Shock And Blood Transfusion

Question 1

Resuscitation

Answer 1

1- fluid therapy
2 - vasopressor and inotropic support
3- monitoring

Question 2

Vasopressors in distributive shock states

Answer 2

Phenylephrine
Noradrenaline
If steroid resistant then vasopressin

Question 3

Inotropic support in cardiogenic shock

Answer 3

Dobutamine

Question 4

Monitoring in shock patients

Answer 4

Heart rate by ECG
Oxygen saturation by pulse oximetry
Blood pressure
Urine output (hourly)

Question 5

Additional monitoring

Answer 5

Central venous pressure
Cardiac output
Base deficit and serum lactate

Question 6

Base deficit and lactate

Answer 6

Above 6mmol/L have higher morbidity and mortality

Question 7

Mixed venous saturation

Answer 7

Normal is 50 to 70 percent
Below 50 percent is cardiogenic shock
Above 70 percent is septic shock

Question 8

End points of resuscitation

Answer 8

Normal pulse. Blood pressure. Urine output. Base deficit. Lactate levels. Mixed venous saturation

Question 9

Occult hypoperfusion

Answer 9

Normal perfusion to brain, Lungs and kidneys. Normal BP . Pulse and urine output . But lactate levels, base deficit and venous saturation are still deranged

Question 10

What happens if you attempt to resuscitate a patient with ongoing blood loss without stopping the bleed first?

Answer 10

Physiological exhaustion.
Coagulopathy
Called Acute traumatic coagulopathy which is part of trauma induced coagulopathy.
Acidosis and hypothermia further reduce the action of coagulation factors.

Question 11

Classification of hemorrhagic shock

Answer 11

Class 1 less than 15 percent
Class 2 15 to 30 percent
Class 3 30 to 40 percent
Class 4 greater than 40 percent

Question 12

Damage control surgery in acute haemorrhage

Answer 12

Stop the bleeding.

Definitive control can be done once patient is hemodynamically state

Question 13

Damage control resuscitation

Answer 13

Anticipate and treat acute traumatic coagulopathy
Allow permissive hypotension till bleeding is controlled
Limit administration of crystalloids and colloids till then

Question 14

Whole blood

Answer 14

Rich in coagulation factors and fresh is more metabolically active than old

Question 15

Packed red cells

Answer 15

330 ml and contains 50-70 percent of hematocrit. Stored in SAG-M at 2-6 degrees for 5 weeks

Question 16

Fresh frozen plasma

Answer 16

Coagulation factors.
Stored at minus 40 to minus 50 degree Celsius.
Shelf life 2 years

Question 17

Cryoprecipitate

Answer 17

Shelf life 2 years
Stored at minus 30
Rich in factor 8 and fibrinogen

Question 18

Platelets

Answer 18

Shelf life of only 5 days
Stored at 20-24
250 into 10 raised to the power 9

Question 19

Prothrombin complex concentrate

Answer 19

Factor 2 7 9 10

Emergency reversal of warfarin therapy

Question 20

Autologous blood

Answer 20

Patients can give their blood 3 weeks before surgery for transfusion during surgery

Question 21

Indications for transfusion

Answer 21

1- acute blood loss
2 - perioperative anemia
3 - symptomatic chronic anemia

Question 22

RBC transfusion criteria

Answer 22

Less than 6 g/dL will benefit from transfusion
6-8 only give if acute blood loss, patient about to go into surgery or is symptomatic
Greater than 8 no need for transfusion

Question 23

Complications from single blood transfusion

Answer 23

Haemolytic transfusion reaction 
Febrile transfusion reaction 
Allergic reaction
HIV 
Hepatitis 
Malaria 
Bacterial infection 
Air embolism 
Thrombophlebitis 
Acute lung injury due to fresh frozen plasma

Question 24

Complications from massive transfusion

Answer 24

Coagulopathy 
Hypothermia 
Hypocalcemia 
Hyperkalemia 
Hypokalemia

Question 25

Management of coagulopathy

Answer 25

Fresh frozen plasma if PTT or PT is greater than 1.5 times normal
Cryoprecipitate if fibrinogen is less than 0.8 g/L
Platelets if count is less than 50 into 10 raised to the power 9

Antifibrinolytics like tranexemic acid and aprotinin are also given