Surgical Bleeding

Question 1

What is the physiological indication for RBC transfusion?

Answer 1

improve oxygen carrying capacity of the blood

Question 2

Transfusion reaction that results from errors involving ABO incompatibility

Answer 2

acute hemolytic rxn

Question 3

What is the treatment protocol for an acute hemolytic transfusion reaction after the transfusion has been stopped?

Answer 3

IV fluids (possibly mannitol), furosemide, and alkalinize the urine

Question 4

Blood component that is particularly implicated in transfusion related acute lung injury

Answer 4

FFP

Question 5

Symptoms include fever, dyspnea, fluid in ET tube, hypoxia within 6 hrs of administration of products

Answer 5

transfusion related acute lung injury

Question 6

How much blood is considered a massive transfusion?

Answer 6

> 3000ml or more than 10 units of PRBCs in 24hrs

Question 7

most common hemostatic abnormality during and after massive transfusion due to washout of unstable clotting factors and platelets

Answer 7

thrombocytopenia

Question 8

What is the most common blood product with bacterial contamination?

Answer 8

platelets

Question 9

caused by patients leucocytes reacting against donor leukocytes

Answer 9

febril non-hemolytic transfusion

Question 10

Indications for this product include multiple coagulation deficiences, DIC, coumadin reversal, deficiency of factor XI or VII

Answer 10

FFP

Question 11

A mathematical “correction” (of the PT ratio) for differences in the sensitivity of thromboplastin reagents

Answer 11

INR

Question 12

What is the best method for local hemostasis

Answer 12

digital pressure

Question 13

Mixture of beeswax and vaseline. Non-absorbable material that becomes soft in hand when warm. Used in bone surgeries

Answer 13

bone wax

Question 14

Common complications of bone wax

Answer 14

allergic rxn, granuloma, infection, interference with bone healing

Question 15

made from animal-skin gelatin, whipped, and baked into its sponge form through which nitrogen has been bubbled in to produce a porous device

Answer 15

gelatin foam (absorbable)

Question 16

What does gel foam need to be soaked in to act directly on the coagulation cascade?

Answer 16

thrombin

Question 17

Works by simple burning of tissue via DC current. Causes scars on skin.

Answer 17

electro-cautery

Question 18

What should you do if a patient’s INR is greater than therapeutic range but < 5.0?

Answer 18

Lower the dose or omit the next dose; resume warfarin therapy at a lower dose when the INR approaches desired range

Question 19

What should you do if a patient has a high INR with serious bleeding or warfarin overdose?

Answer 19

Vitamin K1 (10 mg by slow IV infusion), with fresh plasma transfusion or prothrombin complex concentrate

Question 20

Laboratory results show decreased plts or you’re suspicious of thrombocytopathy. What should you do?

Answer 20

transfuse 5-10 units of plts. consider DDAVP

Question 21

Laboratory results show increased PT, PTT, normal plts and normal/increased levels of fibrinogen. What should you do?

Answer 21

give FFP

Question 22

Laboratory results show increased PT, PTT, low plts, decreased fibrinogen. what should you do?

Answer 22

give fibrin split products, cryo, and plts. Work-up pt for DIC