Polytruama

Question 1

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Stem: A known hepatitis C patient suffered a traumatic splenic rupture with massive blood loss. Spleenectomy done and the patient reecieved a massive blood transfusion. Later, the patient developed epistaxis, bleeding in the NG tube and oozing from the surgical wound. Investigations showed sever thrombocytopenia and low fibrinogen with increased fibrin degradation products.

Q1: What’s your diagnosis?

Answer 1

DIC Dissemented intravascular coagulopathy

Question 2

Define DIC?

Answer 2

Pathological Consumptive Coagulopathy due to activation of coagulation and fibrinolytic system leading to forming microthrombi with consmpution of clotting Fx and platlets. Chch by wide spread hge / Thrombocytopenia / consumption of coagulation factors

Question 3

Q2: How to correct DIC?

Answer 3

Transfusion of FFP and platlet and cryoprecipitate(fibrin, fibrinogen, Fx 8, Fx 13, VWF) and desmopressin

Question 4

Q3: What’s massive transfusion protocol? What are its complications?

Answer 4

rapid administration of large amounts of blood products (at least 6 units of PRBC) in fixed ratios (usually 1:1:1) for the management of hemorrhagic shock. Only a subset of patients with “massive transfusion” will receive a massive transfusion
protocol.

Complications; Volume overload, Hypothermia, Hyperkalemia, Hypocalcemia, platlet dysfunction, coagulopathy

Question 5

Q4: How to minimize the need for blood transfusion?

Answer 5

-Maintain a hemoglobin concentration of 8 g/dL.
-Ensure platelets are at 10 × 10³/μL.
-Use fresh frozen plasma for proven coagulopathies.
-Avoid blood loss using diathermy and normothermia.
-Apply fibrin sealant or glue.
-Administer anti-fibrinolytic agents like tranexamic acid and aprotinin.
-Use haematinics and erythropoietin preoperatively, with iron and folate supplements.
-Use plasma expanders, such as crystalloids and colloids.
-Utilize autologous transfusion.

Question 6

Q5: How platelets are formed? What’s its shelf life?

Answer 6

From megakrycytes by fragmentation
5-6 days

Question 7

Q6: What’s the percentage of platelets and WBCs in packed RBCs?

Answer 7

Platlets; zero
WBCs; 5x106/L

Question 8

Q7: What’s the life span of RBCs?

Answer 8

120 days

Question 9

Q8: What would a hematologist ask F1 before ordering the blood transfusion?

Answer 9

Grouping and cross matching ABO / Rh

Question 10

What’s cross matching? Which antigens are tested? what is meant by group and save?

Answer 10

Test donor RBCs against the recipient serum to detect any potentiality of incompatibility. As recipient ab may cause hemolysis of donor RBCs
ABO / RH
blood group and Ab screen

Question 11

Q9: Why does this patient has bleeding tendency?

Answer 11

Liver dysfunction  Vit K definecy affecting production of coagulation Fx 1972

Question 12

Q10: What are the late manfestations of HCV?

Answer 12

Cirrihosis and hepatocellular carcinoma

Question 13

Q11: What activates intrinsic and extrinsic pathways? How can you test each?

Answer 13

Int; exposure of endothelial collagen / By APTT
Ext; Tissue Fx / By PT

Question 14

Q12: The patient developed a hypersensitivity reaction during blood transfusion, what is the definition of hypersensitivity? What are its types?

Answer 14

Exaggerated immunological response to an Ag.
Types
I – immediate - IgE – Anaphylaxis
II- Cytotoxic – IgM / IgG – Hemolytic anemia
III- Immunocomplex – AgAb – SLE /RA
IV- Cell mediated – T cell – Contact dermatitis / TB
V- autoimmune – Grave’s Dis

Question 15

Q13: The patient has sustained a long bone fracture, can you mention the different stages of bone healing?

Answer 15

Hemtoma Formation – Hrs to Days
Inflammatory Phase – Days to weeks
Fibrocartilagenous callus Formation – 2 wks
Hard Callus Formation – 2 wks to several months
Remodling – 7 mon – years

Question 16

Q14: What are the effects of prolonged imobility on bone healing?

Answer 16

Immobilization impacts bone modeling and remodeling by increasing the activation of remodeling sites while decreasing osteoblastic activity. This dual effect results in a local reduction in bone mass. The heightened remodeling activity exacerbates the deficit in bone formation, leading to weakened bone structure and delayed healing.

Question 17

Fracture was treated by ORIF; then the wound started oozing yellow fluid
Q15: What’s the first test to be done to the fluid?

Answer 17

Swap for C&S

Question 18

Q16: Wound swab and culture revealed PVL, What does PVL stand for? What’s the effect of its cytotoxin?

Answer 18

Panton Valentine Leucocidin
Cytotoxin produced by S. Aureus cuase leucocyte destruction and tissue necrosis.
effect; cuase pores in the membranes and this will cause necrotic lesion like in skin or mecosa

Question 19

Q17: What would you like to do with the implant? Why?

Answer 19

Removing it as it become a septic focus.