Surgical Bleeding, Blood Replacement, and Shock

Question 1

Who is at risk for bleeding trouble?

Answer 1

Patients with:
* Hereditary or acquired coagulation disorders
* Liver or Kidney disease
* Myeloproliferative disorders
* Anticoagulants
* Herbal supplements or vitamins
* High risk for organ ischemia

Question 2

What is the platelet cutoff for severe thrombocytopenia?

What is the patient at risk for?

Answer 2

< 50,000

Spontaneous bleeding

Question 3

What should be on your differential with a prolonged PT but normal aPTT?

Answer 3

• Factor 7 deficiency
• Vitamin K deficiency
• Liver disease

Question 4

What should be on your differential with a prolonged aPTT but normal PT?

Answer 4

• Deficiency in factor 12, 11, 9, 8, or vWF
• Liver disease
• Vitamin K deficiency
• DIC
• HIT
• Specific antibodies (lupus)

Question 5

What are some hard signs of vascular injury?

Answer 5

• Pulsatile bleeding
• Unexplained shock in setting of trauma/post surgical
• No pulse distal to injury
• Expanding or pulsatile hematoma
• Bruit/thrill over affected area

Question 6

How much blood does a 30x30 lap sponge hold?

Answer 6

Somewhere around 12.5-60ml

Question 7

Surgical hemorrhagic shock is usually a result of

Answer 7

inadequate hemostasis

Question 8

What are the types of shock?

Answer 8

• Distributive
• Obstructive
• Cardiogenic
• Hypovolemic

Question 9

How does acidosis impact coagulopathy?

Answer 9

Worsens the bodys ability to coaguate –> end organ dysfunction

Question 10

What is the treatment of shock?

Answer 10

STOP THE BLEEDING!

Restore cellular and organ perfusion with adequately oxygenated blood —> Go back to ABCs (oxygenation, ventilation, and fluid resuscitation)

Question 11

What are the most common lab findings in DIC?

Answer 11

Thrombocytopenia, low fibrinogen, and high D-dimer

Question 12

What type of transfusion is used to treat DIC?

Answer 12

Whole blood transfusions

Question 13

What can acute hemolysis lead to?

Answer 13

DIC

Question 14

When is a cell saver used?

What is a cell saver?

Answer 14

When anticipated blood loss exceeds > 1L or patient refuses allogenic blood

Allows for auto-transfusion, blood is removed cleaned etc. RBCs replaced

Question 15

What is the treatment of a surgical hemorrhage?

Answer 15

Direct cautery and control of the bleeding

Question 16

DIC is most commonly caused by sepsis, what are some other causes?

Answer 16

• Trauma
• Burns
• Shock
• Pregnancy (m/c amniotic fluid emboli)
• Transfusion
• Surgery

Question 17

What suture type is used to quickly control bleeding during a surgical hemorrhage?

Answer 17

Figure 8

Question 18

Sepsis is what kind of shock?

Answer 18

Distributive

Vascular system impaired

Question 19

A loss in blood, fluid, or plasma results in what kind of shock?

Answer 19

Hypovolemic

Question 20

In hypovolemic shock, the body has decreased cardiac preload, stroke volume, and output. The body tries to compensate how which further leads to shock.

Answer 20

Autonomic response to increase stroke volume which leads to decreased myocardial O2 further percipitating shock

Question 21

Does hemorrhagic shock lead to acidemia or alkalemia?

Answer 21

Acidemia

Acidosis worsens coagulopathy –> end organ dysfunction = DIC

Question 22

In hemorrhagic shock, is the patient bradycardic or tachycardic?

Answer 22

Tachycardic to preserve cardiac output

Question 23

What type of fluid is blood?

Answer 23

Colloid

Will increase intravascular volume and improve BP

Question 24

Can fresh plasma reverse warfarin?

Answer 24

Yes, one of the indications to use fresh packed plasma

Question 25

While giving a massive transfusion what electrolyte should also be given?

Answer 25

Give calcium too!

Every 4 units give 1g of calcium