Bleeding Flashcards

1
Q

Mechanism behind head injury -> low BP

A
  • Bleeding
  • Acute Brain Injury:

Catecholamine surge:

  • alpha: increased pulmonary capillary pressure (through peripheral vasoconstriction/pulmonary venous constriction) -> NPO
  • beta: myocardial necrosis: LV Function
  • alpha and beta: platelet/micro-emboli -> damaged endothelium -> NPO

All leads to cardiorespiratory compromise

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2
Q

ECG changes in SAH?

A

Q-T prolongation, T wave abnormalities, ST elevation or depression

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3
Q

What happens in late haemorrhage?

A

Late, vasodilatory phase of hemorrhagic shock - attributed to acidotic conditions, adrenaline receptors do not work as well and those that are, are completely saturated.
Also inflame response to trauma -> vasoplegia

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4
Q

How to mimic blunt trauma in animals?

A

7cm liver laceration

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5
Q

How to mimic penetrating trauma in animals?

A

Cannula in femoral artery - bleed out

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6
Q

What works regardless of acidotic state?

A

vasopressin/ADH

splanchnic circulation - gut/fingers peripherally constrict

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7
Q

Difficulty with animal studies?

A

Homogeneity with animal models and anaesthetised/ventilated - this does not represent the period of hypoxia that hemorrhagic shock leads to in real life, i.e. not tissue damage/inflam response to trauma.
Also liver lac not blunt trauma really

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8
Q

What might give you a crunchy pelvis that is a confounding sign?

A

Iliac wing fracture

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9
Q

Typical on scene HEMS stuff?

A
(Ketamine) sedation
Extrication
Anaesthesia
Blood transfusion
Pleural drainage (thoracostomy)
Splintage
Reversal of warfarin
Rapid scene times
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10
Q

REBOA zone 1

A

take-off of the left subclavian artery down to the celiac trunk

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11
Q

REBOA zone 2

A

celiac trunk to the most caudal renal artery.

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12
Q

REBOA zone 3

A

Most caudal renal artery to the bifurcation.

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13
Q

CODE red indications?

A

Systolic BP <90
Poor response to initial fluids
Suspected active haemorrhage

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14
Q

What is in pack a?

A

6 units RBC, 4 units FFP

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15
Q

Timing of tranexamic acid?

A

Optimal if 1g in 1hr
Beneficial if within 3 hours, potentially harmful if after
Maximal effect for SBP <75 mmHg

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16
Q

Clues for warfarin?

A
Yellow book
Medic alert bracelet
Medical notes
AF on ECG
Sternotomy scar / valve click
17
Q

Emergency reversal of warfarin?

A

Prothrombin Complex concentrate
Contains factors 2, 7, 9, 10
AND protein C and S
Brand names: octaplex/beriplex

Max dose: 3000 IU
Dosing: 1ml/kg
Reconstitute en route to hospital, infuse over 10-20 minutes
Give vitamin K bolus at hospital

18
Q

MOA of Rivaroxaban?

A

Active direct factor Xa inhibitor

19
Q

MOA of Dabigatran

A

Direct thrombin inhibitor

Reversed by idarucizumab

20
Q

MOA of Apixaban

A

Direct factor Xa inhibitor

21
Q

MOA of Tranexamic acid?

A

Antifibrinolytic

Synthetic analog of amino acid lysine: reversible binding on plasmin. Prevents plasmin from degrading fibrin.

22
Q

What is in FFP?

A

Fresh frozen plasma:
All coagulation factors

(slightly decreased V and VIII)

23
Q

What is in cryoprecipitate?

A
aka cryo: plasma replacer
Contains:
fibrinogen
Factor VIII (8)
Von Willebrand factor
Factor XIII (13)
Fibronectin (not useful?)