Surgical Bleeding, Blood Replacement, and Shock Flashcards
Who is at risk for bleeding trouble?
Patients with:
* Hereditary or acquired coagulation disorders
* Liver or Kidney disease
* Myeloproliferative disorders
* Anticoagulants
* Herbal supplements or vitamins
* High risk for organ ischemia
What is the platelet cutoff for severe thrombocytopenia?
What is the patient at risk for?
< 50,000
Spontaneous bleeding
What should be on your differential with a prolonged PT but normal aPTT?
- Factor 7 deficiency
- Vitamin K deficiency
- Liver disease
What should be on your differential with a prolonged aPTT but normal PT?
- Deficiency in factor 12, 11, 9, 8, or vWF
- Liver disease
- Vitamin K deficiency
- DIC
- HIT
- Specific antibodies (lupus)
What are some hard signs of vascular injury?
- Pulsatile bleeding
- Unexplained shock in setting of trauma/post surgical
- No pulse distal to injury
- Expanding or pulsatile hematoma
- Bruit/thrill over affected area
How much blood does a 30x30 lap sponge hold?
Somewhere around 12.5-60ml
Surgical hemorrhagic shock is usually a result of
inadequate hemostasis
What are the types of shock?
- Distributive
- Obstructive
- Cardiogenic
- Hypovolemic
How does acidosis impact coagulopathy?
Worsens the bodys ability to coaguate –> end organ dysfunction
What is the treatment of shock?
STOP THE BLEEDING!
Restore cellular and organ perfusion with adequately oxygenated blood —> Go back to ABCs (oxygenation, ventilation, and fluid resuscitation)
What are the most common lab findings in DIC?
Thrombocytopenia, low fibrinogen, and high D-dimer
What type of transfusion is used to treat DIC?
Whole blood transfusions
What can acute hemolysis lead to?
DIC
When is a cell saver used?
What is a cell saver?
When anticipated blood loss exceeds > 1L or patient refuses allogenic blood
Allows for auto-transfusion, blood is removed cleaned etc. RBCs replaced
What is the treatment of a surgical hemorrhage?
Direct cautery and control of the bleeding
DIC is most commonly caused by sepsis, what are some other causes?
- Trauma
- Burns
- Shock
- Pregnancy (m/c amniotic fluid emboli)
- Transfusion
- Surgery
What suture type is used to quickly control bleeding during a surgical hemorrhage?
Figure 8
Sepsis is what kind of shock?
Distributive
Vascular system impaired
A loss in blood, fluid, or plasma results in what kind of shock?
Hypovolemic
In hypovolemic shock, the body has decreased cardiac preload, stroke volume, and output. The body tries to compensate how which further leads to shock.
Autonomic response to increase stroke volume which leads to decreased myocardial O2 further percipitating shock
Does hemorrhagic shock lead to acidemia or alkalemia?
Acidemia
Acidosis worsens coagulopathy –> end organ dysfunction = DIC
In hemorrhagic shock, is the patient bradycardic or tachycardic?
Tachycardic to preserve cardiac output
What type of fluid is blood?
Colloid
Will increase intravascular volume and improve BP
Can fresh plasma reverse warfarin?
Yes, one of the indications to use fresh packed plasma
While giving a massive transfusion what electrolyte should also be given?
Give calcium too!
Every 4 units give 1g of calcium
