OS - bleeding

Question 1

what are the classification of bleeding problems?

Answer 1

hereditary
acquired
other

Question 2

what type of medications are associated with bleeding risk?

Answer 2

antiplatelets
NOACs
coumarins
heparins

Question 3

what is a sign that someone has a coagulant factor deficiency?

Answer 3

stops bleeding early after procedure then develops subsequent bleed

Question 4

what is a sign someone has platelet abnormalities?

Answer 4

small superficial haemorrhage

Question 5

what is a sign that someone has clotting factor abnormalities?

Answer 5

deep bleeds

Question 6

what are the 4 types of bleeding disorders a pt may present with?

Answer 6

1. vascular abnormalities
2. platelet deficit - number
3. platelet deficit - quality/ function
4. clotting mechanism

Question 7

what platelet volume will cause petechial hemorrhage on its own?

Answer 7

50 x 10(9)L

Question 8

what platelet volume causes petechial haemorrhage and ecchymosis?

Answer 8

20-50 x 10(9)L

Question 9

what platelet volume causes melaena, haematemesis, and haemturia (bloos in stool, vomit and urine)

Answer 9

<20(9)L

Question 10

list types of hereditary bleeding disorders?

Answer 10

haemophillia VII + IX
factor XIII
vW disease
Ehlers Danlos (vascular)

Question 11

list causes of acquired bleeding disorders?

Answer 11

medications
liver disease
alcoholism
haematological malignancy; lymphoma, leukaemia

Question 12

what diseases do patients taking anticoagulants typically present with?

Answer 12

DVT
PE
cardiac syndromes
AF
MI
CVA - ischaemic stroke
TIA

Question 13

list the types of anticoagulants?

Answer 13

coumarins
parenteral heparin
LMW heparin
non vit-k (NOACS)

Question 14

list types of parenteral anticoagulants?

Answer 14

heparin sodium
LMW heparin
Dalteparin sodium
Enoxiparin
Tinzaparin

Question 15

why are parenteral anticoagulants used?

Answer 15

patients on haemodialysis

Question 16

what can long term use of herparin lead to?

Answer 16

platelet disorder

Question 17

name antiplatelets

Answer 17

clopidogrel
aspirin/ NSAIDs
prasugrel
ticagrelor
dipyridamole

Question 18

what do patients on antiplatelets require for xla?

Answer 18

closer haemostatic intervention

Question 19

list NOACs?

Answer 19

apixaban
rivaroxaban
edoxaban
dabigatran

Question 20

how do you manage pts on a NOAC that need xla?

Answer 20

hold back a dose

Question 21

list vitamin K antagonists

Answer 21

coumarins:
warfarin sodium
acenocoumarol

phenindione

Question 22

what must be checked prior to xla for patients taking vitamin k antagonists?

Answer 22

INR is less than 4

Question 23

what are types of spontaneous bleeding?

Answer 23

primary
reactionary
secondary

Question 24

what is primary bleeding?

Answer 24

intra-operative - soft/hard tissues
prolonged - platelet deficit

Question 25

what is reactionary bleeding?

Answer 25

2-3 hours post op when LA wears off

Question 26

what is secondary bleeding?

Answer 26

up to 14 days probably due to infection

Question 27

how is a platelet plug formed?

Answer 27

vasoconstriction platelet adhesion activation aggravation

Question 28

what is normal bleeding after xla?

Answer 28

2-5 mins biting pressure aids termination

Question 29

what is abnormal bleeding after xla?

Answer 29

increase volume, extended duration

Question 30

what are ways to manage bleeding post xla?

Answer 30

pressure suture bone wax crush electrocautery silver nitrate

Question 31

list types of haemostatic agents?

Answer 31

gelatin collagen cellulose based adhesives topical thrombin

Question 32

what is tranexamic acid?

Answer 32

antifibrinolytic

Question 33

when would you refer a pt in regards to bleeding post op?

Answer 33

ongoing severe haemorrhage reached the extent of capabilities decreased BP (100/60) increased HR >100bpm fluid loss

Question 34

what does a haematoma present as?

Answer 34

soft tissue swelling