Circulation Flashcards
Blood that is drawn directly from an on-site donor and does not undergo processing into separate components (RBCs, plasma, and platelets)
Fresh Whole Blood (FWB)
Oxygen carrying capability of the blood
Red blood cells
Cell fragments that are integral to clot formation
Platelets
Contain ALL of your clotting factors/coagulation factors needed in the process to form fibrin strands which cement the platelet plug for clotting
Plasma
Fresh whole blood contains:
RBCs
Platelets
Plasma
Immunological components (WBCs, antibodies, cytokines)
This is used to prevent the blood from clotting and prevent the cells from lysing during the time from collection to delivery.
CPD solution (anticoagulant Citrate and nutrient Phosphate and Dextrose)
Fresh whole blood has a shelf life of:
24-48 hours
Contain markers on surface that characterize the cell type
Also known as antigens-proteins and sugars that the body use to identify the blood cells that belong to the body
RBCs
Classification determined by presence or absence of antigens
ABO
Meaning it has a Rh factor
Rh positive
Meaning without Rh factor
Rh negative
This blood type has neither A & B markers
Type O
This blood type doesn’t have A or B markers, and it doesn’t have Rh factor.
O negative
This blood type doesn’t have A or B markers but does have Rh factor.
One of the two most common blood types
O positive
This blood type has A marker only
A negative
This blood type has A marker and Rh factor, but not B marker. One of the two most common blood types.
A positive
This blood type has B marker only
B negative
This blood type has B marker only
B negative
This blood type has B marker and Rh factor, but not A marker.
B positive
All males can receive what type of blood at any time?
O positive and O negative
All females of childbearing age receive what type of blood
O negative
The only oxygen-carrying cell circulating and are needed to halt and repay oxygen debt.
RBCs
30% blood loss
1) 1500-2000 ml of blood loss
2) > 120 pulse rate per minute
3) Decreased blood pressure
4) 30-40 respirations per minute
5) Urine output 5-15 ml per hour
6) Level of Consciousness exhibiting confused demeanor
Class III Hemorrhagic shock
> 40% of blood loss
1) > 2000 ml of blood loss
2) > 140 pulse rate per minute
3) Decreased blood pressure
4) > 35 respirations per minute
5) Urine output negligible
6) Level of Consciousness exhibiting lethargic demeanor
* Absent radial pulse/systolic blood pressure below 80mmHg*
Class IV Hemorrhagic shock
Potentially life-threatening reaction caused by acute intravascular hemolysis of transfused red blood cells
Hemolytic reaction
Severe hemolytic reactions can occur with as little as how much blood?
10-30 mL
Presenting signs following a blood transfusion :
1) Fever
2) Chills
3) Flank pain
4) Oozing from intravenous sites
Hemolytic reactions
Treatment for hemolytic reactions
Aggressive hydration and diuresis
Recommendation is to give 1 amp of ________ every 4 units of FWB to avoid toxicity and hypocalcemia
Calcium Gluconate
These are common following a blood transfusions; these reactions are characterized by fever, usually accompanied by chills, in the absence of other systemic symptoms.
Febrile non-Hemolytic Reactions
Most common cause of febrile non-hemolytic transfusion reactions due to:
Release of cytokines from WBCs
Treatment for Febrile non-Hemolytic Reactions
1 gram of Tylenol PO/PR every 8 hours
Any allergic reaction other than _______ constitutes an anaphylactic transfusion reaction
Hives
Treatment for anaphylaxis reaction
IM Epinephrine, antihistamines, vasopressors
Are associated with hives but no other allergic findings
Urticarial Reaction
Immediate actions for hemolytic reactions
Immediately stop
Maintain IV/IO line with fluid bolus
Assess for symptoms
Measure vital signs and perform a physical examination
Confirm the correct product was transfused
Contact your local ______________ to coordinate screening your unit for cross type and match
Armed Services Blood Program (ASBP)
Fill out the back of the TCCC card or an ________ prior to transfusion and record vital signs every 10-15 minutes during transfusion
SF 518
In a patient with allergies or history of a previous allergic transfusion reaction give:
25-50mg diphenhydramine IM/PO/IV prophylactically before transfusion
In a patient with a history of febrile reaction give:
1g acetaminophen PO/PR/IV prophylactically before transfusion
Record baseline vitals and continue to record them through and following the transfusion at minimum every 15 minutes. For the first 15 minutes of the transfusion record them every:
5 minutes
Set the flow rate to deliver approximately _____ of blood over the first 15 minutes .
10-30 mL (1gtt/4-6 sec = 1ml/min)
After the first 15 minutes and there is no adverse reaction evident set the main roller clamp to deliver approximately
200ml/min (1 Unit (U) in 2-2.5 minutes)
If a casualty is anticipated to need a significant volume of blood transfusion due to the following:
(a) Hemorrhagic Shock
(b) One or more amputations
(c) Penetrating torso trauma
(d) Evidence of severe bleeding
Administer what medication?
Tranexamic Acid (TXA)
Helps to reduce blood loss from internal hemorrhage sites that cannot be addressed by tourniquets and hemostatic dressings
Prevents the clots from breaking down by keeping fibrin strands around longer to maintain the clot and thus helps to prevent internal bleeding and ultimately prevent death from hemorrhage
TXA
The two major studies have shown a survival benefit from TXA
CRASH-2: 20,000 plus patients in civilian trauma centers
MATTERS (Military Application of Tranexamic Acid in Traumatic Emergency and Resuscitative Surgery) in which 896 casualties treated at a military hospital in Afghanistan.
Survival benefit is greatest when TXA is given within ____ of injury
1 hour
Administer ______ of tranexamic acid in 100 ml normal saline or lactated ringers as soon as possible, but not later than 3 hours after injury
1 gram
Forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis
TXA
TXA
Recommended temperature range for storage:
59-86 degrees F
IV Fluids
Replaces normal ongoing losses
Maintenance therapy
IV fluids
Corrects any existing water and electrolyte deficits
Replacement therapy
Correlation with what is a better indication for adequate perfusion?
Urine output
Cognitive function
IV fluids come in what forms?
Colloids
Crystalloids
Blood and blood products
Used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns)
Colloids (Volume Expanders)
IV fluids
Plasma protein fractions, salt poor albumin, dextran, and hetastarch
Do not diffuse out of the vascular space as quickly as crystalloids
Colloids
Fluids that consist of water and dissolved crystals, such as salts and sugar
Used as maintenance fluids to correct body fluids and electrolyte deficit
Contain electrolytes (e.g., sodium, potassium, calcium, chloride) but lack the large proteins and molecules found in colloid
Crystalloids
Mainstay IV therapy in prehospital settings
Crystalloids
Crystalloids are classified according to their:
Tonicity
Describes the concentration of electrolytes (solutes) dissolved in the
water, as compared with that of body plasma (fluid surrounding the cells)
Tonicity
Crystalloid contains the same amount of electrolytes as the plasma
Isotonic
Most common isotonic solutions
LR
NS
D5W
A crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as:
Hypertonic
Administration of ______ crystalloid causes water to shift from the
extravascular spaces into the bloodstream, increasing the intravascular
volume
Hypertonic
IV fluids used in:
- Shock
- Resuscitation
- Fluid challenges
- Blood transfusions
- Metabolic alkalosis
- Hyponatremia
- DKA
NS
IV fluids
- Use with caution in patients with heart failure, edema, or hypernatremia
- Can lead to volume overload
- Speeds up the lethal triad of hypothermia, coagulopathy, and acidosis
NS
IV fluids used in:
- Dehydration
- Burns
- GI tract fluid loss
- Acute blood loss
- Hypovolemia
LR
IV fluids
-Contains Potassium, can cause hyperkalemia in renal patients
-Patients with liver disease cannot metabolize lactate
-Lactate is converted into bicarb by liver which with larger volumes can
lead to metabolic alkalosis
LR
IV fluids used in:
- Fluid loss and dehydration
- Hypernatremia
D5W
IV fluids
- Solution becomes hypotonic when dextrose is metabolized
- Do not use for resuscitation
- Use cautiously in renal and cardiac patients
D5W
The primary fluid of choice for hypovolemia due to blood loss per TCCC, and DOD Joint trauma surgeon’s protocols.
Fresh Whole Blood
The universal compatibility of ___ blood makes it the ideal choice for
administration in emergent situations
O blood
This is the most common intravenous access method in both hospital and field settings
Peripheral IV catheter
Form of intravenous access that can be used for a prolonged period of time
Peripherally inserted central catheter (PICC)
An infusion tube located in or near the heart, which is at the center of the circulatory system. For example, a Triple Lumen catheter with its tip in the right atrium.
Central Line
Process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system
Intraosseous
It is recommended that the use of intraosseous infusion be limited to a _______ until intravenous access is achieved
Few hours
Placement of an IO needle is indicated during traumatic situations when:
Venous access fail (3 or more attempts)
> 90 seconds
Cases where IV is likely to fail and speed is essential
Needle gauge for IO
16-20
Best site for IO insertion
Flat anteromedial aspect of the tibia.
IO
Palpate the tibial tuberosity. The site for cannulation lies ___ cm below this tuberosity on the anteromedial surface of the tibia
1-3 cm
Complications of IO
Fracture
Compartment syndrome
Osteomyelitis
Skin necrosis
Analgesia in a trauma setting should be typically completed in accordance with:
TCCC three options of pain management
TCCC Option 1 of pain management
Mild to moderate pain and casualty IS able to fight
TCCC Combat Wound Medication Pack (CWMP)
- Tylenol 625 mg
- Meloxicam 15 mg
TCCC Option 2 pain management
Moderate to severe pain, casualty is not in shock or respiratory distress
Oral Transmucosal Fentanyl Citrate (OTFC)
-800 ug
TCCC Option 3 of pain control
Moderate to severe pain
Casualty is in shock or respiratory distress or at risk of developing both
Ketamine 50 mg with Versed
Morphine 5 mg (15mg MAX)
Naloxone (Narcan) 0.4-2.0 mg Q 2-3 minutes
Ondansetron 4 mg
What should be given to all open combat wounds?
Antibiotics
TCCC recommendations for antibiotics
Moxifloxacin
Ertapenem
Antibiotic given if the patient is able to tolerate PO medications
Moxifloxacin
Antibiotic given to patients experiencing shock or unconscious
Ertapenem
AMAL antibiotics
Levofloxacin
Cefazolin
Ceftriaxone
Form for blood transfusions
SF 518
TXA is most beneficial if given within:
1 hour
TXA is pushed over __ minutes
10 minutes
IO
If the procedure is not sterile it can cause:
Osteomyelitis
In an alert patient what should you use with the IO
Lidocaine