Week 11 - Disseminated Intravascular Coagulation Flashcards
what is disseminated intravascular coagulation (DIC)
- serious & life threatening bleeding and thrombotic disorder
- cascade that occurs in response to a disease process/shock
what does DIC result from
- abnormally initiated and accelerated clotting and anticlotting process that occur in response to a disease or injury
describe what occurs in DIC
- accelerated clotting in microcoagulation at the site of tissue injury, leading to depletion of platelets and clotting factors in other parts of the body
- get widespread fibrin & plts deposition in capillaries & arterioles = thrombosis = organ failure
- clotting factor depleted = a stable clot cannot be formed at injury sites = r/o hemorrhage
what causes DIC? what does this mean?
- underlying disease or condition always causes DIC
ex. shock, tissue damage (burns, head injuries etc.), malignancies - the underlying disease must be treated for DIC to resolve
what type of clinical manifestations are seen in DIC
bleeding & thrombotic manifestations
what are some examples of bleeding S&S seen in DIC (16, lots but common sense)
- petechia
- pallor
- purpura
- bleeding
- occult hemorrhage
- tachypnea
- hemopytsis
- tachycardia
- hypotension
- upper & lower GI bleeding
- abdomin distenstion
- bloody stools
- hematuria
- dizziness
- headache
- changes in mental status
- bone & joint pain
what are some examples of thrombotic manifestations seen in DIC (9)
- ischemic tissue necrosis (gangrene)
- hemorrhage necrosis
- tachypnea
- PE
- ARDs
- ECG changes
- abdominal pain
- paralytic ileus
- oliguria & renal failure
(d/t fibrin & plt deposition in microvasculature)
what is used to diagnose DIC (6)
- bleeding tests
- plt count
- d-dimer
- factor assays
- fibrinogen
- fibrin split products
what is the goal of collab care for DIC (4)
- quick diagnose
- stabilize pt
- institute treatment for underlying cause
- provide supportive care for symptoms
what is the treatment for a pt diagnosed w DIC who is not bleeding
- no therapy necessary
- focused on treatment of underlying disease
ex. chemo for malignancy
what is the treatment for a pt w DIC who is bleeding
- support w necessary blood products
- while treating the underlying disease
describe the admin of blood products for pts w DIC who is bleeding; what is a concern w it
- based on specific component deficiencies
- blood products w plts are reserved for a pt w life-threatening hemorrhage
- concern = “adding fuel to the fire” of already activiated coagulation –> however may be required to prevent death r/t hemorrhage
describe the admin of blood products for pts w DIC who is bleeding; what is a concern w it
- based on specific component deficiencies
- blood products w plts are reserved for a pt w life-threatening hemorrhage
- concern = “adding fuel to the fire” of already activiated coagulation –> however may be required to prevent death r/t hemorrhage
how is a pt w manifestations of thrombosis treated? what is a concern w this
- by anticoagulation w heparin or LMWH
- increases r/o hemorrhage
what is included in collab interventions for DIC (6)
- give IV bolus for BP
- treat underlying cause (v imp!)
- assess for signs of bleeding, internal and external (early detection = primary goal)
- assess for indicates that microthrombi are damaging organs (ex. decreased UO)
- admin blood products and meds
- ongoing assessment of hemodynamic status
