Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

ACUTE > ACUTE HAEMORRHAGE > Flashcards

ACUTE HAEMORRHAGE Flashcards

1
Q

Calculate cardiac output?

A

BP/systemic vascular resistance
HR x stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 main pathophysiologies behind shock?

A

Cardiogenic - decreased CO e.g. MI, PE, tamponade
Systemic vascular - increased systemic vascular resistance e.g. sepsis, anaphylaxis, spinal shock
Reduced stroke volume caused by fluid loss e.g. haemorrhage, D&V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can we use the JVP to work out the cause of shock?

A

If it’s high with bibasal creptiattions and pt is cold = likely carcinogenic
If low with postural hypotension and cold = likely hypovolaemia
If low with a bounding pulse and warm = likely septic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the definition of shock clinically?

A

Persistently low BP systolic <90 (or a reduction in 30mmHg if hypertensive usually) AND altered end-organ function e.g. oliguria or confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does haemorrhage present?

A

Pallor
Tachycardia
Clammy
Hypotension - this is actually a late sign of shock!
May be obvious source of bleeding
May have cullens sign of gray turner sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is cullens sign and what can it indicate?

A

a physical exam finding of ecchymoses, or bruising, around the umbilicus.
Caused by intrabdominal haemorrhage - most commonly pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is grey turners sign and what can it indicate?

A

ecchymosis or discoloration of the flank
A sign of intra- or retroperitoneal haemorrhage. Most commonly pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Outline the response of the heart rate in shock?

A

Biphasic response to volume loss - initial vasoconstriction and tachycardia followed by a bradycardia
(This is why absence of tachycardia does not exclude a life threatening haemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Examinations you should do if you suspect a haemorrhage?

A

Inspect pt for obvious sources of bleeding
Assess abdomen and flanks
Do a PR
Assess long bones and pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Class 1 haemorrhage signs?

A

Blood loss <750ml or <15%
HR <100
Normotensive
RR 14-20
Urine output >30ml/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Class 2 haemorrhage signs?

A

Blood loss 750-1500ml or 15-30%
HR 100-120
Normotensive
RR 20-30
Urine output 20-30ml/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Class 3 haemorrhage signs?

A

Blood loss 1500-2000ml or 30-40%
HR 120-140
Decreased BP
RR 30-40
Urine output 5-20ml/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Class 4 haemorrhage signs?

A

Blood loss >2000ml or >40%
HR >140
Decreased BP
RR >40
Urine output <5ml/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which groups of pt should you have a very low threshold for suspecting life-threatening haemorrhage?

A

Pregnant
Trauma cases
Recent surgical procedures
GI bleeds
?ruptured AAA
Pt on anticoagulants, who have hypertension or liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the common causes of life threatening bleeds?

A

Scalp and external causes
Abdomen
Pelvis
Chest
Long bones
Retroperitoneal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the “lethal triad” in acute haemorrhage in trauma patients?

A

Coagulopathy
Hyperthermia
Acidosis

These 3 things are irreversible and have a grave prognosis as the latter 2 both synergistically affect coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Outline how each aspect of the lethal triad impact prognosis in acute haemorrhage?

A

Hypothermia - impairs platelet function and enzymatic function in the clotting cascade
Acidosis - impairs clotting
Coagulopathy - impaired ability of the coagulation system to synthesize blood clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can cause hypothermia in trauma patients?

A

Haemorrhagic shock
TBI
Alcohol intoxication impairing the ability to regulate core temperature
Extremes of age
Prolonged exposure to environment
Those with severe burns
With medical conditions such as diabetes and thyroid disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes acidosis in trauma patient as?

A

Poor perfusion to tissues causing lactic acidosis - due to anaemia from acute blood loss, peripheral vasoconstriction in response to hypothermia and blood loss etc
Excessive resuscitation using unbalanced Crystalloids solutions can also cause acidosis
A pt may also have respiratory acidosis due to hypoventilation e.g. resp depression narcotic use, TBI, flail chest, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do we prevent hypothermia in trauma pts?

A

Limit exposure
Remove wet clothing
Using warming blankets
Use warm fluids and blood products
Keep room warm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do we prevent acidosis in trauma patients?

A

Haemostatic resuscitation and limit crstalloid infusions as much as possible!
Monitor and maximise oxygenation to avoid additional respiratory acidosis
Treat causes of hypoventilation to prevent respiratory acidosis
Measure lactate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do we manage/prevent a coagulopathy in trauma patients?

A

Limit use of crystalloids or unbalanced blood products which could cause a dilutional coagulopathy
Identify high-risk patients with a baseline coagulopathy due to meds or pre-existing medical conditions
Administer TXA to prevent clot breakdown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Investigtaions for haemorrhage secondary to trauma?

A

Establish IV access with 2 wide bore cannulas
Bloods - FBC, U&Es, LFTs, Coag study, ABG/VBG, group and save, emergency cross-match
CT angiography
Pan-CT
FAST USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the gold standard investigation for finding the source of a bleed in acute haemorrhage?

A

CT angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When is FAST ultrasound used in trauma cases?
When suspecting trauma that could cause hemoperitoneum and hemopericardium Good when CT is not possible immediately
26
What is a group & save?
Determines the patient’s blood group is.e. ABO and RhD and screens the blood for any atypical antibodies The process takes around 40 minutes and no blood is issued.
27
What is a crossmatch?
When you physically mix the patient’s blood with the donors blood to check for immune reactions This process taes about 40 minutes but on top of a G&S which must be done before!
28
When would you do group & save and when would you do a crossmatch?
Group & save for when blood loss is not anticipated by blood may be required if greater blood loss than anticipated. Usually patients undergoing planned surgeries that may require transfusion, ideally have samples for group and save taken at preadmission clinics. Cross match is done when blood loss is anticipated
29
Definition of major haemorrhage?
The loss of 1 blood volume (70ml/kg) in 24 hours OR The loss of 50% of the circulating blood within 3 hours OR The loss of blood at a rate >150ml/min
30
Normal blood volume in adults?
70ml/kg
31
Principles of haemorrhage control?
Involve specialities early on Control the bleed: Direct pressure, tourniquet, pelvic binder etc Reversal of any anticoagyulkants Give tranexamic acid Replace lost blood volume: Replace with 1:1 ratio of units of plasma:red cells Use the permissive hypotension approach Avoid the lethal triad of hypothermia - keep pt warm, maximise oxygenation and treat hypoventilation, avoid unbalanced blood products and Crystalloids
32
What is the permissive hypotension approach?
Maintaining a blood pressure lower than physiologic levels in a patient that has suffered from hemorrhagic blood loss. Aim for systolic 80-90 This is to maintain adequate vasoconstriction, organ perfusion, and prevent an undesired coagulopathy during initial fluid resuscitation
33
What is the minimal volume normotensive approach?
A method that looks at the mean arterial pressure and has a target MAP of 65mmHg. If MAP falls below this then fluids/blood is given and if MAP rises above this the fentanyl can be givento drop the MAP again. The aim is to prevent major haemorrhage whilst also maintains adequate perfusion
34
Why do we no longer do the traditional fluid resuscitation with 1-2L of crystalloids fluids in trauma pt with ?acute haemorrhage?
This can cause a dilutional coagulopathy, impaired oxygen delivery due to dilutional anaemia, hypothermia, worsening metabolic acidosis and clot dislodgement. It can also cause further haemorrhage from elevated blood pressure
35
Why can improper administration of crystalloids cause hyperchloremic metabolic acidosis?
As normal saline has a higher concentration of Cl- than blood
36
What are packed red cells stored in?
Sodium citrate, an anticoagulant solution, which functions by binding calcium
37
Whats the threshold for giving packed red cells?
Hb of 70 or 80 in ACS
38
How fast must packed red cells be transfused?
Must be completed within 4 hours from the time the unit is removed from the blood bank
39
How much will 1 unit of red cells increase the Hb by?
By 10g/L on average
40
Whats the target Hb when giving packed red cells?
70-90 80-100 if ACS
41
What is in fresh frozen plasma?
It contains all of the clotting factors
42
What is the thawing time for FFP?
20 minutes
43
What is the universal donor for FFP?
AB
44
Over what time is FFP given?
Over 30-60 minutes but must be used within 4 hours of removal from the blood bank
45
What is the standard adult dose for FFP?
15ml/kg which is 4 units
46
When is FFP indicated?
most suited for 'clinically significant' but without 'major haemorrhage' in patients with a PTratio or APTT ratio > 1.5
47
Storage requirements for platelets?
Stored at 22 degrees for 3-5 days so short supply
48
Threshold for giving platelet transfusion?
30x10^9 if clinically significant bleeding 100x10^9 if severe bleeding or bleeding at critical sites e.g. CNS
49
Target for platelets whilst giving platelet transfusion?
100x10^9
50
Which blood product has the highest risk of bacterial contamination?
Platelets
51
How fast should platelets be given?
Over 30 minutes and must be started within 30 minutes of removal from the lab
52
Which blood product does not need to be ABO comparable?
Platelets
53
What does cryoprecipitate contain?
Fibrinogen Factor 8 Von WIllebrand factor Factor 13
54
When is cryoprecipitate most suitable for?
Significant haemorrhage if fibrinogen <1.5 and uncontrolled bleeding due to haemophilia
55
How is cryoprecipitate made?
produced by further processing of Fresh Frozen Plasma (FFP).
56
Over what time is cryoprecipitate given?
15-20 mins
57
Who should recieve CMV-negative blood?
Pregnant women Intrauterine transfusion Neonates
58
Who should receive irradiated blood products and why?
Used to reduce the risk of graft vs host disease inat risk populations e.g. those receiving blood from first/second-degree family members, Hodgkin lymphoma, recent haematopoeitic stem cell transplants, after anti-thymocyte globulin or alematuzumab therapy, those receiving purine analogues as chemo and those with intrauterine transfuses
59
Observations during a blood transfusion?
Vitals must be recorded within 1 hour of transfusion. Start time 15 mins after start 1 hour after start Within 1 hour of completion time
60
Which cannulas must blood products be administered through and why?
Green or grey cannulas Otherwise the cells haemolyse due to sheering forces on the narrow tube
61
Before asking for a blood product what must you make sure is done?
Correct identification wrist band must be in place Observations must be recorded Verbal consent must be gained Product must be prescribed A patent green or grey cannula must be in place There must be enough stafff members to monitor the pt
62
How many qualified staff members must check the blood product before administration?
2
63
What is SHOT?
Serious Hazards Of Transfusion This is the UK’s leading haemovigilance scheme for adverse events and reactions in blood transfusions from all healthcare organisations. They produce recommendations to improve pt safety in annual reports
64
What are the SHOT 10 steps to transfusion?
Decision to transfuse and consenting of pt Request Sample taking Sample and request receipt Testing Component selection Component labelling Component collection Prescription Administration and monitoring for reactions + documentation
65
Complications of massive haemorrhage?
Hypothermia Hypocalcaemia Hyperkalaemia Delayed type transfusion reactions TRALI TACO Coagulopathy
66
Why can blood products cause hypocalcaemia?
FFP and platelets contain sodium citrate which can chelate calcium
67
Why can blood products cause hyperkalaemia?
Due to the (inevitable) partial haemolysis of the red blood cells and the resultant release of intracellular potassium
68
What is the leading cause of transfusion-related deaths?
TRALI
69
Which blood product has the greatest risk of TRALI?
Plasma components due to leukocyte antibodies causing aggregation and degdranulation of the leukocytes in the lung tissues
70
How do blood products affect coagulopathy?
Clotting abnormalities can occur due to a dilution effect, as the packed red cells transfused do not contain any platelets or clotting factors. Specific conditions like trauma also in themselves can cause coagulopathy. To reduce the risk of any clotting impairment, fresh frozen plasma and platelets should be administered concurrently, typically done for patients receiving more than 4 units RBCs
71
Management of a major bleed whilst on warfarin?
Stop warfarin IV vitamin K Prothrombin complex
72
Management of minor bleeding and an INR >8 whilst on warfarin
Stop warfarin IV vitamin K Restart warfarin when INR <5
73
Management of no bleeding and an INR >8 whilst on warfarin
Stop warfarin Oral vitamin K Restart when INR <5
74
Management of minor bleeding and an INR 5-8 whilst on warfarin
Stop warfarin IV vitamin K Restart warfarin when INR <5
75
Management of no bleeding and an INR 5-8 whilst on warfarin
Withhold 1-2 doses of warfarin and reduce the subsequent maintenance dose
76
Rules for pts on warfarin when they have a planned surgery?
Stop warfarin 5 days before surgery Oral vit K day before surgery if INR >=1.5
77
Rules for pts on warfarin when they have a planned surgery but they are considered high risk of VTE?
Warfarin stopped 5 days before surgery and oral vit K given the day before surgery if INR >=1.5 May require interim therapy with LMWh but this must be stopped at least 24 hours before surgery
78
Rules for pts on warfarin when they have an emergency surgery?
If the surg can be delayed 6-12 hours then give IV vitamin K If the surgery cannot be eluded then give prothrombin complex, IV vit K and check INR before surgery
79
Rules for pts on warfarin when they have an emergency surgery?
If the surgery can be delayed 6-12 hours then give IV vit K If surgery cannot be delayed then give prothrombin complex, IV vit K and check INR before surgery
80
What drug is used to reverse dabigatran?
Idarucizumab
81
What drug is used to reverse apixaban?
Andexanet Alfa
82
What drug is used to reverse rivaroxaban?
Andexanet Alfa
83
Why can blood transfusions cause hypothermia?
As blood products are thawed from frozen and then kept at cool temperatures, they may not be up to body temperature by time of transfusion, especially in a major haemorrhage protocol scenario. Rapid transfusion of these products can lead to a drop in the patient’s core temperature, hence regular monitoring of core body temperature is always required during a blood product transfusion.
84
What are the acute transfusion complications?
Acute haemolytic reaction Transfusion associated circulatory overload Transfusion related acute lung injury Mild allergic reaction Non-haemolytic febrile reactions Anaphylaxis Infective or bacterial shock
85
What are the delayed transfusion complications?
Infections e.g. hep B, HIV, syphilis Graft vs host disease Iron overload if repeated transfusions
86
What causes acute haemolytic reactions to blood transfusions?
ABO-incomparable blood e.g. giving wrong blood type - donor red cel;s are destroyed by the recipients pre-formed antibodies = haemolysis
87
How does acute haemolytic reaction present?
Usually within the first minutes of the start of the transfusion… Fever Abdominal and chest pain Hypotension May be haemoglobinuria from rapid haemolysis
88
Management of acute haemolytic reactions?
Stop transfusion Conform diagnosis - check identity of pt, blood product etc & send blood for direct Coombs testing and repeat typing/cross-matching Supportive care e.g. generous fluid resuscitation
89
What causes transfusion associated circulatory overload?
Excessive rate of transitions on pre-existing HF
90
Presentation of transfusion associated circulatory overload?
Pulmonary oedema Hypertension
91
Management of TACO?
Urgent CXR Slow or stop transfusion Consider if loop diuretic Oxygen if required Pts at risk of overload can be prescribed 20mg furosemide prophylactically during the transfusion to prevent this
92
What causes transfusion-related acute lung injury?
Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood A type of ARDS that has a high mortality
93
Symptoms of TRALI?
Within 6 hours of transfusion… Hypoxia Fever Hypotension
94
Management of TRALI?
Stop transfusion CXR - will show pulmonary infiltrates Oxygen and supportive care Get specialist and ICU input urgently
95
What causes non-haemolytic febrile reactions?
antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage Often the result of sensitisation by previous pregnancies or transfusions
96
Presentation of non-haemolytic febrile reactions?
Fever Chills
97
Which blood products cause non-haemolytic febrile reactions?
Platelet 10-30% RC - 1-2%
98
Management of non-haemolytic febrile reactions?
Slow or stop the transfusion Paracetamol Monitor
99
Presentation of a minor allergic reaction to transfusion?
Pruritus Urticaria
100
Management of a minor allergic reaction?
Temporarily stop the transfusion Antihistamine Monitor
101
What can cause anaphylaxis from a blood transfusion?
Can be caused by patients with IgA deficiency who have anti-IgA antibodies
102
Presentation of anaphylaxis from a blood transfusion?
Within minutes of staring the transfusion hypotension, dyspnoea, wheezing, stridor, angioedema.
103
Management of anaphylaxis from a blood transition?
Stop transfusion IM Adrenaline 0.5ml 1 in 1000 ABC support
104
Complications of acute haemolytic transfusion reactions?
DIC Renal failure
105
What criteria is used for diagnosis of graft vs host disease?
Billingham criteria
106
What is the Billingham criteria?
3 criteria for diagnosis of GVHD: The transplanted tissue contains immunologically functioning cells The recipient and donor are immunologically different The recipient is immunocompromised
107
When might transfusion cause GVHD?
Very rarely In immunocompromised pt

ACUTE (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions