Approach to the Bleeding Patient Flashcards
list a few reasons why patients bleed
- primary hemostatic disorders
- hemorrhage from a mass
- gastrointestinal disorders
- parasitism
- traumatic
- iatrogenic/pharmacologic
Dyspnea differentials
- pharyngeal/laryngeal disease
- pulmonary disease
- pleural space disease
- cardiac
- mediastinal
- hemorrhage
Multifocal bleeding differentials
- traumatic
- coagulopathy/primary hemostatic disorder
what does anticoagulant rodenticide effect the fastest?
anticoagulant rodenticides effect factor 7 fastest which is the vitamin K dependent factor -> bleeding ramps up
what is the most common side effect of blood product administration?
most common side effect is a fever, slow down and it usually goes down
whole blood
Fresh (used within 8 hours) or stored (3-4 week shelf life) whole blood. Give to patients with: absent functional platelets, hypovolemia with coagulopathies, platelet disorders unlikely to receive sustained platelet function.
Packed red blood cells
pRBC’s approximately 21d shelf life, longer with approximate nutrients. For normovolemic, anemic patients
Frozen Plasma
Fresh Frozen Plasma: frozen quickly, all coagulation factors + proteins, <1 year old, FFP appropriate for all coagulopathies
Stored frozen plasma: not frozen as rapidly as FFP or FFP<1 year old shelf life is 5 years, anticoagulant rodenticides and hypoproteinemia
Petechiation Differential
- thrombocytopenia
- thrombocytopathia
- endothelial dysfunction
T/F: BUN and creatinine are trustworthy for AKI
F!
what disease processes require antithrombotic drugs?
IMHA
PLE
PLN
what clotting factors are vitamin K dependent?
2,7,9,10 with 7 being the first effected meaning in the early stages of toxicity only PT will be prolonged
sequestration is often the result of what 2 processes?
vasculitis and splenomegaly
processes that cause increased platelet consumption
DIC
vasculitis
envenomation
thrombosis
what problems can lead to decreased platelet production?
- hereditary disorders
- bone marrow disorders
- drugs
primary v secondary ITP on CBC
primary ITP is much more likely to have SEVERE thrombocytopenia while secondary ITP tends to have a less severe thrombocytopenia
ITP
immune thrombocytopenia
what imaging finding is common with immune mediated disease?
splenomegaly
First line treatment of ITP
- transfusions: fresh frozen plasma or whole blood transfusion
- immunosupressants
what adjunctive treatment are often used in ITP patients with melena?
sucralfate
omeprazole
H2 blockers (famotidine)
how long does azothioprine take to work?
about one month, not a first line intervention for an immune mediated disease but may help get patients off of prednisone sooner
