MANAGEMENT OF CIRCULATION Flashcards
______ is drawn directly from an on-site donor
Fresh Whole Blood (FWB)
Fresh =
not refrigerated or stored
True/false
FBW does not undergo processing into separate components
True
FWB is also known as what to the army?
Low Titer O Whole Blood (LTOWB)
What is a component of FWB that can cause patients to react adversely during the transfusion process.
Immunological components
(WBC’s, antibodies, cytokines, etc)
The blood collection kit contains _____ solution
CPD
(anticoagulant citrate and nutrient phosphate and dextrose)
What is the shelf life for collected FWB?
24 – 48 hours
True/False
All males can receive either O positive or O negative blood at any time
True
All females of childbearing age receive _________ blood ONLY
(unless life or death)
O NEGATIVE
O pos can induce Rh disease
Indications for what?
1. Life threatening injuries that require additional time before definitive care is achieved.
2. Hemorrhagic shock
3. Evidence of severe bleeding to a non-compressible or difficult to compress area with hypotensive patient
4. Delayed evacuation or prolonged evacuation.
transfusion
What class of shock?
30% of 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
What class of 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
Radial pulse will be absent at what BP?
Systolic Below 80mmHg
Complications of Blood Transfusions:
______ is a potentially life-threatening reaction caused by acuteintra vascular hemolysis of transfused red blood cells
Hemolytic Reactions
Complications of Blood
Presenting signs of what:
1)Fever
2)Chills
3)Flank pain
4)Oozing from intravenous sites
Hemolytic Reactions
Complications of Blood
________ : any allergic reaction other than hives. This includes angioedema, wheezing, and/or hypotension
Anaphylaxis Reaction
Citrate Toxicity:
Recommendation though is to give ___ amp of Calcium Gluconate every ____ units of FWB to avoid toxicity and hypocalcemia
1 amp of Calcium
to
4 units of FWB
normal human liver can process ____ units worth of FWB without needing additional Calcium
13
_________: these are common; these reactions are characterized by fever, usually accompanied by chills, in the absence of other systemic symptoms.
Febrile non-Hemolytic Reaction
Febrile non-Hemolytic Reaction tx
1 gram of Tylenol PO/PR every 8 hours
IMMEDIATE ACTIONS (ALL PATIENTS) that develop an acute transfusion reaction should follow these steps:
(a) Immediately stop the transfusion
(b) Start fluid bolus with balanced crystalloid
(c) Assess the patient, including symptoms of fever, respiratory distress, chest pain, back pain, itching, angioedema
(d) Measure VS and PE guided by s/s
(e) Confirm the correct product was transfused to the intended patient and correct blood type of donor
(f) Contact your supervising physician to discuss the appropriate evaluation and initial management as soon as the tactical situation allows
(g) Pass all the information to the next echelon of care
Administering FWB
Monitor the vital signs every ___ minutes for the first ____ minutes and observe the casualty for indications of an adverse reaction.
q 5 min for the first 15 min
Set the flow rate to deliver approximately ____ml of blood over the first 15 minutes. UNLESS what?
10-30
(1gtt/4-6 sec = 1ml/min).
if pre-collected O LowTiter from pre-screened individuals
Indication for what?
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
Tranexamic Acid (TXA)
______ helps to reduce blood loss from internal hemorrhage sites that cannot be addressed by tourniquets and hemostatic dressings
TXA
True/False
TXA promotes new clot formation
FALSE
Does not
TXA Administration
(1) Survival benefit is greatest when TXA is given within ______ of injury.
(2) The greatest decrease in blood loss is seen when TXA is started ASAP!
(3) Administer ______ gram of tranexamic acid in 100 ml normal saline or lactated ringers as soon as possible, but not later than _____ after injury.
(4) When administering TXA is should be administered over ______.
(5) A second infusion of 1 gram TXA may be administered after _________ has been completed.
1) 1 hour
3) 1g, 3 hours
4) 10 minutes
5) initial fluid resuscitation
TXA
Storage and Handling
Recommended temperature range for storage: _____ degrees F.
59-86
IV therapy
______ therapy- replaces normal ongoing losses
Maintenance therapy
IV therapy
_____ therapy - corrects any existing water and electrolyte deficits.
Replacement therapy
IV fluids come in what four different forms:
(a) Colloids
(b) Crystalloids (Isotonic, Hypotonic, Hypertonic)
(c )Blood and blood products
What type of IV fluid?
-Used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns).
-More suitable in hospital setting than field use.
Colloids (Volume Expanders)
What type of IV fluid?
(a) Fluids that consist of water and dissolved crystals, such as salts and sugar.
(b) Used as maintenance fluids to correct body fluids and electrolyte deficit.
Crystalloids
When the crystalloid contains the same amount of electrolytes as the plasma, itis referred to as ____
isotonic
If a crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as _____
hypertonic
Administration of hypertonic crystalloid causes what?
water to shift from the extravascular spaces into the bloodstream, increasing the intravascular volume
Uses of what IV fluid:
a) Shock
b) Resuscitation
c) Fluid challenges
d) Blood transfusions
e) Metabolic alkalosis
f) Hyponatremia
g)DKA
Normal Saline Solution (NSS)
Uses of what IV fluid:
a) Dehydration
b )Burns
c) GI tract fluid loss
d) Acute blood loss
e) Hypovolemia
Lactated Ringers (LR)
Uses of what IV fluid:
a) Fluid loss and dehydration
b) Hypernatremia
D 5 W
D 5 W Special consideration:
a) Solution becomes hypotonic when _____ is metabolized
b) Do not use for ______
c) Use cautiously in _______ patients
a) dextrose
b) resuscitation
c) renal and cardiac
Lactated Ringers (LR) Special consideration:
a) Contains Potassium, can cause _______ in renal patients
b) Patients with liver disease cannot metabolize _____
c) Lactate is converted into bicarb by liver which with larger volumes can lead to ______.
a) hyperkalemia
b) lactate
c) metabolic alkalosis
Normal Saline Solution (NSS) Special consideration:
a) Use with caution in patients with ______, ______, or ______
b) Can lead to ________
c) Speeds up the lethal triad of ______, _______ and ______
a) heart failure, edema, or hypernatremia
b) volume overload
c) hypothermia, coagulopathy, and acidosis
What are the most desirable fluids for replacement due to hemorrhage?
Platelets, Packed red blood cells, and Plasma
OI
The procedure must be performed under sterile conditions to avoid causing ________
osteomyelitis (infection of the bone).
When is IO indicated?
3 failed attempts at venous access or 90 secconds
Intraosseous (IO) Contra-indications
(1) Ipsilateral fracture or crush injury of an extremity
(2) Previous orthopedic procedure near site
(3) Previous IOVA attempts in the same bone
(4) Infection at site
(5) Brittle bones
The best site for IO is the
flat anteromedial aspect of the tibia
IO tibia
The site for cannulation lies ___ cm below the _____ on the anteromedial surface of the tibia
1-3, tuberosity
Complications of IO
(1) tibial fracture, especially in small framed people.
(2) Compartment Syndrome
(3) Osteomyelitis
(4) Skin Necrosis
The intraosseous route should be replaced as soon as what?
a normal vein can becannulated and certainly within a few hours
