surgical bleeding and blood replacement and shock Flashcards
(38 cards)
what are lab workup for bleeding disorders
CBC with platelet count
coagulation studies (PT/INR, aPTT)
what is a severe platelet count with bleeding disorders
< 50,000
when would someon have a prolonged aPTT but a normal PT
deficiency in factor 12, 11, 9,8 or vWF
liver disease
vitamin K deficiency
DIC
HIT
specific antibodies (lupus anticoagulant, anticardiolipin ab)
What is the reversal of wafarin
Vitamin K
What are hard signs of vascular injury
- pulsatile bleeding
- unexplained shock in setting of trauma/post surgical
- no pulse distal to injury
- expanding or pulsatile hematoma
- bruit/thrill over affected area
when is the cell saver used in surgery
when anticipate > 1L of blood loss or patient who refuses allogenic blood
what is the management of surgical hemorrhage
direct repair of vessel
ligature of vessel
direct pressure
tourniquets
electrocautery
topical hemostatic agents (gelatin, cellulose, collagens, topical thrombins, fibrin sealants, platlet sealants)
What are potential complications of tourniquets
nerve injury
possible loss of limb due to loss of perfusion
how long can a tourniquet stay on
2 hours
What is hypovolemic shock
imbalance of O2 supply and demand
volume loss (blood, body fluids, plasma)
how does the body try to compensate for hypovolemic shock
through autonomic response wiht increase SVR
what are the causes of hemorrhagic hypovolemic shock
Trauma
GI bleed
AAA
Surgical bleeding
postpartum hemorrhage
what are the causes of non-hemorrhagic hypovolemic shock
volume loss without blood loss - GI losses, burns, excess osmotic diuresis, 3rd spacing
What is a normal adult blood volume
7% of body weight
usually somewhere around 5L of blood
what is the physiologic repsonse to hemorrhage
- progressive peripheral vasoconstriction
- tachycardia to preserve CO
- release of catecholamines; increase peripheral vascular resistance, increase diastolic BP (narrow pulse pressure)
- contraction of the venous system
- loss of enough volume in the system - low BP
What is the workup for DIC
high index of suspicion at hgih risk pts
start with CBC, peripheral smear and a caog panel
thrombocytopenia + fibrinogen + D-dimer
what is the treatment of DIC
primary - tx underlying d/o
hemodynamic stabilization +/- ventilator support
whole blood transfusions
platlet transfusions
coag factor repletion
how much does one unit of PRBCs increase Hgb
about 1.0 point
what are indications for transfusion
hemoglobin < 7 for most pts
Hemoglobin < 8 for cardiac or ortho sx with preexisting CVD
hemoglobin >7 and evidence of organ ischemia
hemoglobin > 7 and symptomatic and anticipated ongoing loss
hemorrhagic shock
what is blood stored at to prevent bacterial growth
1-6 degrees celcius
what is the infusion rate for blood transfusions
no more than 2mL/minute initially (incase of rxn)
may increase to 5ml/min if no reaction after 15 min
what does FFP provide
coagulation factors
Vitamin K dependent factors (2,7,9,10)
Factor 5 (only source)
what are indications for FFP
abnormal PT/INR and/or aPTT and microvascular bleeding
coagulation factor deficiency when specific concentration unavailable
urgent warfain reversal
how much FFP is given to reverse coumadin
3-10mL/kg
INR: 1.4-1.8
