboembolism (VTE) hoʻopili ʻia ʻelua mau maʻi lapaʻau pili pono: Deep Vein Thrombosis (DVT), kahi i puka ai ke koko (thrombus) i loko o kahi aʻa hohonu, maʻa mau i ka bipi, ʻūhā, pelvis, a i ʻole ka lima luna, a me Pulmonary Embolism (PE), he ʻāpana koko i haʻi ʻia i ka wā e hemo ai ke koko. hele ma ka ʻaoʻao ʻākau o ka puʻuwai, a moe i loko o nā aʻa nui o ka māmā.

Wahi a ka World Health Organization (WHO) a me ka United States Centers for Disease Control and Prevention (CDC), ʻo ka venous blood clots ke kolu o ke kumu nui o ka make ma ka honua holoʻokoʻa (ma hope o ka hōʻeha ʻana o ka naʻau a me ka hahau ʻana), pepehi i nā haneli haneli o nā kānaka i kēlā me kēia makahiki. ʻO ka mea nui, ʻo ka Pulmonary Embolism kekahi o nā kumu hiki ke pale ʻia i ka make hikiwawe: inā ʻike mua ʻia kahi Deep Vein Thrombosis ma ka wāwae a mālama ʻia me ka lāʻau anticoagulant ("hoʻemi koko") ma mua o ka hemo ʻana, a i ʻole ke kuhi hewa nui e like me ka ** lomilomi ʻana i ka pipi ʻokiʻoki a pehu ** i pale ʻia, hiki ke pale ʻia ka maʻi ʻeha.

ʻO ka ʻike pehea e haʻi ai i ka ʻokoʻa ma waena o kahi ʻiʻo maʻamau a me kahi Deep Vein Thrombosis, pehea e ʻike ai i ka umauma a me ka hanu ʻana i nā hae ʻulaʻula o ka Pulmonary Embolism, a me ka mea e hana ai i nā minuke ma mua o ka hōʻea ʻana o nā paramedics e hoʻopakele i nā ola.

E hana i kēia i kēia manawa

Inā manaʻo ʻoe he koko koko i loko o kahi lālā (DVT) a i ʻole he koko koko i hele i ka māmā (Pulmonary Embolism), e hahai i kēia mau hana ʻeono:

  1. Inā loaʻa kekahi mau hōʻailona o ka Pulmonary Embolism (PE), e kelepona koke i kāu helu ulia pōpilikia kūloko: Inā loaʻa ke kanaka ** ʻeha hikiwawe, ʻaʻole i wehewehe ʻia o ka hanu**, ** ʻeha ʻeha o ka umauma, kua, a i ʻole ʻaoʻao ʻaoʻao e ʻoi aʻe ana i ka wā e huki ai i ka hanu hohonu a i ʻole ka ʻuʻu ʻana , ** ka piʻi ʻana o ka naʻau (ʻoi aku ma mua o 100 mau kuʻikuʻi i kēlā me kēia minuke), ** ʻaʻa koko a ʻulaʻula paha. poʻo māmā/ maule**, e kelepona iā 911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ʻEulopa, a i ʻole 999 ma United Kingdom (a i ʻole e nānā i kā mākou helu pilikia papa kuhikuhi). Mai hoʻokele iā ʻoe iho i ka haukapila no ka PE i manaʻo ʻia.
  2. Noho i ka mea maʻi Pulmonary Embolism ma ke ʻano kū pololei a mālama pono iā ia: E kōkua i kahi kanaka i manaʻo ʻia me ka PE e noho ma kahi kūpono semi-kūpono ʻoluʻolu (45 degere) e hilinaʻi iki i mua a i kākoʻo ʻia paha e nā uluna, e wehe i nā lole paʻa ma ka ʻāʻī a me ka pūhaka, a e hoʻomaha iā lākou e hōʻemi i ka hoʻohana ʻana i ka oxygen. Mai ʻae iā lākou e hele i lalo i nā alapiʻi e hālāwai me ka ambulance.
  3. ʻAʻole lomilomi, hamo, ʻōwili huʻihuʻi, a hoʻopili paha i ka pū lomilomi i kahi wāwae i manaʻo ʻia he DVT: He nui ka poʻe e kuhi hewa i ka ʻeha hohonu a me ka ʻeha o ka ʻōpū koko bipi no ka "ʻiʻo huki" a i ʻole "charley horse" ma hope o ka holo lōʻihi ʻana a i ʻole ke ʻoki ʻana a hoʻāʻo e hoʻomaʻemaʻe ikaika a hoʻohana paha i ka pū lomilomi hohonu. ** ʻO ka lomilomi ʻana i ka wāwae me ka DVT e uhaʻi kino i ke koko palupalu i wehe ʻia mai ka paia vein**, e hoʻouna pololei ana i loko o ka puʻuwai a me nā akemāmā ma ke ʻano he Pulmonary Embolism nui i loko o kekona.
  4. Inā loaʻa iā ʻoe nā hōʻailona o ka DVT ma hoʻokahi wāwae a lima paha (me ka ʻole o ka umauma/na hanu), e kiʻi i ka loiloi ultrasound olakino i ka lā hoʻokahi: Inā ʻike ʻia kahi bipi keiki, ʻūhā, a lima paha ** pehu (ʻoi aku ka nui o ka pōʻai ma mua o kekahi ʻaoʻao), mehana i ka hoʻopā ʻana, ** ʻulaʻula, ʻulaʻula, a ʻeleʻele paha i ka wā e kū ai i ka maʻi maʻi, a i ʻole ka maʻi maʻi ** ke keʻena a i ʻole ke keʻena diagnostic koʻikoʻi i kēia lā no kahi ultrasound compression venous duplex. Mai kali i hoʻokahi pule no ka hoʻonohonoho maʻamau o ke keʻena.
  5. E hoʻomaha mālie i ka lālā pehu a mai hele wāwae a hoʻoikaika kino: ʻOiai e kali ana no ka loiloi ʻana i kahi DVT i manaʻo ʻia, e hoʻōki i ka hele wāwae, ka holo ʻana, a i ʻole ka hoʻopololei ʻana i ka wāwae. E hoʻomaha mālie me ke kākoʻo ʻole ʻia o ka wāwae ma luna o kahi moe a i ʻole moe, a pale i ka hele ʻana i kou mau wāwae a i ʻole ke komo ʻana i nā pūkini paʻa kiʻekiʻe o ke kuli e hoʻopololei i ke keiki bipi.
  6. E mākaukau e hoʻomaka i ka CPR lima-wale inā he PE nui ka mea e hāʻule ai: Hiki i ka pulmonary embolism "noho" nui ke hoʻopaʻa loa i ke kahe koko mai loko mai o ka ventricle ʻākau o ka puʻuwai (hoʻopuʻi kūʻē), ma muli o ka maule koke ʻana a me ka hopu ʻana i ka naʻau. Inā lilo ke kanaka i mea pane ʻole a hoʻōki i ka hanu maʻamau (a i ʻole e hāhā i kekahi manawa wale nō), e hoʻomoe iā lākou ma luna o kahi ʻili paʻa a hoʻomaka koke i ka paʻakikī, wikiwiki. CPR lima wale nō ma ka 100 a hiki i ka 120 kaomi i ka minuke.
flowchart TD
    A["Hoʻopiʻi ʻia i ke koko koko pilikia (VTE)"] --> B{"Pokole Hiki i ka hanu, ka ʻeha o ka umauma Pleuritic, ka puʻuwai heihei, a i ʻole ka maule?"}
    B -->|"ʻAe (Suspected Pulmonary Embolism)"| C["E kelepona i ka Ambulance Emergency (911 / 112 / 999) koke"]
    C --> D["Noho ma'i Semi-Upright (45 Degere) + Wehe i nā lole pa'a"]
    D --> E["E hoomau i ka hoomanawanui; E hoʻomaka i ka CPR inā ʻaʻole pane"]
    B -->|"ʻAʻole (Hoʻopā ʻia nā hōʻailona i hoʻokahi wāwae a lima paha)"| F{"ʻAha ʻaoʻao 1, Pumehana, ʻIli ʻulaʻula/ʻulaʻula, a ʻeha ʻeha i ka bipi bipi/ ʻūhā?"}
    F -->|"ʻAe (Suspected Deep Vein Thrombosis)"| G["STOP: Mai Lomilomi, Rub, Foam-Roll, a i ʻole e hōʻolo i ka lālā"]
    G --> H["Hoʻomaha mālie i nā lālā; Mai hele wāwae ʻole"]
    H --> I["Lawe ʻia i kēia lā i ka Halemaʻi ER no ka Ultrasound Venous Lā Hoʻokahi"]
    F -->|"ʻAʻole"| J["Mākaʻikaʻi i nā mea pōʻino (ka ʻoki hou ʻana, lele lōʻihi, estrogen, maʻi maʻi)"]

No ke aha e make ai ka pū lomilomi percussive a i ʻole ka pipi hohonu ma kahi DVT

ʻO kahi Deep Vein Thrombosis hou i hana ʻia i loko o ka popliteal a i ʻole femoral vein o ka wāwae he palupalu a palupalu, pili ʻia i ka valve vein i loko e like me ka gelatin pulu. ʻO ka hoʻohana ʻana i ke kaomi manamana lima hohonu, ka ʻūhā ʻūhā, a i ʻole ka pū lomilomi kiʻekiʻe ma luna o ke kua o ka bipi ʻeha a i ʻole ka ʻūhā i loko e ʻako i ka ʻāʻī o ka paia o ka vein. I loko o ʻekolu mau puʻuwai puʻuwai, ua ʻōpuʻu aʻe kēlā ʻōpū i ka inferior vena cava, ma o ka atrium ʻākau a me ka ventricle ʻākau o ka puʻuwai, a paʻi i loko o ke kumu aʻa o ka pulmonary, e ālai ana i ka hoʻololi ʻana o ka oxygen a hoʻōki koke i ka puka ʻana o ka naʻau. Ke pehu a eha paha kekahi bipi keiki ma hope o ka huakaʻi, ʻokiʻoki, maʻi, a ʻeha paha, e hoʻokaʻawale loa i nā lima a me nā mea lomilomi mai ka wāwae.

Pehea e ʻike ai i kahi Deep Vein Thrombosis (DVT) me kahi ʻiʻo ʻiʻo maʻamau

No ka mea, he ʻakaʻaka ka hapalua o ka poʻe i hoʻomohala i kahi DVT i ka wā mua, ua huki wale lākou i ka ʻiʻo bipi a i ʻole moe ma ko lākou wāwae he mea ʻakaʻaka, ʻo ka ʻike pehea e hoʻohālikelike ai i kahi venous clot me kahi maʻi musculoskeletal he mea koʻikoʻi.

ʻO ka Deep Vein Thrombosis (DVT) vs ka papaʻaina hoʻohālikelike hoʻohālikelike

Hōʻikeʻike lapaʻau ʻOrdinary Muscle Cramp ("Charley Horse") a i ʻole ka ʻiʻo pipi huki ʻO ka ʻaʻaʻaʻa hohonu (DVT, ke koko koko i loko o ka hohonu hohonu)
Pehea i hoomaka ai ʻO ka spasm paʻa koke i ka wā hoʻoikaika kino a i ke aumoe paha e maʻalahi i loko o 10 mau minuke o ka hoʻomaloʻo mālie, A i ʻole e hoʻomaka i ka manawa kūpono o ka sprint/lele. Hoʻoulu ʻia ma mua o 1 a 3 mau lā (pinepine 2 a 14 lā ma hope o ka holo lōʻihi ʻana/kaʻa, ʻokiʻoki, nā wāwae wāwae, ka halemai, a i ʻole ka hoʻomaka ʻana o ka estrogen/ka hoʻokele hānau).
Pehu ʻike ʻia (Ka pōʻai) ʻAʻohe a i ʻole ka liʻiliʻi. Ana nā bipi ʻelua i ka mamao like a puni. E ʻike ʻia ka pehu ʻaoʻao hoʻokahi (unilateral): E hoʻohana i kahi ana lipine maʻalahi 10 knm (4 iniha) ma lalo o ka piko (tibial tuberosity), kahi ʻāpuni bipi 3 kenimika (1.2 ʻīniha) a ʻoi aku paha ka nui ma mua o ka wāwae ʻē aʻe ka hōʻailona kino ikaika loa o kahi DVT.
Ka wela a me ke kala ʻO ka wela o ka ʻili maʻamau a me ke kala ʻili maʻamau. ʻOi aku ka mahanahana o ka wāwae pehu ma ke kua o kou lima** ma mua o ka wāwae ʻē aʻe, a ʻo ka ʻili he ʻulaʻula, ʻālohilohi, poni ʻeleʻele, a i ʻole ʻeleʻele/ʻulaʻula**, pinepine me nā aʻaʻaʻa o luna.
Ka hopena o ka hoʻomaha a me ke kū ʻana ʻOi aku ka maikaʻi ke hoʻomaha mālie; ʻeha nui i ka wā e ʻaelike ai i kēlā ʻiʻo kikoʻī. ʻO ka hohonu hohonu, ka puʻupuʻu a i ʻole ka piha ʻana e ʻoi aku ka ʻino i ka wā e kū mālie ai ʻole e waiho ʻia ka wāwae e kau i lalo** (ke hoʻi hope ke koko venous ma hope o ka ʻōpū).
Pitting Edema ʻAʻole. Ke kaomi mālie ʻana i kou manamana lima ma luna o ka iwi a i ʻole ka kuʻekuʻe wāwae no 5 kekona e waiho i kahi ** ʻike ʻia ka dimple/indentation ("pitting edema")** e mau ana ma hope o kou hāpai ʻana i kou manamana lima.

Ke helu ʻana i kāu pilikia lapaʻau: ʻo ka Modified Wells Score no DVT

Ma nā keʻena ulia pōpilikia o ka haukapila ma ka honua holoʻokoʻa, hoʻohana nā kauka i ka Wells Criteria for DVT no ka loiloi ʻana i ka hopena o ka wāwae ʻeha a pehu paha he koko koko. Hiki iā ʻoe ke nānā i kēia mau kumu pilikia koʻikoʻi he 10 no ka hoʻomaopopo ʻana i ke kumu e mālama nui ai nā kauka i nā hōʻailona wāwae kikoʻī (hoʻohui ʻia kēlā me kēia mea +1 helu):

  1. Ka maʻi maʻi maʻi ʻaʻa (lāʻau i loko o nā mahina 6 i hala iho nei a i ʻole mālama palliative): +1 helu.
  2. ** ʻO ka maʻi lolo, paresis, a i ʻole ka hoʻoheheʻe ʻia ʻana o ka plaster / ka hoʻopaʻa wāwae hele wāwae** o ka wāwae: +1 helu.
  3. Ua moe i kahi moe no 3 mau lā a ʻoi aku paha, A i ʻole ** ʻoki nui i loko o nā pule he 12 i hala iho nei** e koi ana i ka anesthesia āpau a i ʻole ka ʻāpana: +1 helu.
  4. Ka ʻoluʻolu kūloko ma ka ʻōnaehana venous hohonu (i lalo i ke kua waena o ka bipi keiki a i ʻole ma ka ʻāʻī o ka ʻūhā o loko): +1 helu.
  5. Pehu ka wāwae holoʻokoʻa (mai ka ʻūhā/ ʻūhā a hiki i ka kuʻekuʻe wāwae): +1 helu.
  6. ** ʻO ka pehu ʻana o ka pipi ma kahi o 3 kenimika (1.2 iniha) ʻoi aku ka nui** ma mua o ka wāwae ʻaʻohe hōʻailona (ana ʻia he 10 knm ma lalo o ka tuberosity tibial): +1 helu.
  7. Pitting edema pili i ka wāwae hōʻailona: +1 helu.
  8. Collateral superficial veins (ʻike ʻia, ʻaʻohe varicose veins surface e kū ana i waho ma ka wāwae pehu i ke kahe ʻana o ke koko a puni ka paʻa hohonu): +1 helu.
  9. ** DVT i kākau mua ʻia** i ka wā i hala: +1 helu.
  10. (E hoʻomaopopo: Inā he DVT kekahi hōʻailona ʻē aʻe, e like me ka cellulitis a i ʻole ka waimaka i ʻike ʻia, e unuhi nā kauka i 2 mau helu; ʻo ka helu o 2 a ʻoi aku paha e hōʻike ana i ka nui o ka lāʻau lapaʻau e koi ana i ke kiʻi ultrasound koke).

E makaʻala iā Phlegmasia Cerulea Dolens (ka wāwae ʻeha polū)

I nā hihia koʻikoʻi o ka iliofemoral DVT nui kahi kokoke i nā aʻa hohonu a me nā ʻaʻa koʻikoʻi e kahe ana i ka wāwae e paʻa paʻa, piʻi kiʻekiʻe ke kaomi ʻana i loko o ka wāwae i hiki ʻole i ke koko koko ke komo hou i ka lālā. Pehu nui ka wāwae holoʻokoʻa, huli i ka ** ʻulaʻula-ʻulaʻula cyanotic hohonu**, lilo i ** ʻeha loa **, a ulu aʻe ka ʻōpū a i ʻole ka nalowale ʻana o ka manaʻo (Phlegmasia Cerulea Dolens). ʻO kēia kahi lāʻau lapaʻau e hoʻoweliweli i ke ola e alakaʻi i ka gangrene venous, amputation, a me ka haʻalulu hypovolemic i loko o nā hola ke ʻole e mālama koke ʻia i loko o ka haukapila me ka thrombolysis a i ʻole ka thrombectomy i kuhikuhi ʻia e ka catheter.

Ka ʻike ʻana i kahi Pulmonary Embolism (PE): i ka wā e hiki ai ke koko i ka māmā

I ka wā e haki ai ka ʻāpana o ka DVT (embolizes), hoʻolei ʻia ʻo ia i luna ma o nā ʻaʻa nui o ka ʻōpū i ka ʻaoʻao ʻākau o ka puʻuwai, a hoʻopaʻa pololei iā ia i loko o nā lālā ** pulmonary arterial ** o ka māmā.

ʻO ka mea nui, ** a hiki i ka 40 pakeneka o nā poʻe maʻi i loaʻa i ka Pulmonary Embolism e hoʻoweliweli i ke ola, ʻaʻole i ʻike ʻia ka ʻeha wāwae a i ʻole ka pehu ma mua**, no ka mea, ua hoʻokumu ʻia ka clot i loko o nā aʻa pelvic hohonu, a i ʻole no ka haki ʻana o ka ʻōpū wāwae holoʻokoʻa i ka manawa hoʻokahi a hele i ka māmā.

Pehea ka pepehi ʻana o ka Pulmonary Embolism (Right Heart Strain, ʻaʻole haʻahaʻa oxygen wale nō)

ʻO ka manaʻo kuhihewa maʻamau, ʻo ka Pulmonary Embolism e hōʻeha wale iā ʻoe ma ka hoʻohaʻahaʻa ʻana i nā pae o ka oxygen i loko o kahi ʻāpana o ka māmā. ʻO ka ʻoiaʻiʻo, ʻo ka Massive a i ʻole Submassive ("Saddle") Pulmonary Embolism i pepehi ma o acute Obstructive Shock and Right Ventricular Failure:

  1. Ke hoʻopaʻa ʻia ka 50% a ʻoi aʻe paha o ka lāʻau pulmonary arterial kahi ʻāʻī nui, ʻo ka ** ʻĀkau ʻĀkau** o ka puʻuwai e paʻi koke i ka pā pōhaku o ke kaomi.
  2. ʻAʻole hiki ke hele i ke koko ma waena o ka māmā a hiki i ka Left Ventricle**.
  3. No ka piʻi ʻole ʻana o ka ventricle hema, hāʻule ke kahe o ke koko ʻōnaehana i ka lolo a me nā ʻaʻa coronary i ʻole, e maule koke ai (syncope), ʻeha ʻeha o ka umauma, a me Pulseless Electrical Activity (PEA) hopu puʻuwai.

Nā hōʻailona o ka Pulmonary Embolism vs Heart Attack papa hoʻohālikelike

Hōʻailona Ana ʻO ka maʻi ʻehaʻeha o ka ʻōpū (PE) ʻO ka maʻi ʻeha o ka naʻau.
** Hōʻailona hōʻailona #1 ** Pōkole o ka hanu hikiwawe ʻole i wehewehe ʻia (Dyspnea) i ka hoʻomaha a i ʻole me ka hoʻoikaika liʻiliʻi (e loaʻa i ka 80%+ o nā hihia), e hoʻomaka ana i loko o kekona a i ʻole mau minuke. Ke kaomi o ka umauma waena, ʻomi, piha, a paʻa paha ("ʻelepani e noho ana ma ka umauma"), hoʻomālamalama pinepine i ka lima hema, āwae, ʻāʻī, a i ʻole ke kua.
Ke ʻano o ka ʻeha o ka umauma ** ʻEha ʻeha "Pleuritic" maʻamau** (maʻa mau ma ka ʻaoʻao o ka umauma, ma lalo o ka iwi ʻaoʻao, a ma lalo paha o ka ʻāʻī poʻohiwi) e ʻeha nui i kēlā me kēia manawa āu e hanu hohonu ai, ʻuʻu, a ʻakaʻaka paha ** (koe naʻe he PE kikowaena nui, ka mea e hoʻoulu ai i ke koʻikoʻi ma waena o ka hope hope). ʻO ke kaumaha, kaumaha, ʻeha, a ʻeha ʻeha paha ʻaʻole ** loli** ke hanu ʻoe i loko a i waho paha.
**Ka Puuwai a me ka Hanu ** Tachycardia hoʻomau (>100 BPM) a me Tachypnea (>20 hanu/min), holo ka puʻuwai a me ka māmā e hoʻopaʻi i ka moena māmā i ālai ʻia. Hiki ke wikiwiki, maʻamau, a lohi paha ka puʻuwai (bradycardia i nā hōʻeha puʻuwai haʻahaʻa), i hui pū ʻia me ka hou aʻe (diaphoresis).
** ʻAi a me ka Sputum** ʻO ka ʻuʻu maloʻo a i ʻole ka ʻāʻī ʻana o ka sputum i hoʻoheheʻe ʻia i ke koko (hemoptysis)** ma muli o kahi wē o ka ʻiʻo o ka māmā peripheral e make ana i ke kahe ʻole o ke koko (pulmonary infarction). ʻO ka maʻamau, ʻaʻohe maʻi (koe ke hoʻopiha ʻia nā māmā me ka wai huʻi ʻole o ka naʻau nui).
** Maule (Syncope) ma ke kū ʻana** Hae ʻulaʻula nui no ka PE Nui: ʻO ka maule a kokoke maule paha i ke kū ʻana a i ʻole ka hele ʻana i ka lumi ʻauʻau ʻo ia ka ** ʻo ka hōʻailona mua loa ** o kahi maʻi pulmonary embolism nui e ālai ana i ka ʻōpala nui. Hiki ke hana me ka lethal ventricular arrhythmias.
Ka Laʻa Loaʻa Loa Hiki ke pehu, mahana, a ʻeha paha kekahi bipi keiki a ʻūhā paha (a i ʻole ka mōʻaukala o ka hōʻoki ʻana, lele, ka hāpai ʻana, ka maʻi kanesa, a i ʻole COVID-19). ʻO ka mōʻaukala o ke koko kiʻekiʻe, ka puhi paka, ka maʻi diabetes, a i ʻole ka cholesterol kiʻekiʻe.

Ka hoʻomaopopo ʻana i ka Virchow's Triad: ʻo wai ka mea i ʻoi aku ka nui o ka pilikia no ke koko koko?

I ka makahiki 1856, ua ʻike ke kauka ʻo Rudolf Virchow i ka ʻekolu mau maʻi kino ("Virchow's Triad") e hoʻokaʻe ʻino ai ke koko i loko o ke aʻa kanaka. Kokoke i kēlā me kēia DVT a me ka hopena PE mai hoʻokahi a ʻoi aku paha o kēia mau mea hoʻoulu ʻekolu:

  1. Venous Stasis (Hoʻolohi a Hoʻohui ʻia ke Koko):
    • ʻAʻole e like me nā ʻaʻa, ʻaʻohe ʻiʻo puʻuwai o nā ʻāʻī o kou mau wāwae e pahū pololei iā lākou; ke hilinaʻi nei lākou i kou ʻiʻo bipi e ʻomi ana i nā aʻa hohonu i kēlā me kēia manawa e hele ai ʻoe i kahi ʻanuʻu (ʻo ka "pauma ʻiʻo bipi").
    • Nā Hoʻomaka: Noho ʻole ʻia no 4+ hola ma kahi noho mokulele haʻahaʻa, kaʻa, kaʻa, a i ʻole ka noho pāʻani/keʻena; e moe ana ma kahi moena o ka haukapila ma hope o ke oki ʻana a i ʻole ka maʻi pneumonia; ke komo ʻana i ka wāwae plaster a i ʻole ke kāmaʻa hele wāwae orthopedic; maʻi lolo ma hope o ka hahau ʻana a i ʻole ka ʻeha iwi kuamoʻo; a i ʻole ka hāpai ʻana i ka wā hope (kahi e kaomi ai ka ʻōpū kaumaha ma nā ʻaʻa pelvic iliac).
  2. Hypercoagulability ("Sticky" Blood Prone to Clotting):
    • Na mea hoʻoulu i loaʻa: Ka maʻi maʻi ʻaʻai a me ka chemotherapy (hoʻokuʻu ʻia nā pūmua pro-coagulant ka maʻi maʻi, e hoʻonui ana i ka pilikia o ka clot 4- a hiki i ka 7-fold); ** ʻO ka hāpai ʻana a me nā pule 6 mua ma hope o ka hānau ʻana** (ke hoʻonui maoli ke kino i nā kumu hoʻopaʻapaʻa ʻelima mau manawa e pale ai i ka hemorrhage i ka wā hānau); ** ʻO nā lāʻau lapaʻau i loaʻa i ka estrogen** (nā lāʻau hoʻomalu hānau waha i hui pū ʻia, nā ʻāpana estrogen / apo, a me ka lāʻau hoʻololi homoni); Uhi/vaping; ** ʻO COVID-19 koʻikoʻi a i ʻole nā ​​maʻi ʻōnaehana **; obesity; a me ka maʻi ʻeha o ka ʻōpū (Crohn's / ulcerative colitis).
    • Nā maʻi Genetic Clotting Disorders (Thrombophilias): Factor V Leiden mutation (ʻike ʻia ma kahi o 5% o ka poʻe ʻEulopa), Prothrombin G20210A mutation, Antiphospholipid Syndrome, a me nā hemahema o nā anticoagulants maoli (Protein C, Protein Smbin, III a i ʻole Protein Protein).
  3. Endothelial Injury (Pino i ka Lining Inner o ka Pa'a Vein):
    • Nā hoʻomaka: Orthopedic ** ʻoki ʻoki ʻāʻī a i ʻole ke kuli**, ʻoki ʻoki ʻokiʻoki/ ʻōpū, ʻoki iwi, ʻeha ʻeha i ka wāwae, i loko o ka ** laina PICC / catheters venous waena / pacemakers** (ke kumu #1 o Upper-Extremity DVT ma ka lima a me ka ʻāʻī subclavian poʻohiwi).

Pehea e pale aku ai i ka DVT a me ka PE i ka wā lōʻihi o nā mokulele, nā huakaʻi alanui, a me ka hoʻihoʻi ʻana ma hope o ka ʻoki ʻana

Inā ʻoe e holo ana i kahi mokulele honua he 10 mau hola, e holo ana ma ka ʻāina, a i ʻole e hoʻi hou ana ma ka home ma hope o ka ʻoki ʻana, ʻo ka hoʻohana ʻana i nā lula mechanical a me ka hydration e ʻoki i kou pilikia o ka venous clot a hiki i ka 80 pakeneka:

  • E hana i ka "Seated Ankle Pumps" a me Calf Raises i kēlā me kēia 30 minuke: ʻOiai e noho ana ma ka noho mokulele a i ʻole ma ke pākaukau, i kēlā me kēia hapalua hola e hana ** 20 puʻu wāwae lohi a ikaika **: kanu i kou mau kuʻekuʻe wāwae ma ka papahele a huki ikaika i kou manamana lima i luna i kou mau ʻāʻī (e kikoo ana i ke keiki bipi), a laila e kaomi i kou manamana wāwae i lalo i ka papahele a hoʻokiʻekiʻe i kou mau kuʻekuʻe wāwae kiʻekiʻe. Hoʻopiʻi lima kēia i nā * sinuses venous hohonu * i loko o kāu mau keiki bipi a hoʻokuʻu i ke koko kūpaʻa i kou puʻuwai.
  • E kākau i kahi noho aisle a hele wāwae no 3 mau minuke i kēlā me kēia 1 a 2 hola: Ma nā mokulele a i ʻole kaʻa kaʻaahi e lōʻihi ana ma mua o 4 mau hola, kū i luna a hele i ke ala i kēlā me kēia hola a ʻelua paha; ma nā huakaʻi alanui kaʻa lōʻihi, kū ma kahi plaza hoʻomaha i kēlā me kēia 2 hola e hele wikiwiki a puni ke kaʻa.
  • E hoʻohana i nā kāmaʻa koʻikoʻi i hoʻopaʻa ʻia (15-20 mmHg a i ʻole 20-30 mmHg) inā loaʻa iā ʻoe nā kumu pilikia: Hoʻokomo pono ʻia nā pūkuʻi-kiʻekiʻe ** mau pūkuʻi koʻikoʻi puka ** (ʻo ia ka mea ʻoi loa ma ka kuʻekuʻe wāwae a wehe mālie i ke keiki bipi) pālua i ka wikiwiki o ke kahe o ke koko i loko o nā aʻa hohonu. E kau iā lākou i ke kakahiaka ma mua o ka pehu ʻana o kou mau kuʻekuʻe wāwae, a e hōʻoia i ka ʻaʻa o luna ** ʻaʻole e ʻōwili ʻia i lalo i loko o kahi ʻāpana paʻa paʻa paʻa ma hope o kou kuli ** (e like me ka tourniquet a * hoʻopuʻi i nā ʻōpū).
  • E hoʻomaʻemaʻe ʻia me ka wai a pale aku i ka waiʻona nui a i ʻole nā ​​​​lāʻau hiamoe ma nā mokulele: He haʻahaʻa haʻahaʻa ka haʻahaʻa haʻahaʻa (ma lalo o 15%) i loko o nā hale mokulele i hoʻopaʻa ʻia, ʻo ia ka mea e hoʻomaloʻo iā ʻoe a mānoanoa i kou koko viscosity (hemoconcentration). E inu i 250 milliliters (8 auneke) o ka wai no kēlā me kēia hola ma ka lewa, e pale i ka waiʻona waiʻona, a ʻaʻole loa e lawe i nā lāʻau hoʻomaha hoʻomaha maikaʻi e hoʻohālua ai ʻoe ma kahi noho haʻahaʻa waena me ke kukuli ʻana o kou mau kuli no 8 mau hola pololei me ka hoʻololi ʻole i ke kūlana.
  • Mai ʻaʻa i kou mau wāwae ma nā kuli a i ʻole e kaomi ikaika i ke kua o kāu mau keiki bipi i ka ʻaoʻao o ka noho: ʻO ka hele ʻana i kekahi kuli ma luna o kekahi ʻē aʻe e pine pololei i ka popliteal vein ma hope pono o ka hui kuli. E hoʻopaʻa i nā wāwae ʻelua ma ka papahele a mālama pono i ka hakahaka ma lalo o ka noho i mua ou e kikoo aku i kou mau wāwae.

E lawe i ke kōkua mua a me ka papa CPR

No ka mea hiki i ka Pulmonary Embolism ke hoʻoulu koke i ka syncope a me ka hopu ʻana i ka naʻau me ka ʻole o ka ʻōlelo aʻo ʻana, ʻo ka ʻike i ka ʻike ʻana i ka hanu ʻana a me ka hana ʻana i nā hoʻopaʻa umauma kiʻekiʻe he mea nui ia no kēlā me kēia ʻohana. E hoʻopaʻa inoa i kahi papa CPR a me ke kōkua mua ma o ke Keʻa ʻulaʻula, St John Ambulance, ka American Heart Association, a i ʻole kahi mea lapaʻau pilikia kūloko.

Nīnau pinepine

Should I take an adult Aspirin (325 mg) if I think I have a DVT in my leg instead of going to the hospital?

**No, do NOT try to self-treat a suspected DVT or Pulmonary Embolism at home with aspirin instead of going to the emergency room.** There is a fundamental pharmacological difference between an **arterial clot** (in a heart attack, where high-pressure blood flow is driven by sticky **platelets**, which aspirin blocks) and a **venous clot (DVT / PE)** (in slow-moving low-pressure veins, where clots are built out of a dense mesh of **fibrin protein** driven by the coagulation cascade). Aspirin is very weak against venous fibrin clots and **cannot stop an existing DVT from growing and breaking loose into a fatal Pulmonary Embolism**. True DVT and PE treatment requires prescription **anticoagulant medications**, such as Direct Oral Anticoagulants (DOACs like apixaban/Eliquis or rivaroxaban/Xarelto) or injectable Low-Molecular-Weight Heparin (enoxaparin/Lovenox), started immediately after an emergency ultrasound or CT angiogram.

Do "blood thinners" (anticoagulants like Eliquis, Xarelto, or Warfarin) actually dissolve the blood clot right away?

Despite the popular nickname "blood thinners," standard anticoagulant medications **do not actually thin the viscosity of your blood and do not directly dissolve the existing clot on contact**. Instead, anticoagulants immediately **halt the clotting cascade so the clot stops growing bigger and cannot form a fragile new tail that breaks off into your lungs**, giving your body's own natural internal clot-busting enzyme (*plasmin / fibrinolysis*) the next **2 to 12 weeks** to gradually dissolve, shrink, and remodel the clot safely against the vein wall. (Only in life-threatening *Massive PE with shock* or limb-threatening *Phlegmasia* do hospital ICU doctors infuse aggressive "clot-buster" *thrombolytic* drugs like tPA or use mechanical suction catheters, because thrombolytics carry a high risk of brain bleeding).

Can you get a DVT blood clot in your arm, shoulder, or neck instead of your leg?

**Yes.** About **5 to 10 percent of all Deep Vein Thromboses occur in the upper extremities** (the axillary, subclavian, or internal jugular veins in the arm, shoulder, and neck), and they can also break loose and cause a Pulmonary Embolism. Upper-extremity DVT happens in two primary groups: **(1) Medical patients with indwelling central venous catheters, PICC lines, chemotherapy ports, or cardiac pacemaker wires** running through the vein under the collarbone; and **(2) Young athletes, weightlifters, swimmers, baseball pitchers, or painters/mechanics ("Paget-Schroetter Syndrome" / Effort Thrombosis)** who perform repetitive overhead arm movements where the collarbone and first rib pinch the subclavian vein (*Thoracic Outlet*). Warning signs include **sudden swelling of one entire arm and hand, a heavy aching shoulder/arm, bluish/reddish skin tint on that arm, and visible dilated veins across the front of the chest and shoulder**.

Why are pregnant women and new mothers in the first 6 weeks after giving birth at such high risk for DVT and PE?

Pregnancy and the **postpartum period (especially the first 6 weeks after vaginal delivery or Cesarean section)** represent the highest-risk window for venous blood clots in young women, carrying a clot risk **5 to 20 times higher** than non-pregnant women of the same age. All three parts of Virchow's Triad converge at once: (1) the placenta and hormones massively increase clotting factors (fibrinogen and Factor VIII) while lowering natural Protein S to protect the mother from bleeding to death when the placenta detaches; (2) the heavy uterus physically compresses the **left common iliac vein** in the pelvis (which is why **over 80% of pregnancy DVTs occur in the LEFT leg**); and (3) childbirth or C-section surgery causes pelvic vein endothelial trauma and reduced mobility. Any pregnant or postpartum mother with **one-sided leg/groin swelling or sudden shortness of breath** must be evaluated immediately in an emergency room (never dismissed as "normal pregnancy swelling or tiredness").

What is "Homans' Sign" (pulling the toes up to check for calf pain) and why do doctors say not to rely on it?

Older first aid books taught **Homans' Sign**, forcibly flexing the patient's foot upward at the ankle (*dorsiflexion*) to see if it causes pain in the back of the calf. Modern clinical medicine has completely abandoned Homans' Sign for two critical reasons: **(1) It is wildly inaccurate**: Clinical studies proved Homans' Sign is absent in over **60% of people who actually have a dangerous DVT**, and positive in over **50% of people who just have a pulled muscle or sciatica**, giving a false sense of security. **(2) Theoretical dislodgement risk**: Violently jerking the foot upward stretches the deep calf veins around a fresh thrombus. Never use toe-pulling tests to "rule out" a blood clot, only a D-dimer blood test and a venous duplex ultrasound can safely rule out a DVT.

What is the difference between a superficial blood clot (Superficial Thrombophlebitis) and a Deep Vein Thrombosis (DVT)?

Your legs have two vein systems: **superficial veins** right under the skin (including varicose veins) and **deep veins** buried deep inside the calf and thigh muscles next to the bones. **Superficial Thrombophlebitis** is a clot and inflammation in a surface vein, you can usually feel it with your fingertips as a **tender, warm, red, cord-like hard lump right under the skin**, without swelling of the entire lower leg. However, while superficial phlebitis used to be considered completely benign, ultrasound studies show that **up to 20 to 25 percent of people with extensive superficial clots in the thigh (especially in the Great Saphenous Vein within 3 to 5 cm of the groin crease) also have an underlying DVT or see the clot grow inward into the deep vein system**. Therefore, any suspected superficial vein clot still requires a medical ultrasound evaluation.

Nānā ʻia nā kumu

  • Na Center for Disease Control and Prevention (CDC): Venous Thromboembolism (Blood Clots): Hooki i ka Clot, Hoolaha i ka Huaolelo Campaign, Risk Factors, and Long-Distance Travel Prevention (United States).
  • American Society of Hematology (ASH): Nā Hoʻomaʻamaʻa Kauka no ka mālama ʻana i ka Thromboembolism Venous: ʻIke a me ka mālama ʻana i ka DVT a me ka Pulmonary Embolism (United States / International).
  • European Society of Cardiology (ESC): *Alakaʻi no ka ʻike a me ka mālama ʻana i ka maʻi maʻi maʻi maʻi maʻi * (European Union).
  • National Institute for Health and Care Excellence (NICE) & NHS: Venous Thromboembolic Diseases: Diagnosis, Management, and Thrombophilia Testing (NG158) (United Kingdom).
  • Ahahui Puʻuwai ʻAmelika (AHA): Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (United States).
  • Thrombosis Canada & World Health Organization (WHO): Nā alakaʻi lapaʻau no Deep Vein Thrombosis, Pregnancy-Associated VTE, a me ka WHO WRIGHT Project on Travel Hazards (Kanada / International).

Nā alakaʻi pili