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PMPR 430 > Hemorrhagic Shock and Hemostatic Agents > Flashcards

Hemorrhagic Shock and Hemostatic Agents Flashcards

1
Q

What is shock

A

A life threatening state of generalized, insufficient perfusion due to hemodynamic instability (lack of blood flow)

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2
Q

What happens at the cellular level when there is a hemorrhage

A

Depletion of cells (red and platelets), decreased platelet function, depletion of clotting factors and loss of activity,

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3
Q

What are corrective measures the body tries to make during a hemorrhage

A

Active coagulation cascade (procoagulant effects), lactic acidosis, vasoconstriction, endothelium and neutrophil activation, increased vascular permeability

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4
Q

T/F: Hemorrhagic shock causes a decrease in cardiac output, decrease in blood pressure, decrease in perfusion, and less oxygen for tissues

A

True

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5
Q

Why does urine output decrease in hemorrhagic stroke

A

There is hypoperfusion of the kidneys (most likely other organs as well)

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6
Q

T/F: Blood pressure decreases while heart rate increases in order to keep cardiac output the same

A

True

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7
Q

What are the 4 steps to managing massive hemorrhage

A

Control the bleeding/minimize blood loss
Aggressive resuscitation
Management of BP and acidosis
Treatment coagulopathy

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8
Q

What is the goal of aggresive resuscitation

A

Provide adequate oxygen delivery to meet demand and reverse any ongoing tissue hypoperfusion

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9
Q

What are the product options for resuscitation

A

Colloids and/or crystalloids

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10
Q

What is the best colloid to use, others

A

Blood, albumin Hetastarch

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11
Q

Where does blood come from

A

Donor and auto transfusion (not ideal but doesn’t require testing)

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12
Q

What are the components of blood from most to least

A

Plasma, RBCs, WBCs, platelets (whole blood)

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13
Q

When a patient is low on hemoglobin what blood product can be given, shelf life/ what is a low hemoglobin level

A

Packed RBCs, 42 days/ less than 13.5 g/dL (males) and less than 12 g/dL (females)

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14
Q

What blood product would be used to elevate blood pressure

A

Fresh Frozen Plasma

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15
Q

When would a patient get platelets

A

Platelet count is less than 10,000 (prevent spontaneous hemorrhage)

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16
Q

What are risk of blood administration

A

Compatability, fever, allergy, acute hemolytic anemia, transfusion related acute lung injury

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17
Q

T/F: Hetastarch can be given for the most critically ill

A

False: Hetastarch should not be used under any circumstances

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18
Q

What is the main job of albumin, can it be used in hemorrhagic shock

A

volume expansion, no

19
Q

What are the two preferred crystalloid solutions for resuscitation

A

Ringer’s lactate and 0.9 NaCl (both isotonic and stay in the vasculature)

20
Q

Which crystalloid is preferred in hemorrhagic shock and why

A

Lactated ringer: off set acidosis (converted to bicarbonate) and minimizes chloride load

21
Q

How much crystalloid should be given

A

Less than 3L in the first 6 hours (warm not cold)

22
Q

What should be monitored from improvement once given fluids

A

Urine output, CVP, blood pressure, heart rate

23
Q

What is the absolute best way to reverse the acidosis caused by hemorrhagic stroke, other methods

A

Restore perfusion and oxygenation, sodium bicarbonate adminstration: serum bicarbonate 6mEq/L and pH is less than 7.1 (also aids in catecholamine response)

24
Q

When a patient has hemorrhagic shock what are the vasopressors that should be used to maintain BP (order from most used to least used)

A

Phenylephrine, Vasopressin, norephinephrine, epinephrine, dopamine

25
Q

What are the factor deficeint coagulopathies

A

Hemophilia A: deficiency of Factor 8
Hemophilia B: deficiency of Factor 9
Von Willebrand disease: Deficiency in vWf

26
Q

What expensive concentrate of blood plasma would be good for hemorrhage caused by coagulopathy and low fibrinogen

A

Cryoprecipitate

27
Q

What are the three indications for hemostatic agents

A

disease state coagulopathy, trauma, medication reversal

28
Q

What are the drugs that can be given for Hemophilia A induced coagulopathy, MOA

A

Desmopressin:increases plasma Factor 8 activity and Antihemophilic Factor: Replaces missing Factor 8

29
Q

What are the drugs that can be given for Hemophilia B induced coagulopathy, MOA

A

Coagulation Factor 9 recombinant: Replaces missing Factor 9
Factor 9 Complex: Contains Factor 9,2,7, 10
Recombinant Factor 7a: Complexed with TF activates 9a and 10a PLUS converts prothrombin to thrombin

30
Q

For the hemophilia factors how are they all administered, what should be monitored, what are the severe ADEs

A

Administered IV, bleeding and thrombosis along with factor activity, anaphylaxis and thrombosis

31
Q

What other disease states can cause coagulopathies

A

liver cirrhosis, malabsorption, cancer, bacterial infections, intense exercise

32
Q

What agent can be used for coagulopathies caused by other,MOA

A

Aminocaproic acid (amicar): inhibits activation of plasminogen which decreases the conversion to plasminogen to plasmin

33
Q

What is the trauma induced coagulopathy hemostatic agent

A

Recombinant Factor 7a

34
Q

What medications that cause coagulopathies can be reversed with other agents

A

Warfarin, Heparin, LMWH (partially),” Xabans”,

35
Q

What medications cant be reversed by other agents

A

Direct Thrombin inhibitors and Antiplatelets

36
Q

What is the reversal agent heparin

A

Protamine

37
Q

What is the reversal agent Wafarin

A

Vitamin K and Prothrombin Complex Concentrate

38
Q

What does coagulation Factor Xa recombinant reverse and what is the Brand name

A

Rivaroxiban and apixiban, Andexxa

39
Q

What is the monoclonal antibody used to reverse a direct thrombin inhibitor, which direct thrombin inhibitor, whats the brand name

A

Idarucizumab: Praxbind/ Dabigatran

40
Q

How much blood loss is considered class 1 hemorrhagic

A

Less than 15%

41
Q 
How much blood loss is considered class 2
hemorrhagic, what is the usual heart rate
A

15-30%, 100-120

42
Q

How much blood loss is considered class 3 hemorrhagic, what is the usual heart rate, what has happened to the systolic blood pressure

A

30-40%, 120-140, decreased

43
Q

How much blood loss is considered class 4 hemorrhagic, what is the HR, RR CNS symptoms

A

Greater than 40%, Greater than 140, greater than 35, lethargic

44
Q

What is the normal adult volume of blood

A

7% of total body weight

PMPR 430 (21 decks)

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