Shock And Blood Transfusion Flashcards
Resuscitation
1- fluid therapy
2 - vasopressor and inotropic support
3- monitoring
Vasopressors in distributive shock states
Phenylephrine
Noradrenaline
If steroid resistant then vasopressin
Inotropic support in cardiogenic shock
Dobutamine
Monitoring in shock patients
Heart rate by ECG
Oxygen saturation by pulse oximetry
Blood pressure
Urine output (hourly)
Additional monitoring
Central venous pressure
Cardiac output
Base deficit and serum lactate
Base deficit and lactate
Above 6mmol/L have higher morbidity and mortality
Mixed venous saturation
Normal is 50 to 70 percent
Below 50 percent is cardiogenic shock
Above 70 percent is septic shock
End points of resuscitation
Normal pulse. Blood pressure. Urine output. Base deficit. Lactate levels. Mixed venous saturation
Occult hypoperfusion
Normal perfusion to brain, Lungs and kidneys. Normal BP . Pulse and urine output . But lactate levels, base deficit and venous saturation are still deranged
What happens if you attempt to resuscitate a patient with ongoing blood loss without stopping the bleed first?
Physiological exhaustion.
Coagulopathy
Called Acute traumatic coagulopathy which is part of trauma induced coagulopathy.
Acidosis and hypothermia further reduce the action of coagulation factors.
Classification of hemorrhagic shock
Class 1 less than 15 percent
Class 2 15 to 30 percent
Class 3 30 to 40 percent
Class 4 greater than 40 percent
Damage control surgery in acute haemorrhage
Stop the bleeding.
Definitive control can be done once patient is hemodynamically state
Damage control resuscitation
Anticipate and treat acute traumatic coagulopathy
Allow permissive hypotension till bleeding is controlled
Limit administration of crystalloids and colloids till then
Whole blood
Rich in coagulation factors and fresh is more metabolically active than old
Packed red cells
330 ml and contains 50-70 percent of hematocrit. Stored in SAG-M at 2-6 degrees for 5 weeks
Fresh frozen plasma
Coagulation factors.
Stored at minus 40 to minus 50 degree Celsius.
Shelf life 2 years
Cryoprecipitate
Shelf life 2 years
Stored at minus 30
Rich in factor 8 and fibrinogen
Platelets
Shelf life of only 5 days
Stored at 20-24
250 into 10 raised to the power 9
Prothrombin complex concentrate
Factor 2 7 9 10
Emergency reversal of warfarin therapy
Autologous blood
Patients can give their blood 3 weeks before surgery for transfusion during surgery
Indications for transfusion
1- acute blood loss
2 - perioperative anemia
3 - symptomatic chronic anemia
RBC transfusion criteria
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
Complications from single blood transfusion
Haemolytic transfusion reaction Febrile transfusion reaction Allergic reaction HIV Hepatitis Malaria Bacterial infection Air embolism Thrombophlebitis Acute lung injury due to fresh frozen plasma
Complications from massive transfusion
Coagulopathy Hypothermia Hypocalcemia Hyperkalemia Hypokalemia
