Circulation Flashcards by Brandon Bazeluk

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)

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Oxygen carrying capability of the blood

Red blood cells

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Cell fragments that are integral to clot formation

Platelets

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Contain ALL of your clotting factors/coagulation factors needed in the process to form fibrin strands which cement the platelet plug for clotting

Plasma

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Fresh whole blood contains:

RBCs

Platelets

Plasma

Immunological components (WBCs, antibodies, cytokines)

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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)

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Fresh whole blood has a shelf life of:

24-48 hours

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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

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Classification determined by presence or absence of antigens

ABO

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Meaning it has a Rh factor

Rh positive

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Meaning without Rh factor

Rh negative

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This blood type has neither A & B markers

Type O

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This blood type doesn’t have A or B markers, and it doesn’t have Rh factor.

O negative

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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

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This blood type has A marker with no Rh factor

A negative

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This blood type has A marker and Rh factor, but not B marker. One of the two most common blood types.

A positive

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This blood type has B marker only and no Rh factor

B negative

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This blood type has B marker only

B negative

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This blood type has B marker and Rh factor, but not A marker.

B positive

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All males can receive what type of blood at any time?

O positive and O negative

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All females of childbearing age receive what type of blood

O negative

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The only oxygen-carrying cell circulating and are needed to halt and repay oxygen debt.

RBCs

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30-40% 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

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> 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

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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

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

IV fluids used in: - Dehydration - Burns - GI tract fluid loss - Acute blood loss - Hypovolemia

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

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