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Clin Med IV: Operative > surgical bleeding and blood replacement and shock > Flashcards

surgical bleeding and blood replacement and shock Flashcards

1
Q

what are lab workup for bleeding disorders

A

CBC with platelet count
coagulation studies (PT/INR, aPTT)

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2
Q

what is a severe platelet count with bleeding disorders

A

< 50,000

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3
Q

when would someon have a prolonged aPTT but a normal PT

A

deficiency in factor 12, 11, 9,8 or vWF
liver disease
vitamin K deficiency
DIC
HIT
specific antibodies (lupus anticoagulant, anticardiolipin ab)

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4
Q

What is the reversal of wafarin

A

Vitamin K

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5
Q

What are hard signs of vascular injury

A
  • pulsatile bleeding
  • unexplained shock in setting of trauma/post surgical
  • no pulse distal to injury
  • expanding or pulsatile hematoma
  • bruit/thrill over affected area
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6
Q

when is the cell saver used in surgery

A

when anticipate > 1L of blood loss or patient who refuses allogenic blood

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7
Q

what is the management of surgical hemorrhage

A

direct repair of vessel
ligature of vessel
direct pressure
tourniquets
electrocautery
topical hemostatic agents (gelatin, cellulose, collagens, topical thrombins, fibrin sealants, platlet sealants)

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8
Q

What are potential complications of tourniquets

A

nerve injury
possible loss of limb due to loss of perfusion

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9
Q

how long can a tourniquet stay on

A

2 hours

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10
Q

What is hypovolemic shock

A

imbalance of O2 supply and demand
volume loss (blood, body fluids, plasma)

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11
Q

how does the body try to compensate for hypovolemic shock

A

through autonomic response wiht increase SVR

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12
Q

what are the causes of hemorrhagic hypovolemic shock

A

Trauma
GI bleed
AAA
Surgical bleeding
postpartum hemorrhage

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13
Q

what are the causes of non-hemorrhagic hypovolemic shock

A

volume loss without blood loss - GI losses, burns, excess osmotic diuresis, 3rd spacing

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14
Q

What is a normal adult blood volume

A

7% of body weight
usually somewhere around 5L of blood

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15
Q

what is the physiologic repsonse to hemorrhage

A
  1. progressive peripheral vasoconstriction
  2. tachycardia to preserve CO
  3. release of catecholamines; increase peripheral vascular resistance, increase diastolic BP (narrow pulse pressure)
  4. contraction of the venous system
  5. loss of enough volume in the system - low BP
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16
Q

What is the workup for DIC

A

high index of suspicion at hgih risk pts
start with CBC, peripheral smear and a caog panel
thrombocytopenia + fibrinogen + D-dimer

17
Q

what is the treatment of DIC

A

primary - tx underlying d/o
hemodynamic stabilization +/- ventilator support
whole blood transfusions
platlet transfusions
coag factor repletion

18
Q

how much does one unit of PRBCs increase Hgb

A

about 1.0 point

19
Q

what are indications for transfusion

A

hemoglobin < 7 for most pts
Hemoglobin < 8 for cardiac or ortho sx with preexisting CVD
hemoglobin >7 and evidence of organ ischemia
hemoglobin > 7 and symptomatic and anticipated ongoing loss
hemorrhagic shock

20
Q

what is blood stored at to prevent bacterial growth

A

1-6 degrees celcius

21
Q

what is the infusion rate for blood transfusions

A

no more than 2mL/minute initially (incase of rxn)
may increase to 5ml/min if no reaction after 15 min

22
Q

what does FFP provide

A

coagulation factors
Vitamin K dependent factors (2,7,9,10)
Factor 5 (only source)

23
Q

what are indications for FFP

A

abnormal PT/INR and/or aPTT and microvascular bleeding
coagulation factor deficiency when specific concentration unavailable
urgent warfain reversal

24
Q

how much FFP is given to reverse coumadin

A

3-10mL/kg
INR: 1.4-1.8

25
Q

how much is the platelet count elevated after one unit of platelets?

A

increased by 50,000 per unit

26
Q

what are indications for platlets

A

platelets < 50 with normal function
platelets < 100 with knonwn dysfunction
known platelet dysfunction and microvascular bleeding or potential ongoing bleeding

27
Q

what is a MTP

A

massive transfusion protocol
1 blood volume in 24 hours or 1/2 blood volume in 4 hours
includes: RBC, plasma and platelets

28
Q

what is given in conjunction with MTP protocol

A

calcium!
every 4 units, can give 1g calcium

29
Q

what are complications of transfusion

A

infection
allergic reactions
immunologic reaction
volume overload
hyperkalemia
iron overload

30
Q

how soon is a febrile reaction seen after transfusion

A

in 1 hour

associated with cytokine release. stop blood and treat with antipyretics

31
Q

What is TRALI

A

transfusion-related acute lung injury (ARDS): life threatening reaction where neutrophils are activated leadign to respiratory distress within 6 hours

32
Q

what is the presentation of TRALI

A

ARDS, fever, chills
lack signs of volume overload
need supportive care (O2, aiway and pressor support)

33
Q

What is TACO

A

Transfusion-associated circulatory overload
pulmonary edema d/t circulatory overload, occurs if transfused quickly

34
Q

what is the presentation of TACO

A

Hypertensive, elevated JVD
need to diuresis the patine tand vent support

35
Q

What is acute hemolysis

A

life threatening reaction where there is acute intravascular hemolysis of RBCS
Typcailly d/t mismatched blood

36
Q

what is the presentation of transfusion complications

A

fever, chills, flank pain, oozing from IV (DIC), NV
can progress to DIC

stop the blood, replace IV tubing, give IV fluids, diuretics and steroids

37
Q

What is DIC

A

disseminated intravascular coagulation
may result as complication of transfusion
life threatening d/o with both bleeding and clotting

38
Q

what is the treatment of DIC

A

supportive care with ABCS, FFP, Cryoprecipititate, vitamin K
all depend on level of bleeding

Clin Med IV: Operative (6 decks)

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