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PHLEGMASIA
Tracy Groller & Deb Halliday Journal Article Presentation
MEDU 610Professor: Camie Modjadidi
April 7, 2011
OBJECTIVES
Define Phlegmasia
Understand the Disease Process
Understand the Treatment Options Care of the Phlegmasia Patient
NORMAL BLOOD FLOW
YouTube - CIRCULATION
DEEP VEIN THROMBOSIS FORMATION
YouTube - How DVT forms
DEFENITIONS Phlegmasia /phleg·ma·sia/ (fleg-ma
´zhah)- Old term for inflamation of the veins caused
by Deep Venous Thrombosis (DVT) which is a blood clot.
Phlegmasia al´ba do´lens-Milk leg; DVT of the femoral vein with swelling of the leg.
Phlegmasia ceru´lea do´lens- An acute form of DVT, with pronounced
edema (swelling) and severe cyanosis (blue discoloration) of the limb (leg/arm).
CAUSES OF PHLEGMASIA
Pregnancy May-Thurner’s
Syndrome (Compression)
Surgery Trauma Malignancy Untreated DVT
Vena Cava (Filter)
Legs
PHLEGMASIA ALBA DOLENS
Pathophysiology Clot Affects Deep Veins Return of Some Blood Flow Less Severe
Symptoms Edema (swelling) Pain Blanching (white leg) without cyanosis
(blue leg)
PHLEGMASIA ALBA DOLENS
PHLEGMASIA CERULA DOLENS
Pathophysiology Clot Affects Deep and Superficial Veins Mostly found in Left Leg Absolutely No Return of Blood Flow
Symptoms Severe Edema (Significant Swelling) Agonizing Pain Cyanosis (Blue Color) Loss of Movement Loss of Feeling Compartment Syndrome—which may lead to
limb loss
PHLEGMASIA CERULA DOLENS
DIAGNOSTIC STUDIES
Non-Invasive (Without Puncture) Ultrasound—Most
Reliable MRI/MRV
Invasive (With Puncture) Venogram
COMPLICATIONS OF UNTREATED PHLEGMASIA
Pulmonary Embolism
Valvular Insufficiency
Venous Gangrene/Ulceration
Limb Death
Death
TREATMENT OPTIONS
Anticoagulation
Possible Inferior Vena Cava Filter
Mechanical Debulking
YouTube - Thrombectomy animation
TREATMENT OPTIONS
Catheter Direct Thrombolysis (CDL) TPA/Retavase (Clot
Buster)
Stenting
TREATMENT OPTIONS
Surgical Thrombectomy
Fasciotomy• Compartment
Syndrome Treatment
Amputation
CARE FOR THE PHLEGMASIA PATIENT
Vital Signs (O2 Sat)
Bedrest with Limb Elevation
Pulse Evaluation
Motor and Neurological Function
Wound Assessment and Care
Catheter-Direct Thrombolysis Patient Care
BLOOD CLOT CYCLE
RESOLVECHRONIC
BLOOD CLOT
ACUTEBLOOD CLOT
DECREASED RETURN BLOOD FLOW
REFERENCES
"Blood Flow" Retrieved from YouTube 4/2/11.
Dardik, A., Rahhal, D. (2009). Phlegmasia alba and cerulea dolens. Retrieved from: http://emedicine.medscape.com/article/461809-print.
http://medical-dictionary.thefreedictionary.com/phlegmasia
“Thrombectomy Animation” Retrieved from YouTube 4/2/11.