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Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation. Paramedic Program Chemeketa Community College. Stage 1 Vasoconstriction. Anaerobic metabolism replaces aerobic metabolism Lactate and hydrogen ion production increases Leaky capillary syndrome occurs. Stage 2 Capillary and Venule Opening.

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Disseminated Intravascular Coagulation

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  1. Disseminated Intravascular Coagulation Paramedic Program Chemeketa Community College

  2. Stage 1Vasoconstriction • Anaerobic metabolism replaces aerobic metabolism • Lactate and hydrogen ion production increases • Leaky capillary syndrome occurs

  3. Stage 2Capillary and Venule Opening • Precapillary sphincter relaxes • Vascular space expands • Postcapillary sphincters remain closed • Blood pools in capillary system • Blood flow through arterioles is less • Additional capillaries and venules open • Increased hypoxemia and acidosis

  4. Cardiac output falls! • Viscera (lungs, liver, kidneys, GI mucosa congested • Anaerobic metabolism, lactic acid increases • Respirations increase • Rouleaux formation occurs • Clotting mechanisms are affected

  5. Stage 3Disseminated Intravascular Coagulation • A complication of severe injury, trauma, or disease • May occur in 30-50% of patients with sepsis

  6. Mortality/morbidity • In general: 18% • Septic abortion: 50% • Major trauma: DIC approximately doubles mortality rate

  7. Resistant to treatment • Still irreversible • Blood coagulates in microcirculation • Capillaries are clogged • Lactic acid production increases

  8. Wash out phase occurs • Water, sodium leak into cell • Potassium leaks out • Microinfarcts develop in viscera • Pulmonary capillaries are permeable • Pulmonary edema occurs • ARDS occurs

  9. Two phases of DIC • #1 • Free thrombin in blood • Fibrin deposits • Aggregation of platelets

  10. #2 • Hemorrhage caused by depletion of clotting factors • Multiple – system organ failure results • Loss of platelets and clotting factors • Fibrinolysis • Fibrin degradation interference • Small vessel obstruction, tissue ischemia, RBC injury, anemia from fibrin deposits

  11. Common causes of DIC • Trauma • Complications of OB • Infection (gram-negative sepsis, gram-positive infections) • HIV, hepatitis • Malignancy; leukemias, metastatic • Snake-bite • Hypoxia

  12. Other causes • Liver disease • Infant and adult RDS • Thermal injury: Burns • Massive transfusion • MI • Crohn’s disease • Aortic aneurysms

  13. Risk factors • Pregnancy • Prostatic surgery • Head injury • Inflammatory states

  14. DDX • Massive hepatic necrosis • Vitamin K deficiency • Thrombocytopenia purpura • Hemolytic-uremic syndrome • Primary fibrinolysis

  15. Epistaxis Gingival bleeding Mucosal bleeding Hemoptysis Hematemesis Cough Dyspnea Localized rales Tachypnea Pleural friction rub Confusion Disorientation Stool blood Hematuria Fever Petechiae Purpura Ecchymosis Anuria Thrombosis Stupor Peripheral cyanoses S/S of DIC

  16. Management of DIC • Reverse underlying cause • Replace platelets • Replace coagulation factors • Replace blood

  17. Medications • Heparin (contraindicated in head injury) • Broad-spectrum antibiotics for sepsis

  18. Bye Bye, now

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