1-49
1-49. LIFE THREATENING COMPLICATIONS
a. Pulmonary Embolism. Pulmonary embolism is the occlusion of the pulmonary arteries by a thrombus originating in the venous system. Patients with lower extremity fractures are most susceptible to pulmonary embolism due to their relative
inactivity. This condition may occur with or without symptoms. If symptoms do occur, they may present as substernal pain, dyspnea, apprehension, weak and rapid pulse, shock, or simply a subtle deterioration of the patient's condition for no obvious reason. The treatment ordered by the physician will be symptomatic and normally involves the use of anticoagulant therapy and elastic stockings.
b. Fat Embolism. In fat embolism, fat droplets enter the circulatory system, obstructing blood flow and causing inflammatory reactions in the affected vessels. Onset usually occurs within 24-72 hours after injury. Fat emboli in the lungs may result in defective transfer of respiratory gases, causing dyspnea and air hunger. Some emboli may affect the central nervous system and cause restlessness and confusion. Again, treatment addresses the signs and symptoms. Oxygen is normally administered and, if necessary, the physician will order intubation and mechanical ventilation.
Anti-inflammatory and diuretic medications will often be used as well.
c. Gas Gangrene. Gas gangrene is a severe infection of skeletal muscle caused by the bacteria Clostridium. These bacteria are anaerobes and spore formers normally found in soil and in the intestinal tract of man. Gas gangrene occurs most often in wounds that have been grossly contaminated at the time of
injury, in wounds that have a small but deep open wound area, and in wounds that have a compromised blood supply and therefore a decreased oxygen supply. Gas gangrene causes production of toxins and decomposition of tissue. Necrotic tissue will produce gas bubbles, which are evidenced by crepitus (crackling) in the soft tissue, along with severe pain and edema. Nursing personnel should observe for signs of apprehension, fever, chills, increased pulse, increased respiratory rate, and frothy foul-smelling drainage from the wound. Strict nursing observation is critical for patients with susceptible wounds because gas gangrene will often progress to a severe stage deep in the tissue before any signs or symptoms become evident. In treating gas gangrene, the physician will open the wound for debridement and irrigation. Antibiotic therapy and hyperbaric oxygen therapy will be initiated. Frequently, amputation of the affected extremity is necessary.
d. Tetanus. Tetanus is an acute infection caused by the tetanus bacillus, another anaerobic spore former. The bacteria is introduced through a wound that has been contaminated with soil, feces, or dust. Toxins that have an affinity for nervous tissue cause hyperirritability, restlessness, muscle rigidity, and tonic muscular spasms of almost every muscle group. The patient may have difficulty opening the mouth due to spasm of facial muscles. Tetanus is sometimes referred to as "lockjaw" for this reason. Treatment is similar in nature to that of gangrene, with the addition of anti-convulsive drugs.
