Sepsis can be identified as the cause of dic in 20 of

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If not treated quickly, DIC will progress to MODS and death! Sepsis can be identified as the cause of DIC in 20% of cases(most common cause) Metabolic acidosis and poor perfusion to the tissues in shock increases the release of free radicals which can trigger DIC Other causes: massive trauma burns cardiac arrest heat stroke chemotherapy Clotting and bleeding are the two mechanisms of DIC Thrombi in the capillaries can lead to cyanosis(fingers,nose,ears,toes) In severe untreated cases, Gangrene can occur Central ischemia can display as resp. insufficiency and failure, AKI, bowel infarction, and ischemic stroke Assessment: Bruising Blood drainage With progression of DIC, the patient is at risk for severe GI or subarachnoid hemorrhage Labs: Increased coagulant activity Increased fibrinolytic activity Impaired regulatory function End-organ failure Elevated aPTT, PT, and INR Although platelets may be WNL, serial exams reveal a declining trend An unexpected drop of at least 50% in the platelet count, particularly with known contributing factors and associated s/s strongly indicates DIC Damaged RBCs are called schistocytes Once the fibrinolytic process begins, fibrin degradation products are released and levels are elveated in the blood D-dimer is used to evaluate the degree of clot breakdown
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Common findings r/t organ failure in DIC include: resp failure(indicated by abnormal ABG's liver failure(indicated by a elevated liver enzymes) renal impairment(indicated by increased BUN and Creat.) Strong indicators of DIC PT- >12.5 seconds a prolonged PT indicates the need for FFP aPTT- >40 seconds Platelets- <50,000, or at least a 50% drop from baseline D-dimer->250 mg/mL Fibrin degradation products(FDP)- >40mg/mL Fibrinogen- <100mg/dL administer cryoprecipitate Primary intervention: PREVENTION Medical Management Fluids Inotropic agents pRBC's Platelet transsfusions use cautiously because antiplatelet antibodies can form; they can be activated during future platelet transfusions and cause DIC Heparin is contraindicated in patients who have just had surgery or with GI or CNS bleeding FFP and Cryo are both made from plasma Meds may include: antibiotics vasopressors inotropic agents analgesics
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