371: Medical/Surgical

Question 1

What are the 3 categories of the Glasgow Coma Scale (GCS)?

Answer 1

1. Eye opening
2. Verbal response
3. Motor response

Max score = 15
Lowest score = 3

“Less than 8, intubate”

Question 2

Pancytopenia

Answer 2

Entire CBC is suppressed, marked decrease in number of RBCs, WBCs, and platelets

Question 3

What are the 3 proteins in blood plasma?

Answer 3

1. Albumin (58%)
2. Globulin (38%)
3. Fibrinogen (4%)

Question 4

What causes a decrease in RBC production?

Answer 4

1. Deficient nutrients (iron, B12, folic acid)
2. Decreased erythropoietin
3. Decreased iron availability

Question 5

When are packed RBCs administered?

Answer 5

1. Severe or symptomatic anemia
2. Acute blood loss

1 unit = increased Hb by 10

Question 6

When are platelets administered?

Answer 6

1. Bleeding caused by thrombocytopenia

Platelet = < 10-20 x 109/L

Question 7

When is albumin administered?

Answer 7

1. Helps fluid balance
2. Hypovolemic shock
3. Hypoaluminemia

Question 8

When is Fresh frozen plasma administered?

Answer 8

To improve clotting

1. Bleeding causes by deficiency of clotting factors (ex. Vitamin K, excess warfarin, hemorrhage, etc)

Question 9

When is cryoprecipitate administered?

Answer 9

Replaces clotting factors fibrinogen and factor 7

Question 10

What is the procedure for administering blood products?

Answer 10

1. Patient has stable vitals for 30min before administration
2. Test dose of 50ml/hr for the first 15min
3. Reassess vitals and pt after 15min
4. Complete transfusion within 4 hours of removal from storage
5. Flush tubing with NS
6. Acute reactions may occur up to 6 hours post transfusion

Question 11

What is a mild allergic reaction to blood products and how would it be managed?

Answer 11

Uticaria (hives), itchiness, or rash in less than 2/3 of body

1. Antihistamines or steroid

Question 12

What is an extensive allergic reaction of blood products and how would it be managed?

Answer 12

Symptoms in love more than 2/3 of body’s surface

1. DO NOT RESTART TRANSFUSION
2. Administer antihistamine or steroid

Question 13

How would you manage a febrile non-hemolytic transfusion reaction?

Answer 13

1. Stop transfusion
2. Run NS TKVO
3. Check vitals, re-check blood product and or ID, notify MD and blood bank
4. Administer Tylenol (antipyretic)
5. Meperidine (Demerol) 25-50mg IV for severe rigours if no contraindications

Question 14

How would you manage bacterial sepsis from a blood transfusion?

Answer 14

S/S: rigors, fever, tachycardia, hypotension, n/v, dyspnea, disseminated intravascular coagulation

1. STOP Transfusion
2. Run NS TKVO
3. Check vitals, re-check blood product and pt ID, notify MD and Blood Bank, send the blood
4. Broad-spectrum antibiotics

Question 15

How do you manage an Acute Hemolytic Transfusion Reaction?

Answer 15

Incompatible blood, RBC breaking doe. And hemolysis in patient.

S/S: fever, chills, hemoglobinuria, pain, hypotension, n/v, dyspnea, renal failure, DIC

1. STOP Transfusion
2. Group and Screen
3. Urine sample

Question 16

How would you manage Transfusion-Related Circulatory Overload (TACO)?

Answer 16

S/S: dyspnea, orthopnea, cyanosis, tachycardia, increased venous pressure, and hypertension

1. STOP TRANSFUSION
2. Run NS TKVO
3. Check vitals, re-check blood product and pt ID, notify MD, notify blood bank and send blood
4. Oxygen
5. Diuretics
6. Chest X-ray
7. ABG
8. Additional BW

Question 17

How would you manage Transfusion Related Acute Lung Injury (TRALI)?

Answer 17

Acute hypoxemja with new bilateral lung infiltrates due to antigen-antibody interactions.

1. STOP TRANSFUSION
2. Run NS TKVO
3. Check vitals, re-check blood product and pt ID, notify MD, notify blood bank and send blood
4. Group and Screen
5. Chest X-ray
6. Blood gases
7. Vasopressors and Respiratory Support