MANAGEMENT OF CIRCULATION Flashcards
1
Q
What form of blood is drawn directly from an on-site donor and does not undergo processing into separate components?
A
Fresh Whole Blood (FWB)
2
Q
What is the oxygen carrying capability of the blood?
A
Red blood cells
3
Q
What are cell fragments that are integral to clot formation ?
A
Platelets
4
Q
What contains ALL of your clotting factors/coagulation factors needed in the process to form fibrin strands which cements the platelet plug for clotting?
A
Plasma
5
Q
What is included in the blood collection kit that is used to prevent the blood from clotting and prevents the cells from lysing during the time from collection to delivery?
A
CPD Solution (anticoagulant citrate and nutrient phosphate and dextrose)
6
Q
What is the shelf life for collected FWB?
A
24-48 hours
7
Q
What are proteins in sugars that the body uses to identify the blood cells that belong to the body?
A
Antigen
8
Q
What blood type doesn’t have A or B markers, and it doesn’t have Rh factors?
A
O negative
9
Q
What blood type doesn’t have A or B markers, but does have Rh factor?
A
O positive
One of the most common
10
Q
What blood type has the A marker only?
A
A negative
11
Q
What blood type has A marker and Rh factor but not the B marker?
A
A positive
One of the most common
12
Q
What blood type has the B marker only?
A
B negative
13
Q
What blood type has the B marker and Rh factor, but not A marker?
A
B Positive
14
Q
What blood type has all three types of markers- A, B, and Rh Factor?
A
AB Negative
15
Q
All males can receive either ____ or ____ blood at any time
A
- O positive
2. O negative
16
Q
All females of child bearing age receive ____ ONLY (unless it is a matter of life and death and there is none of this blood type available)
A
O NEGATIVE ONLY
17
Q
If the female becomes pregnant with an Rh-positive baby (father has to be Rhpositive), then the Rh-negative mother that was exposed to Rh-positive blood
(thus making antibodies against Rh factor) will start to attack the fetal blood
cells inducing ______ leading to fetal death
A
Hydrops fetalis
18
Q
The benefit of ____ lies in the combination of volume, oxygen carrying capacity, and clotting factors in one fluid
A
whole blood
19
Q
What are the only oxygen-carrying cell circulating and are needed to halt and repay oxygen debt?
A
Red blood cells
20
Q
True or False
Repayment of oxygen debt should start as early as possible following traumatic hemorrhage
A
True
21
Q
_____ associated with traumatic hemorrhage increases mortality and should be addressed as soon as possible following trauma
A
Coagulopathy
22
Q
Indications for transfusion
What class of Hemorrhagic shock includes the following?
- 30% of blood loss
- 1500-2000 ml of blood loss
- > 120 HR
- Decreased blood pressure
- 30-40 RR
- Urine output 5-15ml per hour**
- Level of consciousness exhibiting confused demeanor
A
Class III Hemorrhagic Shock
23
Q
Indications for transfusion
What class of Hemorrhagic shock includes the following?
- > 40% of blood loss
- > 2000ml of blood loss
- > 140 HR
- Decreased blood pressure
- > 35 respirations per minute
- Urine output negligible
- Level of consciousness exhibiting lethargic demeanor
* Absent radial pulse/systolic blood pressure below 80mmHg*
A
Class IV Hemorrhagic Shock
24
Q
What is a potentially life-threatening reaction caused by acute intravascular hemolysis of transfused red blood cells?
A
Hemolytic reactions
25
Hemolytic reactions may have presenting signs such as what?
1. Fever
2. Chills
3. Flank pain
4. Oozing from IV sites
26
The treatment of what involves aggressive hydration and diuresis (to prevent kidney damage from lysed RBC elements) ?
Hemolytic reactions
27
What is any allergic reaction other than hives which includes angioedema, wheezing, and/or hypotension?
Anaphylaxis reaction
28
What is the recommendation for Citrate toxicity?
1 amp of Calcium Gluconate every 4 units of FWB to avoid toxicity and hypocalcemia
29
What reactions are common and are characterized by fever, usually accompanied by chills, in the absence of other systemic symptoms; the development of other symptoms is not known at the time of the initial fever making this a diagnosis of exclusion and you must first rule out that this is not a hemolytic reaction, sepsis?
Febrile non-hemolytic reactions
30
The most common cause of what is due to the release of cytokines from white blood cells?
Febrile Non-hemolytic transfusion reactions
31
What are associated with hives but no other allergic findings (wheezing, angioedema, and hypotension)?
Urticarial reactions
32
True or False
Urticarial reactions
The most common cause is an antigen- antibody interaction that occurs between patient and the product; commonly implicated antigens include a number of donor serum proteins.
True
33
What are the IMMEDIATE ACTIONS for all patients that develop and acute transfusion reaction?
1. Stop the transfusion
2. Maintain IV/IO line start fluid bolus with BALANCED CRYSTALOID
3. Asses pt for sx of fever, respiratory distress, chest pain, back pain, itching, angioedema
4. Measure vitals and perform exam guided by symptoms
5. Confirm the correct product was transfused to the intended patient and correct blood type of the donor
6. Contact Physician supervisor to discuss the appropriate evaluation and initial management as soon as tactical situation allows
7. Pass all info to next echelon
34
Severe Hemolytic transfusion reactions can be lethal with as little as ___ to ___ ml ?
10-30 ml
35
Contact your local _____ to coordinate screening of blood for your unit for cross type and match
Armed Services Blood Program
36
Administrative Responsibility
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
37
Collecting Donor Blood
Blood should be drawn into an unexpired, intact commercial single unit whole blood collection bag; ____ml capacity containing ___ml of CPD or CPDA-1 anticoagulant
1. 600ml
| 2. 63 ml
38
Transfusion Procedure
In a patient with allergies or history of previous allergic transfusion reaction give what medication prophylactically before transfusion?
25-50mg Diphenhydramine IM/IV/PO
39
Transfusion Procedure
In a patient with a history of febrile reaction you should give what medication prophylactically ?
1 gram acetaminophen PO/PR/IV
40
Transfusion Procedure
Record baseline vitals and continue to record them through and following the transfusion at minimum every ___minutes. For the first ___minutes of the transfusion record them every __ minutes.
1. 15 minutes
2. 15 minutes
3. 5 minutes
41
Beginning the infusion of blood
Set the flow rate to deliver approximately ___ to ___ ml of blood over the first __ minutes
1. 10-30ml
2. 15 minutes
(1gtt/4-6 sec = 1ml/min)
42
Beginning the infusion of blood
After the first 15 minutes and there is no adverse reaction evident, set the main roller clamp to deliver approximately ___ml/min
1. 200ml/min
| 1 unit (U) in 2-2.5 minutes
43
Blood transfusion
Document the procedure on the ____ and ____ or patient AAR and forward to the Role III hospital in country
1. SF 518
| 2. SF 600
44
What medication should be given to a casualty if it is anticipated they need a significant volume of blood transfusion due to the following?
1. Hemorrhagic shock
2. One or more amputations
3. Penetrating torso trauma
4. Evidence of severe bleeding
TXA
45
What helps to reduce blood loss from internal hemorrhage sites that cannot be addressed by tourniquets and hemostatic dressings, DOES NOT promote new clot formation?
TXA
46
Survival benefit is greatest when TXA is given within ___ hour(s) of injury
1 hour
47
Administer ___ gram of TXA in 100ml NS or LR as soon as possible, but not later than ___ hours after injury
1. 1 gram
| 2. 3 hours
48
TXA should be administered over _____ minutes
10 minutes
49
What forms an irreversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis?
TXA
50
What is the recommended temperature range for the storage of TXA?
59-86 F
51
Life sustaining fluids
What replaces normal ongoing fluids?
Maintenance therapy
52
Life sustaining fluids
What corrects any existing water and electrolyte deficits?
Replacement therapy
53
IV fluids come in what four different forms?
1. Colloids
2. Crystalloids (isotonic, hypotonic, hypertonic)
3. Blood
4. Blood products
54
True or False
Correlation with cognitive function and/or urine output is often a better
indication of adequate perfusion.
True
55
What solution is used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns)?
Colloids (volume expanders)
1. Expanders are found in dextran, plasma, and albumin
56
What is the following IV solution?
1. Plasma protein fractions, salt poor albumin, dextran, and hetastarch
2. Does not diffuse out of the vascular space as quickly as crystalloids
3. More crystalloids fluid is needed than this to achieve the same goal of boosting intravascular fluid volume, but crystalloids are less expensive
Colloids
57
What IV solution is more suitable in a hospital setting than in field use?
Colloids
58
What IV fluids consist of water and dissolved crystals, such as salts and sugar and are used as a maintenance fluid to correct body fluid and electrolyte deficits?
Crystalloids
59
What contains electrolytes (sodium, potassium, calcium, chloride) but lack the large protein molecules found in colloids?
Crystalloids
60
What are the mainstay of IV therapy in the prehospital setting and are classified according to their tonicity?
Crystalloids
61
What describes the concentration of electrolytes (solutes) dissolved in the water, as compared with that of body plasma (fluid surrounding the cells) ?
Tonicity
62
When the crystalloid contains the same amount of electrolytes as the plasma, it is referred to as what?
Isotonic
63
What are the most common isotonic solutions?
1. LR
2. NS
3. 5% dextrose in water (D5W)
64
If a crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as what?
Hypertonic
65
Normal Saline Solution has what uses?
1. Shock
2. Resuscitation
3. Fluid challenges
4. Blood transfusions
5. Metabolic alkalosis
6. Hyponatremia
7. DKA
66
What are some special considerations for NS?
1. Use with caution in patients with heart failure, edema, or hypernatremia
2. Can lead to volume overload
3. Speeds up the lethal triad of hypothermia, coagulopathy, and acidosis
67
What are some uses for LR?
1. Dehydration
2. Burns
3. GI tract fluid loss
4. Acute blood loss
5. Hypovolemia
68
What are some special considerations for LR?
1. Contains Potassium, can cause hyperkalemia in renal patients
2. Patients with liver disease cannot metabolize lactate
3. Lactate is converted into bicarb by liver which with larger volumes can
lead to metabolic alkalosis.
69
What are some uses of D5W?
1. Fluid loss and dehydration
| 2. Hypernatremia
70
What are some special considerations for D5W ?
1. Solution becomes hypotonic when dextrose is metabolized
2. Do not use for resuscitation
3. Use cautiously in renal and cardiac patients
71
What is the primary fluid of choice for hypovolemia due to blood loss per TCCC and DOD Joint trauma surgeon's protocols?
Fresh Whole Blood
72
The universal compatibility of ____ blood makes it the ideal choice for administration in emergent situations
O blood
73
What are some different modes of IV administration?
1. Peripheral IV Catheter
2. PICC
3. Central Line
4. Intraosseous
74
What is the most common IV access method is both hospital and field settings?
Peripheral IV catheter
75
What is a form of IV access that can be used for a prolonged period of time? (long chemo regimens, extended antibiotic therapy, or total parenteral nutrition)
Peripherally inserted central catheter (PICC)
76
What is an infusion tube located in or near the heart, which is at the center of the circulatory system?
Central line
77
What is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system?
IO
78
What is one of the quickest ways to establish access for rapid infusion of fluids, drugs, and blood products in emergency situations as well as resuscitation?
IO
79
What kind of access is a temporary measure and is recommended that the use of this infusion is to be limited to a few hours until IV access is achieved?
IO
80
What are some contraindications for IO access?
1. Ipsilateral fracture or crush injury of an extremity
2. Previous orthopedic procedure near the selected insertion site
3. Previous IOVA attempts in the same bone
4. Infection at the selected insertion site
5. Inability to locate landmarks
6. Brittle bones
81
What is the best site to use for an IO?
Anteromedial aspect of the tibia
| anterior aspect of the femur and the superior chest can also be used
82
True or False
Placement of an intraosseous needle is indicated during traumatic situations when attempts at venous access fail (three attempts or 90 seconds) or in cases where it is likely to fail, and speed is of the essence.
True
83
How big is the needle use for the IO?
16-20 gauge
84
IO Sites: Tibia
The site for cannulation lies __ to __ cm below the tuberosity on the anteromedial surface of the tibia
1-3 cm
85
What are some complications of an IO?
1. Tibial fractures
2. Compartment syndrome
3. Osteomyelitis
4. Skin necrosis
86
Analgesia in a trauma setting should be typically completed in accordance with what?
TCCC three options of pain management
87
What is TCCC analgesia option 1 for mild to moderate pain and the casualty IS still able to fight?
1. Tylenol 625mg, 2 tablets PO q 8hours. Max 4 grams over 24hrs
2. Meloxicam 7.5 to 15mg PO daily
88
What is TCCC analgesia option 2 for moderate to severe pain and the casualty IS NOT in shock or respiratory distress and casualty is NOT at significant risk of developing either?
1. Oral Transmucosal Fentanyl Citrate (OTFC) 800mcg, place between cheek and gum, instruct patient not to chew
89
What is TCCC analgesia option 3 for moderate to severe pain and the casualty IS in shock or respiratory distress OR the casualty is at significant RISK of either developing either condition?
Ketamine 50mg IM or IN (intranasal) w/ repeat dose every 30 minutes or 20mg IV or IO w/ repeat dose every 20 minutes ** end point is control of pain or development of nystagmus
90
What is an alternative to OTFC is IV access has been established?
Morphine 5 mg IV/IO. Max of 15 mg. Reassess in 10 minutes and repeat as necessary to control severe pain. Ensure to monitor for respiratory depression.
91
What are the TCCC recommended antibiotics?
1. Moxifloxacin (Avelox) 400mg IV/PO q 24hrs (if able to tolerate PO meds)
2. Ertapenem (Ivanz) 1 gram IV q 24hrs
3. Levofloxacin (Levaquin) 750mg IV/PO q 24hrs
4. Cefazolin (Ancef, Kefzol) 1 gram IV q 8hrs for 7 days
5. Ceftriaxone 2 grams IV q 12hrs
