MANAGEMENT OF CIRCULATION

Question 1

______ is drawn directly from an on-site donor

Answer 1

Fresh Whole Blood (FWB)

Question 2

Fresh =

Answer 2

not refrigerated or stored

Question 3

True/false
FBW does not undergo processing into separate components

Answer 3

True

Question 4

FWB is also known as what to the army?

Answer 4

Low Titer O Whole Blood (LTOWB)

Question 5

What is a component of FWB that can cause patients to react adversely during the transfusion process.

Answer 5

Immunological components
(WBC’s, antibodies, cytokines, etc)

Question 6

The blood collection kit contains _____ solution

Answer 6

CPD
(anticoagulant citrate and nutrient phosphate and dextrose)

Question 7

What is the shelf life for collected FWB?

Answer 7

24 – 48 hours

Question 8

True/False
All males can receive either O positive or O negative blood at any time

Answer 8

True

Question 9

All females of childbearing age receive _________ blood ONLY
(unless life or death)

Answer 9

O NEGATIVE
O pos can induce Rh disease

Question 10

Indications for what?
1. Life threatening injuries that require additional time before definitive care is achieved.
2. Hemorrhagic shock
3. Evidence of severe bleeding to a non-compressible or difficult to compress area with hypotensive patient
4. Delayed evacuation or prolonged evacuation.

Answer 10

transfusion

Question 11

What class of shock?
30% of blood loss
1) 1500-2000 ml of blood loss
2) > 120 pulse rate per minute
3) Decreased blood pressure
4) 30-40 respirations per minute
5) Urine output 5-15 ml per hour
6) Level of Consciousness exhibiting confused demeanor

Answer 11

Class III

Question 12

What class of shock?
> 40% of blood loss
1) > 2000 ml of blood loss
2) > 140 pulse rate per minute
3) Decreased blood pressure
4) > 35 respirations per minute
5) Urine output negligible
6) Level of Consciousness exhibiting lethargic demeanor
Absent radial pulse/systolic blood pressure below 80mmHg

Answer 12

Class IV

Question 13

Radial pulse will be absent at what BP?

Answer 13

Systolic Below 80mmHg

Question 14

Complications of Blood Transfusions:
______ is a potentially life-threatening reaction caused by acuteintra vascular hemolysis of transfused red blood cells

Answer 14

Hemolytic Reactions

Question 15

Complications of Blood
Presenting signs of what:
1)Fever
2)Chills
3)Flank pain
4)Oozing from intravenous sites

Answer 15

Hemolytic Reactions

Question 16

Complications of Blood
________ : any allergic reaction other than hives. This includes angioedema, wheezing, and/or hypotension

Answer 16

Anaphylaxis Reaction

Question 17

Citrate Toxicity:
Recommendation though is to give ___ amp of Calcium Gluconate every ____ units of FWB to avoid toxicity and hypocalcemia

Answer 17

1 amp of Calcium
to
4 units of FWB

Question 18

normal human liver can process ____ units worth of FWB without needing additional Calcium

Answer 18

13

Question 19

_________: these are common; these reactions are characterized by fever, usually accompanied by chills, in the absence of other systemic symptoms.

Answer 19

Febrile non-Hemolytic Reaction

Question 20

Febrile non-Hemolytic Reaction tx

Answer 20

1 gram of Tylenol PO/PR every 8 hours

Question 21

IMMEDIATE ACTIONS (ALL PATIENTS) that develop an acute transfusion reaction should follow these steps:

Answer 21

(a) Immediately stop the transfusion
(b) Start fluid bolus with balanced crystalloid
(c) Assess the patient, including symptoms of fever, respiratory distress, chest pain, back pain, itching, angioedema
(d) Measure VS and PE guided by s/s
(e) Confirm the correct product was transfused to the intended patient and correct blood type of donor
(f) Contact your supervising physician to discuss the appropriate evaluation and initial management as soon as the tactical situation allows
(g) Pass all the information to the next echelon of care

Question 22

Administering FWB
Monitor the vital signs every ___ minutes for the first ____ minutes and observe the casualty for indications of an adverse reaction.

Answer 22

q 5 min for the first 15 min

Question 23

Set the flow rate to deliver approximately ____ml of blood over the first 15 minutes. UNLESS what?

Answer 23

10-30
(1gtt/4-6 sec = 1ml/min).

if pre-collected O LowTiter from pre-screened individuals

Question 24

Indication for what?
If a casualty is anticipated to need a significant volume of blood transfusion due to the following:
(a) Hemorrhagic Shock
(b) One or more amputations
(c) Penetrating torso trauma
(d) Evidence of severe bleeding

Answer 24

Tranexamic Acid (TXA)

Question 25

______ helps to reduce blood loss from internal hemorrhage sites that cannot be addressed by tourniquets and hemostatic dressings

Answer 25

TXA

Question 26

True/False TXA promotes new clot formation

Answer 26

FALSE Does not

Question 27

TXA Administration (1) Survival benefit is greatest when TXA is given within ______ of injury. (2) The greatest decrease in blood loss is seen when TXA is started ASAP! (3) Administer ______ gram of tranexamic acid in 100 ml normal saline or lactated ringers as soon as possible, but not later than _____ after injury. (4) When administering TXA is should be administered over ______. (5) A second infusion of 1 gram TXA may be administered after _________ has been completed.

Answer 27

1) 1 hour 3) 1g, 3 hours 4) 10 minutes 5) initial fluid resuscitation

Question 28

TXA Storage and Handling Recommended temperature range for storage: _____ degrees F.

Answer 28

59-86

Question 29

IV therapy ______ therapy- replaces normal ongoing losses

Answer 29

Maintenance therapy

Question 30

IV therapy _____ therapy - corrects any existing water and electrolyte deficits.

Answer 30

Replacement therapy

Question 31

IV fluids come in what four different forms:

Answer 31

(a) Colloids (b) Crystalloids (Isotonic, Hypotonic, Hypertonic) (c )Blood and blood products

Question 32

What type of IV fluid? -Used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns). -More suitable in hospital setting than field use.

Answer 32

Colloids (Volume Expanders)

Question 33

What type of IV fluid? (a) Fluids that consist of water and dissolved crystals, such as salts and sugar. (b) Used as maintenance fluids to correct body fluids and electrolyte deficit.

Answer 33

Crystalloids

Question 34

When the crystalloid contains the same amount of electrolytes as the plasma, itis referred to as ____

Answer 34

isotonic

Question 35

If a crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as _____

Answer 35

hypertonic

Question 36

Administration of hypertonic crystalloid causes what?

Answer 36

water to shift from the extravascular spaces into the bloodstream, increasing the intravascular volume

Question 37

Uses of what IV fluid: a) Shock b) Resuscitation c) Fluid challenges d) Blood transfusions e) Metabolic alkalosis f) Hyponatremia g)DKA

Answer 37

Normal Saline Solution (NSS)

Question 38

Uses of what IV fluid: a) Dehydration b )Burns c) GI tract fluid loss d) Acute blood loss e) Hypovolemia

Answer 38

Lactated Ringers (LR)

Question 39

Uses of what IV fluid: a) Fluid loss and dehydration b) Hypernatremia

Answer 39

D 5 W

Question 40

D 5 W Special consideration: a) Solution becomes hypotonic when _____ is metabolized b) Do not use for ______ c) Use cautiously in _______ patients

Answer 40

a) dextrose b) resuscitation c) renal and cardiac

Question 41

Lactated Ringers (LR) Special consideration: a) Contains Potassium, can cause _______ in renal patients b) Patients with liver disease cannot metabolize _____ c) Lactate is converted into bicarb by liver which with larger volumes can lead to ______.

Answer 41

a) hyperkalemia b) lactate c) metabolic alkalosis

Question 42

Normal Saline Solution (NSS) Special consideration: a) Use with caution in patients with ______, ______, or ______ b) Can lead to ________ c) Speeds up the lethal triad of ______, _______ and ______

Answer 42

a) heart failure, edema, or hypernatremia b) volume overload c) hypothermia, coagulopathy, and acidosis

Question 43

What are the most desirable fluids for replacement due to hemorrhage?

Answer 43

Platelets, Packed red blood cells, and Plasma

Question 44

OI The procedure must be performed under sterile conditions to avoid causing ________

Answer 44

osteomyelitis (infection of the bone).

Question 45

When is IO indicated?

Answer 45

3 failed attempts at venous access or 90 secconds

Question 46

Intraosseous (IO) Contra-indications

Answer 46

(1) Ipsilateral fracture or crush injury of an extremity (2) Previous orthopedic procedure near site (3) Previous IOVA attempts in the same bone (4) Infection at site (5) Brittle bones

Question 47

The best site for IO is the

Answer 47

flat anteromedial aspect of the tibia

Question 48

IO tibia The site for cannulation lies ___ cm below the _____ on the anteromedial surface of the tibia

Answer 48

1-3, tuberosity

Question 49

Complications of IO

Answer 49

(1) tibial fracture, especially in small framed people. (2) Compartment Syndrome (3) Osteomyelitis (4) Skin Necrosis

Question 50

The intraosseous route should be replaced as soon as what?

Answer 50

a normal vein can becannulated and certainly within a few hours