Phase 1 - Week 3 (Blood) Flashcards
List the regions of the abdomen
- Right hypochondrium (top right)
- Epigastric (top middle)
- Left hypochondrium (top left)
- Right lumbar (middle right)
- Umbilical (middle)
- Left lumbar (middle left)
- Right iliac (bottom right)
- Hypogastric (bottom middle)
- Left iliac (bottom left)
List the cell types that B cell precursors can mature into
B cells
When is definitive Haemostasis achieved?
When Fibrin formed by blood coagulation is added to the platelet mass and platelet- induced clot retraction/compaction occurs.
Adduction
Motion that pulls structure closer to the midline of the body or limb
Erythropoiesis
Production of new Erythrocytes, constant process as old RBCs are replaced
Describe the classificatios of Hypovolaemic Shock in terms of pulse rate
Class I = <100
Class II = >100
Class III = >120
Class IV = >140
Stages of Haemostasis
- Vasoconstriction
- Platelet aggregation (formation of primary platelet plug)
- Blood coagulation (formation of definitive fibrin clot)
Describe the standard precautions involved in SICP
- Hand hygiene at the 5 moments
- Care in use and disposal of sharps
- Correct use of personal protective equipment for contact with all blood, body fluids, secretions + excretions
- Providing care in a suitably clean environment with adequate decontaminated equipment
- Safe disposal of waste
- Safe management of use linen
Describe the mechanism of action of Haemoglobin
Iron combines reversibly with oxygen. The individual globin chains interact to facilitate the offloading of oxygen at lower oxygen saturations. Haemoglobin has a high affinity for oxygen in the lungs and a low affinity for oxygen in the tissues.
What is the main protein found in plasma and what is its function?
Albumin - controls osmotic pressure
Describe the first aid response to wounds which may contain foreign objects
- Ensure airway is clear (if bleeding from mouth/nose)
- Wear gloves to protect from infection
- Remove clothing around wound
- Don’t pull foreign objects out of wound - could be acting as a plug to reduce bleeding
- Apply pressure on either side of the object
- Lie patient down/raise legs to treat for shock (unless legs are injured)
- Apply bandage
- check circulation
What is the role of Von Willebrand’s factor in platelet function
Adhesion of platelets to the vascular endothelium is mediated by VWF that also carries factor VIII coagulation factor.
List the cell types that T cell precursors can mature into
- Natural Killer Cells
- T cells - Cytotoxic or Helper
Explain the cause of Shock
After blood loss, the drop in oxygen carrying capacity due to the decrease in RBCs means that oxygenation of tissues is not adequate to maintain normal metabolic functions
Explain the observations made in the Breathing stage of ATLS
- Check for fractures (sternum/scapula)
- Can have ‘flail’ - loose part of ribs due to fracture, falls in when inhaling
- Haemothorax - collection of blood in pleural space
- Pneumothorax - collection of air in pleural space (collapsed lung)
Describe the function of the primary platelet plug
The unstable primary haemostatic plug produced by these platelet reactions in the first minute or so following injury is usually sufficient to provide temporary control of bleeding.
Define differentiation
The process by which relatively unspecialised cells, e.g. stem cells, acquire specialised structural and/or functional features that characterise the cells, tissue or organs of the organism
Elevation
Movement in a superior direction
List the cell types that granulocyte CFUs can mature into
- Monocytes (which mature into Macrophages or Neutrophils)
Explain the structure and role of the cytoskeleton in RBCs
Responsible for maintaining shape, proteins include spectrin, actin, ankyrin. Spectrin is most abundant consists of Alpha and Beta chains wound around each other.
Describe the structure of the plasma membrane of platelets.
Coated by glycoprotein 1b and GP2b-GP3a, involved in the attachment of platelets of platelets to Von Willebrand’s factor. Membrane is invaginated to form a system of cytoplasmic channels called the invaginated membrane system.
Unipotent
Can give rise to one specific adult body tissue cell
Describe the classifications of Hypovolaemic Shock in terms of respiration rate
Class I = 14-20
Class II = 20-30
Class III = 30-40
Class IV = >40
How are proteins encoded?
Read from mRNA in codons of 3 bases according to the genetic code
Explain the observations made in the Circulation stage of ATLS
- Check for cardiac tamponade - bleeding between surface of heart and pericardium limiting movement of heart
- Tension pneumothorax
- Major haemothorax - >1l blood in chest
List the possible types of post-translational modifications
- Glycosylation (sugar chains added)
- Phosphorylation
- Other - hydroxylation, Prenylation, Acyl lipidation etc.
Describe the steps involved in the Intrinsic Pathway of blood coagulation
- Factor VII and Factor V = Factor VIIa
and Factor Va by the small amounts of thrombin generated during initiation
- XII = XIIa due to exposed collagen
XI = XIa due to XIIa
IX = IXa due to XIa (and calcium)
- Factor IXa and Factor VIIa = Intrinsic Xase
How can more than one protein be produced from one gene?
Post-translational modifications
Describe the steps involved in the Extrinsic Pathway of blood coagulation
- Tissue factor + plasma factor VII = Factor VIIa-Tissue factor (Extrinsic Factor Xase)
- Factor IX = Factor IXa
and
Factor X = Factor Xa by Extrinsic Factor Xase
- Factor IXa and Factor Xa convert Prothrombin = Thrombin
Describe the structure of erythrocytes
- Non-nucleated, biconcave-shaped cells - Lack organelles - only have a plasma membrane, cytoskeleton, haemoglobin and glycolytic enzymes
Describe bites + treatment
- Small entry wound - Possibly deep - Foreign body contamination - Animal -Human - Human blood borne viruses - Antibiotics, tetanus, vaccines - Irrigation, delayed closure?(infection)
How is spontaneous clotting of blood prevented in blood vessels?
- Structure of the endothelial lining - smooth vessel walls. - Chemicals to prevent clotting - thrombomodulin, nitric oxide, prostacyclin
Describe the structure of a Haemoglobin molecule
2 x Alpha chains 2 x Beta Chains 4 x Haem molecules with 4 Iron atoms
Why must coagulation be amplified after the Extrinsic Pathway
Not enough thrombin is produced during extrinsic pathway to initiate fibrin polymerisation.
Describe the production of platelets
Platelets are small cytoplasmic discoid fragments derived from megakaryocytes under the control of thrompoietin, a glycoprotein produced in the kidneys and liver. Magekaryocytes develop cytoplasmic projections that become proplatelets which fragment into platelets (takes 7-10 days). Platelets bind and degrade thrombopoietin, a mechanism that regulates platelet production.
Multipotent
Can give rise to tissue specific cell type of the human body
Outline the 5 moments of hand hygiene
- Before touching patient
- Before clean/aseptic procedures
- After touching a patient
- After touching a patient’s immediate surroundings
- After body fluid exposure
Transcriptome
All the mRNA molecules expressed from the genome
Briefly explain the steps involved in the clotting cascade.
- Initiation (Extrinsic Pathway)
- Amplification (Intrinsic Pathway)
- Common pathway
Abduction
Motion that pulls structure away from the midline of the body or limb
List some examples of wounds
- Abrasions
- Degloving
- Incision
- Laceration
- Bites
- Burns
Describe the symptoms associated with shock
- Increase in pulse
- Decrease in blood pressure - last sign
- Increase in respiratory rate (v. reliable measure)
- Decrease in urine output
- Altered mental status
Describe how the components of blood other than RBCs are replaced after blood loss
Plasma is mostly water, so water retention by kidneys helps make up lost plasma. Salts in plasma are absorbed through the digestive system. All blood proteins are synthesised in the liver.
Describe the role of the triage nurse
- First point of contact for patients in emergency setting
- Assess patients - type of injury or illness, its severity, symptoms, patient explanation of emergency, and vital signs - and decide who will be seen first (traffic light system)
Medial
Closer to the midline of the body
How is RBC replacement stimulated after blood loss?
- Peritubular cells in the kidneys recognise that the oxygen level in the blood has decreased (due to loss of RBC) and secrete the hormone Erythropoietin.
- Erythropoietin travels in the bloodstream to bone marrow which stimulates an increase in the activity of HSCs to produce more cells required to replace lost cells
Role of the Smooth ER
Lipid synthesis + metabolism
List the sources of potential infection
- Blood and other body fluids
- Secretions or excretions (excluding sweat)
- Non-intact skin
- Mucous membranes
- Equipment or items in care environment that could be contiminated
List the types of Personal Protective Equipment (PPE)
- Non-latex disposable gloves
- Disposable aprons
- Sterile gloves
- Sterile aprons
- Eye protection
- Masks and respirators