Bleeding Flashcards
Questions
Is there an emergency needing immediate resuscitation or senior help?
Why is the patient bleeding?
In case of bleeding disorders, what is the mechanism?
How would you test the mechanism
Prothrombin time
Activated partial thromboplastin time
Thrombin time
D-dimers
What is purpose of prothrombin time
Thromboplastin is added to test the extrinsic system
Tests for abnormalities in factors I, II, VII, X
What prolongs prothrombin time
Warfarin
Vitamin K deficiency
Liver disease
Disseminated intravascular coagulation (DIC - a condition in which blood clots form throughout the body)
What is purpose of Activate partial thromboplastin time
Tests the intrinsic system
Tests for abnormalities in in factor I, II, V, VII, IX, X, XI, XII
What prolongs activate partial thromboplastin time
Heparin treatment
Haemophilia
Disseminated intravascular dcoagulation
Liver disease
What is purpose of thrombin
Converts Fibrinogen to Fibrin
What prolongs Thrombin time
Heparin treatment
Disseminated intravascular coagulation
Dysfibrinogenaemia
What are D-dimers
A fibrin degradation product released from cross-linked fibrin during fibrinolysis
When would you find D-dimers
During DIC, or in presence of venous thromboembolism (deep vein thrombosis or pulmonary embolism)
When could D-dimers be raised, but not due to bleeding
Inflammation, e.g. infection or malignancy
Management if shocked
Resuscitate
How to tell if patient is at risk of excessive bleeding before op
Bleeding history:
Past history of excessive, prolonged or unexplained bleeding
Co-morbidities such as lupus or liver disease
