dic

• patho

  • syndrome that arises as a complication of serious or life threatening conditions
  • accelerated clotting and formation of throbuses, resulting in decreased clotting factors and platelets leading to uncontrollable hemorrhage
• characterized by

  • thrombosis then bleeding results from depletion of clotting factors, platelets, and RBCs
  • purpura
  • can result in MODS or death
• causes

  • infection/sepsis most common
  • severe trauma/tissue injury
  • cancers
  • abrupt placentae, placenta previa, missed abortion, amniotic fluid embolism
  • wrong blood transfusion
  • snake bite
  • shock
  • Massive MI
• stage 1

  • thrombotic stage
  • numerous thrombi and emboli form in microvaculature causing impaired perfusion and circulation and organ ischemia
  • excessive clotting
  • neuro changes/ embolic stroke
  • cyanosis
  • petechiae
  • ischemic tissue necrosis (gangrene)
  • chest pain
  • tachypnea
  • ARDS
  • ekg changes
  • abd pain
  • paralytic ileus
  • oliguria
  • renal failure
• stage 2

  hemorrhagic/bleeding phase

  • due to depletion of coag factors, thrombin, and platelets
  • neuro changes/ hemorrhagic stroke
  • pallor
  • petechiae
  • purpura
  • oozing blood
  • hematoma
  • hemoptysis
  • tachycardia
  • hypotension
  • gi bleed
  • abd distension
  • hematuria
• symptoms by system

  • ssx secondary to excessive clotting
  • first thrombi then bleeding
  • skin: petechiae, poor perfusion, purpura
  • cardio: ST elevation, MI
  • Resp: hemoptysis, SOB with PE
  • renal: decreased urine output, increased bun and creat, bloody urine, decreased kidney perfusion
  • gi: decreased bowel sounds, decreased motility, no BM if clot, blood in vomit and stool
  • vitals: hypotension, tachycardia, pain
• management

  • primary goal is to treat the cause
  • maintain organ perfusion with fluids, inotropic meds, pressors
  • maintain coag factors with protein C
  • infection control
  • thorough assessment
  • bleeding precautions
  • turn q2, blow up mattress
  • avoid sticky tape
• meds

  • Blood products- FFP, Cryo, PRBCs, Platelets
  • abx
  • heparin
  • fluids and inotropes
  • pain mgmt
  • pressors for BP