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. 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

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

10. 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

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
S/S of DIC
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

19. Bye Bye,
now