Trauma, Transfusion, Coags

Question 1

NEXUS criteria (clear c-spine)

Answer 1

Awake and alert (no intox),
no distracting injuries,
no midline spine tenderness,
no focal neurologic deficits

Question 2

sudden hypotension with high CVP in trauma. WDYD?

Answer 2

Confirm, palpate, TEE

Question 3

TEG Response: long R time

Answer 3

Give FFP (or protamine if heparinized)

Question 4

TEG Response: short MA

Answer 4

platelets or fibrinogen (clarify then treat)

Question 5

TEG Response: short LY30

Answer 5

give TXA or Amicar

Question 6

2 theorized mechanisms of TRALI

Answer 6

neutrophil priming (by donor Ab)
non-Ab related (many possibilities)

Question 7

What is PT? What does it define

Answer 7

Prothrombin Time
Different in every lab (INR standardizes)
Extrinsic pathway (so measures factor 7)
- this makes it the best to detect liver disease

Question 8

PT vs PTT mnemonic

Answer 8

PTT: INtrinsic (the T’s are in a relationship)
PT: EXtrinsic (the T’s have broken up)

Question 9

Coagulation factor with the shortest half life? Is it a part of the intrinsic or extrinsic pathway?

Answer 9

Factor 7 - 4-6 hours (this makes it a good the first indicator of liver disease)

Question 10

Intrinsic Pathway Factors
Extrinsic Pathway Factors
Common pathway Factors

Answer 10

Intrinsic: 9, 11, 12
Extrinsic: 7
Common: 1, 2, 5, 8, 10

Question 11

Shockable rhythms

Answer 11

V fib and PULSELESS V-Tach (defibrillate)

SVT, afib (cardiovert)

Question 12

How do you treat DIC

Answer 12

The only way is to treat the cause.
Yes giving products can “feed” the DIC, but if the patient is bleeding out you have to give FFP/Plt/Cryo
NEVER GIVE TXA IN DIC

Question 13

What is DIC?

Answer 13

When something tips the balance of clot formation and fibrinolysis in favor of clot formation. Small clots everywhere (worse for small vessels ie: kidney, brain, liver, lung) that use up clotting factors and platelets. You get paradoxical bleeding because there are no materials to form good clots. You also see increased fibrin/clot degradation products that further interfere with clotting

Question 14

Lab values seen in DIC

Answer 14

*PT/INR and *PTT are increased –> show a lack of circulating clotting factors
D-Dimer and fibrin degradation products are elevated –> lots of clots being broken down
Platelets are gone
*these lab values are normalized in chronic DIC

Question 15

List some causes of DIC

Answer 15

Blood transfusion reaction, Cancer (esp. leukemia), Pancreatitis, Sepsis
Liver disease, Pre-eclampsia, retained placenta, Recent surgery or anesthesia, Severe trauma
Large hemangioma

Question 16

Can you give TXA to a patient in DIC?

Answer 16

NO!

Question 17

can you give TXA to a patient with trauma associated or dilutional coagulopathy?

Answer 17

YES! but only in the first 3 hours after a trauma

Question 18

Tachyrhythmia: Wide complex –> Regular

Answer 18

Vtach

SVT w/aberrancy (adenosine)

Question 19

T/Screen vs. T/Cross

Answer 19

Type = ABO and Rh test
Screen = recipient plasma with commercial RBC assay w/known antigens
Cross = recipient plasma mixed with donor RBC

Question 20

Patient develops VTach intraop. WDYD?

Answer 20

pulseless–> defib; Pulse –> cardiovert

Unstable–> the above + start CPR