1 Disseminated Intravascular Coagulation Paramedic Program Chemeketa Community College

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

3 Stage 2 Capillary 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 3 Disseminated 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 S/S of DIC 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

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

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19 Bye Bye, now