Disseminated Intravascular Coagulation
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| show | “ A pathological form of coagulation that is diffuse rather than localized, as would be the case with normal coagulation”
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| show | Hemostasis is the stopping of bleeding Hemostasis is achieved when there is a balance between coagulation and bleeding There should be a balance between the two
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| show | o First on the scene o When activated they clump together and begin the cascadeo They are a stop gap, they themselves cannot form a clot and maintain a clot on their owno They are the beginning of clot formationo Can be measured with a CBC or alo
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| Factors II, V, VII, VIII, X, XIII: | show 🗑
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| show | o The precursor to thrombin. o The time is takes on the conversion can be measured… the prothrombin timeo Coumadin prolongs PT (Heparin PTT- antithrombin III)
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| show | o Converts fibrinogen to fibrin. o Thrombin time is the time is takes for this conversion
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| show | o a protein that is converted to fibrino can be measured in a serum level
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| Fibrin | show 🗑
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| Fibrin degradation products/fibrin split products (FDP/FSP) | show 🗑
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| show | formed when a plasmin digests clotted fibrino Can also be measured in the blood.o Sign of clot formation and subsequent lysis of a clot
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| Anti-thrombin III | show 🗑
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| show | o A coagulation factor in the blood and tissues that accelerates blood clotting.o Can be measured in seconds, (PTT or aPTT-same thing)
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| show | o precursor of plasmin
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| Plasmin | show 🗑
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| show | o dissolution of a fibrin doto breakdown of a clot
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| Normal coagulation | show 🗑
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| show | problems/substances in the blood itself that cause a clot to form
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| show | o trauma to the tissues or damage to blood vesselso outside (stab wound, surgery etc.)
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| Steps in Clotting Cascade | show 🗑
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| show | The body is working on fibrinolysis An automatic reaction The enzymes necessary for lysing a clot are located in the clot itself When the clot is dissolved fibrin degradation products (FDP’s or FSP’s) and fragment D (D-timer) are released into
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| show | Clot formation Plasminogen Plasminogen activator Plasmin (goes to site) The breakdown of clot…release of FDP’s into blood (can be measured) lets you lysis of clots is occulting in the body TPA (tissue plasminogen activator) is given in ca
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| Pathophysiology of DIC | show 🗑
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| Causes of DIC | show 🗑
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| show | The bacteria (usually Gram -) in the blood releases endotoxins which cause a systemic inflammatory reaction (SIRS-body wide inflammation) which activates the clotting cascade This begins in the hyperdynamic (warm) phase of septic shocko s/s of warm
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| show | Neuro: decreased alertness, possible CVA symptoms, change in level of consciousness Cardiovascular: decreased peripheral pulses (if emboli/thrombus forms in an artery supplying an extremity) Resp: hypoxia, inspiratory pain (caused by PE) Ren
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| show | Skin: petechiae, oozing from mucous membranes, venipuncture, IV and surgical sites Resp: tachypnea, hemoptysis, hemothorax, SOB Cardiovascular: tachycardia, hypotension, decreased pulses GI: heme-positive stools (guaiac +), NG tube (hemoccu
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| Lab Values in DIC | show 🗑
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| PT (10-13 sec) | show 🗑
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| show | prolonged
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| Platelets (150-450) | show 🗑
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| show | prolonged
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| Fibrinogen (200-400) | show 🗑
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| FDPs (less than 10) | show 🗑
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| show | increased (when clots are being lysed-see increase with pathological clots)
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| Treatment of DIC | show 🗑
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| show | Anticoagulants: can prevent the formation of further clot development and allow time for the clotting factors to replenish themselves by the liver before they have all been consumed Example: heparin (IV), low molecular weight (Lovenox) Used in t
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| show | o derived from plasma and concentrated fibrinogeno used when fibrinogen levels are low or with active bleedingo best if matched with blood typeo small volume given IV push
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| Fresh Frozen Plasma | show 🗑
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| show | o Given with thrombocytopenia and active bleedingo Can be multiple or single donor I one infusiono Given quickly oven 15-30 mino Fever is a common reaction to the foreign protein (not anaphylactic)o Blood type match is not necessary
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| Packed Red Blood Cells | show 🗑
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