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20 Cards in this Set
- Front
- Back
Disseminated Intravascular Coagulopathy (DIC)
Definition |
-A disorder or imbalance in the coagulation system characterized by generalized clotting in the microcirculation followed by clot lysis.
-Clot formation causes peripheral and organ ischemia. -Clot lysis produces anticoagulants that cause uncontrolled bleeding in a system that has used up many of its clotting factors. |
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Causes of DIC
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-Always a result of a primary condition that triggers the clotting cascade.
-Sepsis, shock of any kind, trauma, crush injury, acidosis, obstetrical complications, eclampsia, retained placenta, incomplete abortion, amniotic fluid embolism, malignancies. |
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Pathophysiology of DIC
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-Presenting condition damages the endothelial lining of the blood vessel. Endothelial cells release tissue thromboplastin. Factor VII (extrinsic pathway) or factor XII (intrinsic pathway) is activated in the clotting cascade.
-Platelets become activated and become sticky. As they aggregate they release mediators that are powerful vasoconstrictors (serotonin, histamine, adenosine diphosphate, and thromboxane-A). -This vasoconstriction reduces blood loss. |
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Pathophysiology of DIC (con't)
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-Clotting cascade continues with prothrombin being converted to thrombin.
-Thrombin converts fibrinogen to fibrin (at last the clot). -Endothelial cells now release prostoclyclin a vasodilator and platelet inhibitor to counter the prior effects. -Mediators called antithrombins (protein S, protein C) along with t-PA keep clot formation in check, not allowing the clotting cascade to go overboard. -In DIC thrombin formation beats clot lysing |
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Pathophysiology of DIC (con't)
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-Massive clotting uses up clotting factors.
-Clots obstruct arterioles and capillaries causing tissue hypoperfusion. -Hemorrhage occurs because clots can’t form at sites of endothelial injury. |
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Signs and Symptoms
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-Bleeding from multiple sites that are unrelated.
-Ischemia in peripheral tissues fingers, nose, toes. -Acute renal failure from thrombosis in the glomerulus's. |
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Laboratory Findings
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-4 basic components to diagnose
-Evidence of coagulation -Evidence of clot lysis -Evidence of consumption of clotting factors -Organ damage |
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Evidence of Coagulation
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-Platelet count drops as a sign of rapid clot formation.
-A decrease to 50,000 per ml, or 50% drop from baseline raises the suspicion of DIC. -Caution heparin, hypothermia, and infection can suppress platelet levels. -Fibrinogen is rapidly used up in clot formation, but can be made quickly so the drop in fibrinogen can be mild to moderate in DIC. |
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Evidence of clot lysis
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-As clots are lysed fibrin degradation products are produced and rise dramatically.
- Normal < 10 -FDP are powerful anticoagulants. -D-Dimer produced when clots are lysed and more indicative of DIC. The higher the level the more severe the DIC. -Caution D-Dimer can elevate from dissolving DVT or other clot. |
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Evidence of consumption of clotting factors
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PT and PTT prolonged as clotting factors are used up
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Lab normal values
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Platelet count: 150,000-400,000/mm3
Fibrinogen: 150-400 mg/dl FDP: <10 mcg/ml D-Dimer: <200 mg/ml PT: 12 sec (INR 1.0) APTT: <33 sec |
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Treatment
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-ABC first
-Correct the underlying condition. -Administer volume and blood products as needed. -Consider vasopressors if needed. -Fresh Frozen plasma for clotting factors. -Platelets if needed. -Cryoprecipitate for fibrinogen -Heparin drip or low molecular weight heparin. -Activated Protein C (Xigris). |
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Nursing Care
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-Assess vital signs, urine output every hour for hemodynamic stability.
-Assess oxygenation with SAO2 every hour. -Assess neuro status every hour. -Assess peripheral ischemia. -Clotting profile every four hours. -Avoid needle sticks. -Use arterial line and venous lines that are in place. -Avoid cuff pressures which can increase bruising. -Handle patient gently to avoid bruising. -Suction only when necessary and with low suction. -Consider low pressure bed to prevent skin breakdown. -Explain all procedures, answer all questions, provide emotional support. |