Development of Thrombi and Thrombosis (Nursing)

00:01 Hey, thrombi happen.

00:03 So let's talk about what these gel-like masses of platelets and fibrin really are.

00:08 This is an example of what happens in a body that's not taking antiplatelets, anticoagulants or thrombolytics.

00:16 Okay. Now, I use this example cuz it's something that's happen to me in more than one occasion.

00:21 You're making dinner and I cut my thumb because I'm in a hurry and I'm trying to go too fast.

00:26 So you've cut your finger which first that hurts. Next, what happens in the body? Why don't I bleed to death from a cut in my thumb? Well, if my body is clotting appropriately, let's walk through the first step.

00:39 First of all the platelets they're in my circulation they form this little plug because they stick to the cut edges of the vessel.

00:47 Now, these platelets that get there first release these chemicals that attract more platelets to come.

00:54 So that's what stops your finger from bleeding externally.

00:57 So once you get to that point when all the platelets have got there, they'll stop the bleeding externally, but there's still more work to be done internally.

01:07 See the clotting factors cause these fibrin strands to stick together and they seal the wound from the inside.

01:13 So first, the platelets stick to the cut edges of the vessel.

01:18 They attract more platelets and they form a plug.

01:21 So now we shouldn’t have bleeding to the outside.

01:24 But the next step, the clotting factors cause these fibrin strands to stick together and they seal the wound from the inside.

01:31 Finally, the wound will heal and the blood clot will dissolve. Is that not super cool? The body just dissolves it with the work of this enzyme called plasmin.

01:41 Should take a couple days for that to happen. Now that's normal.

01:45 That's the process that happens in thrombi. One, two, three.

01:50 Now, what I want you to do is to pause the video and see if you can write this in your own words.

01:56 Don't write out all the words, but write out step one, two and three.

01:59 Who are the major players? What happens in your own margin of your notes? Okay. So when a blood clot is carried in the blood stream it lodges itself in a vessel.

02:17 Now, we have a problem. So, let's say the blood clot is in a little more serious spot.

02:23 I actually had a pulmonary embolism and it was one of the most scariest things I've ever experienced.

02:30 I can tell you exactly when that clot broke off from my leg and when it travel through my body and lodge itself in my pulmonary vessels.

02:39 The world went dark. I saw stars. I passed out and then I had to woke back up and really felt miserable.

02:47 I was extremely short of breath. I couldn’t breathe, I couldn't walk, I couldn't move and I was all at home alone.

02:55 Now, what every nurse does is and just waits a few minutes and thinks she can push through it.

02:59 But luckily I ended having a friend take me to the hospital, and I was able to get really good care.

03:05 But that was the problem, I had a blood clot.

03:08 Somehow I had a damaged vessel in my leg and clots built up there.

03:12 We call those deep vein thrombosis or DVT.

03:16 So because of some predisposing factors that I had and some immobility and I was extremely dehydrated, I had some clots developed, broke off, travel through the blood stream when it lodges itself in a really important vessel like my pulmonary supply.

03:32 That's why I had a pulmonary embolism.

03:35 Now, think where your heart is and where your lungs are.

03:39 If I've got a big clot in that area.

03:41 The heart is gonna have a hard time, the lungs are gonna have a hard time, and it actually threw me into heart failure because my heart was having to work so hard to try and get blood past that big clot. It had made the diameter of the vessel so very tiny.

03:56 That is the worst case scenario, is the death of a tissue that's not getting adequate blood supply.

04:02 Now, the part that made my pulmonary embolism so traumatic for me was that the very first patient I saw die when I was a nursing student had a pulmonary embolism.

04:13 She was this lovely elderly lady and I had taken care of her for several days in a row.

04:19 She had a great sense of humor and while she was talking to me one time, she got this look and just was gone.

04:27 I called the code. The code team rushes in which is always traumatic, and she was blue from here up.

04:34 There was no rescuing her. Her clot had lodged in a place where they could not get any blood supply through.

04:41 So CPR and the whole code team, nothing they could do to bring her back.

04:46 So that was the memory I had in my brain when I found out that I had been diagnosed with a pulmonary embolus.

04:53 Now, I did not have a severe effect obviously cuz I'm talking to you today as that patient had.

04:59 But I wanna tell you, it is traumatic. You will never forget that experience.

05:05 So we wanna do everything we can to help patients avoid going through that.

05:10 So, examples of when a clot might be an innaculous clot.

05:15 Might be something that was beneficial or in my case, it was because of my risk factors to develop clots and I was immobile a lot because I've been really, really sick and I was extremely dehydrated.

05:27 All those added to the clot building up in my leg, and then it broke off and lodged and gave me a pulmonary embolus.

05:34 So mine was not death but people can die from a pulmonary embolism.

05:39 If that clot lodges in the blood supply to my heart that would cause a myocardial infarction or a heart attack.

05:46 Now DVT, it can lodge in your lower legs that's where mine initiated but it broke off and gave me even more trouble in my lungs.

05:55 Lastly, embolic stroke. So thrombi happen and that’s a good thing.

06:01 If I'm cooking dinner or I have surgery. I want clots.

06:05 But when clots break off and travel to other places and they block off really important blood supplies.

06:11 Now, we've got some life threatening emergencies.

06:14 Okay, so you've got an idea of what a problem clots can be but let's talk about a clot, the differences of them in an artery or a vein.

06:24 See, in arterial blood clot, this is how it starts.

06:26 There's some damage to the arterial wall or some raptured plaque, right? Talk about atherosclerosis. Those types of things going on.

06:33 So either the arterial wall has been damaged or some of the plaque is raptured and broke off.

06:39 Well, then platelets are here to the damage. Just like they did when I cut my finger cooking dinner.

06:44 Now after they adhere, platelets release ADP and TXA2.

06:51 See, that's why we can look at those special lab test to help us kinda keep an eye on that.

06:56 So those two things ADP and TXA2 attract more platelets.

07:02 Alright, so an arterial blood clot usually comes from damaged to the arterial wall or maybe a rapture of plaque.

07:09 Platelets adhere to the damage, that's their job.

07:12 And then they release these substances ADP and TXA2, and that's what attracts more platelets.

07:19 Now, a venous blood clots a little different.

07:21 When we say deep vein thrombosis, that's what we're talking about a venous clot.

07:27 That means that the blood flow is kinda sluggish all the way down there, it's slow and it's stagnant.

07:33 It's very different than an arterial blood clot. That initiates the coagulation cascade which produces that fibrin, right? Which really really sticky. So venous blood clot is a lot slower and stagnant.

07:48 Now, how you can remember that is your arterial blood pressure is much higher, right? That's blood being pushed out to the rest of the body.

07:54 The venous pressures are lower because that's blood returning back to the heart.

07:59 So that's another reason why the blood flow is really slow and stagnant particularly problematic for people in their lower extremities.

08:06 If they stand a lot or if they sit, they don't move around very much, that can be a real problem.

08:12 So, when this blood gets real sluggish and hangs out down there, that’s what initiates the coagulation cascade.

08:19 You've got the fibrin and now you got this net of fibrin that collects our red blood cells and platelets and makes a clot.

08:27 Okay, so an arterial blood clot there is an injury.

08:30 And that's where the platelets gathered and that's why they connect it and they made a plug.

08:34 But where venous blood clot everything is really slow and stagnant.

08:41 Think of it kinda like a sloth. Just kind of barely moving around, right? That kicks in the coagulation cascade, we got all these extra fibrin, and then I've got a net and that net catches the red blood cells and the platelets and that makes a giant clot.

08:58 These can get pretty big.