Hemostasis Flashcards
Hemorrhage shock classification
o Class 1: 15% circulating blood - Sign: mild tachycardia o Class 2: 15-30% - Sign: increased HR & RR, but decreased pulse pressure o Class 3: 30-40% - Signs: “”+ pale mm, prolonged CRT & hypotension o Class 4: >40% - Signs: life threatening
Defect in primary hemostasis CS
ecchymoses, spontaneous bleeding from surface (petechia with thrombocytopenia)
Defect in secondary hemostasis cs
hematomas, bleeding into SQ/ muscles/joints
What does 1 plt at 100 x translate to?
15,000 plt, if 10-15 plt present you good!
What does a prolonged PT mean?
means extrinsic +/- common pathway defect
How do you measure intrinsic pathway +/- common
PTT and ACT
T/F Technical causes account for majority of significant operative bleeding?
True; can be d/t inadequate repair of vessel, occult injury, damage during sx to organ, damage to structure remote from sx site.
What emergency instrumentation should be present for surgical bleeding?
Hemostatic forceps (crush & activate coag) and vascular clamps (atraumatic for temporary occlusion)
Regional pressure:
Should be applies with vessels ~ 1 mm diameter, be careful with torniquets because they can cause nerve or lymphatic damage with over tightening
T/F
Torniquets are good for distal bleeding?
True when applies proximal in the limb!
- do for a short period (30 min)
What is the most secure form of hemostasis?
vascular ligationl first throw is critical
What is the minimum amount of throws for security?
4; 6 if tying a strand to a loop!
Is a granny or half hitch along surgically acceptable?
NO, this will slip so requires a square know on top!
Are friction knots more secure than surgeon knot?
Yes, is can be used with large pedicle tissue and vessels.
T or F
Electrocautery= electrosurgery?
False
- electrocautery: current heats up instrument (no ground or current flow)
- electrosurgery- instrument is not heated, instead involves energy transferred to tissue!
