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 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

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

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

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

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

Microinfarcts develop in viscera Pulmonary capillaries are permeable 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

Two phases of DIC 1) free thrombin in blood Fibrin deposits Aggregation of platelets

Hemorrhage caused by depletion of clotting factors 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

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

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

Risk factors Pregnancy Prostatic surgery Head injury Inflammatory states

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

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

Management of DIC Reverse underlying cause Replace platelets Replace coagulation factors Replace blood

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

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