1. PHLEGMASIA Tracy Groller & Deb Halliday Journal Article Presentation MEDU 610 Professor: Camie Modjadidi April 7, 2011

2. OBJECTIVES  Define Phlegmasia  Understand the Disease Process  Understand the Treatment Options  Care of the Phlegmasia Patient

3. NORMAL BLOOD FLOW  YouTube - CIRCULATION YouTube - CIRCULATION

4. DEEP VEIN THROMBOSIS FORMATION  YouTube - How DVT forms YouTube - How DVT forms

5. 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).

6. CAUSES OF PHLEGMASIA  Pregnancy  May-Thurner’s Syndrome (Compression)  Surgery  Trauma  Malignancy  Untreated DVT Vena Cava ( Filter) Legs

7. 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)

8. PHLEGMASIA ALBA DOLENS

9. 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

10. PHLEGMASIA CERULA DOLENS

11. DIAGNOSTIC STUDIES  Non-Invasive (Without Puncture) Ultrasound—Most Reliable MRI/MRV  Invasive (With Puncture) Venogram

12. COMPLICATIONS OF UNTREATED PHLEGMASIA  Pulmonary Embolism  Valvular Insufficiency  Venous Gangrene/Ulceration  Limb Death  Death

13. TREATMENT OPTIONS  Anticoagulation  Possible Inferior Vena Cava Filter  Mechanical Debulking YouTube - Thrombectomy animation

14. TREATMENT OPTIONS  Catheter Direct Thrombolysis (CDL) TPA/Retavase (Clot Buster)  Stenting

15. TREATMENT OPTIONS  Surgical Thrombectomy  Fasciotomy Compartment Syndrome Treatment  Amputation

16. 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

17. BLOOD CLOT CYCLE DECREASED RETURN BLOOD FLOW ACUTE BLOOD CLOT CHRONIC BLOOD CLOT RESOLVE

18. 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://emedicine.medscape.com/article/461809-print  http://medical-dictionary.thefreedictionary.com/phlegmasia http://medical-dictionary.thefreedictionary.com/phlegmasia  “Thrombectomy Animation” Retrieved from YouTube 4/2/11.