TOPIC 9. ARTERIAL TROMBOSIS AND EMBOLISM

Change your attitude

Objective: To emphasize the fact that situations depend largely on the attitude with which we view them.

Requirements: Pen and paper.

Total time for the exercise: 20 to 30 minutes

Trainer notes:

Ask the participants to make a list of their feelings when they go for work.

Then ask the participants to make a list of their feelings when they are at play, relaxing, doing leisurely activities.

Then ask the participants to make a list of things that are common to both the situation.

Then ask the participants to share their feelings about work.

Expect to hear

● Dull

● Stressed out

● Frustration

● Not getting due

● Mundane

● Routine

Then ask the participants to share their feelings about play/relaxation?

Expect to hear

● Joyful

● Enthusiastic

● Enjoying every moment

● Feel great, fabulous

Then ask the participants what is the common factor in both these types of situations?

Expect to hear

● Me!

Then you can say,

How we are in situations and how situations shape up for us, depends on one consistent factor and that is You.

Our attitude towards the situations is of prime importance because that will steer us through the situations and will determine the course. Whether we brood in situations or smile through them and get up and do something, is all up to us.

“The price of excellence is discipline. The price of mediocrity is disappointment.”

ICE BREAKERS

Oranges & Peaches

Purpose

The aim is to have fun and make the participants feel energetic.

● Ask the participants to make a circle. Tell them that you will call out a few words and

each word will have a corresponding action. When you say oranges, the participants

must jump ahead, when you say apple, the participants must jump back, peaches means

that the participants must jump to the left and strawberry means the person must jump to

the right.

● Those who do not do the action when the name is called loud, are dismissed from the

game.

● Allow the participants to practice for a few rounds.

Facilitator notes

The trainer must be enthusiastic. Once the game sets in, the trainer must call out the names rapidly and must mix n match the names.

ALL RIGHT – OK

Every time, you, facilitator, says “alright”, your participants respond with “OK”. Each time you say “OK”, your participants respond with “alright”.

This game is played for the rest of the progression.

CREATIVE HAND SHAKE

● Instruct the participants to find three people they don’t know (one at a time), shake their

hand and look them in the eye.

● Now find three more people you don’t know, and one at a time look them in the eye,

and perform high fives.

● Now find three more people you don’t know, look them in the eye, and perform over

the back high fives.

● Finally, find the only remaining three people in the room you don’t know, look them in

the eye, and create, between you and your partner, a completely “new” handshake. Each

of the three handshakes must be unique (although all of your participants will be

watching and learning from the creative attempts going on around them).

● Ask any pair who is particularly proud of their handshakes to demonstrate for the whole

group.

TRAIN MASSAGE

Purpose: Icebreaker to be played at the end of the day with any group.

● Ask the class to divide themselves into two groups, one for males and the other for

females and ask each group to form a line.

● Then ask each person to massage the person in front of him and keep the train moving.

● The trainer must keep giving instructions like “Tickle the person, no go chop chop

chop”.

Facilitator notes

Important for the trainer to be enthusiastic and must rapidly give instructions.

Sow a thought, and you will reap a word;

Sow a word, and you will reap an action;

Sow an action, and you will reap a habit;

Sow a habit, and you will reap a character.

Sow a character, and you will reap a destiny.

TOPIC 9. ARTERIAL TROMBOSIS AND EMBOLISM

ACUTE UPPER EXTREMITY ISCHEMIA

Acute ischemia in the upper extremity constitutes 10–15% of all acute extremity ischemia. The etiology is emboli in 90% of the patients. The reason for this higher rate compared with the leg is that atherosclerosis is less common in arm arteries. Emboli have the same origins as in the lower extremity and usually end up obstructing the brachial artery. Sometimes plaques or an aneurysm in the subclavian or axillary arteries is the primary source of emboli. Embolization to the right arm is more common than to the left due to the vascular anatomy. For the 10% of patients with atherosclerosis and acute thrombosis as the main cause for their arm ischemia, the primary lesions are located in the brachiocephalic trunk or in the subclavian artery. Such pathologies are usually asymptomatic due to well-developed collaterals around the shoulder joint until thrombosis occurs, and they cause either micro- or macroembolization. Other less frequent causes of acute upper extremity ischemia are listed in Table 1

Table 1. Less common causes of acute upper extremity ischemia

Subclavian artery thrombosis is a condition in which the blood flow through the vessel is obstructed. The condition usually occurs secondary to some form of antecedent injury to the vessel, hypercoagulable state, or atherosclerotic changes. The condition is common in young athletic individuals who exert a significant amount of upper body activity. Sudden occlusion from emboli followed by thrombosis of the artery is common in the population with signs of significant atherosclerotic disease.

The patient presenting with acute subclavian artery occlusion usually has a history of repetitive use and/or stress injury to the upper extremity on the affected side. A history of upper extremity claudication is common.

In situations in which the occlusion is secondary to atherosclerosis, acute thromboses of the artery are generally asymptomatic. In fact, in 9% of autopsy series, the left subclavian artery was either stenotic or occluded. If symptoms are present, upper extremity claudication on the affected side is most common. The patient may also present with dizziness, vertigo, imbalance, visual disturbances, or hemisensory dysfunction indicative of a subclavian steal syndrome. However, note that subclavian steal is observed on 2% of cerebral angiograms and causes no symptoms.

Date: 2014-12-29; view: 1162