ITP/TTP/HIT/DIC
Most common acquired thrombocytopenia
What is immune thrombocytopenia?
Acquired immune disorder where there is abnormal platelet destruction. This usually presents as an acute condition in kids, but as a chronic condition in adults. Thrombocytopenia results from antiplatelet antibodies, impaired platelet production, and T-cell-mediated destruction of platelets.
This condition, characterized by the accumulation of fluid in the abdomen, is most commonly caused by cirrhosis but can also result from heart failure, cancer, or kidney disease.
What is ascites?
Common scale used to assess agitation in ICU patients
What is the Richmond Agitation-Sedation Scale (RASS)?
scored -5 to +4. -5 is no response to voice or stimulation and +4 is violent and dangerous to self and others.
Burn percentage for: anterior bilateral arms, bilateral posterior legs, and anterior face
What is 31.5%
Use the rule of 9s to calculate the percentage
This type of care focuses on providing relief from the symptoms and stress of a serious illness, with the goal of improving quality of life for both the patient and their family. These patients may continue to receive curative treatments
What is palliative care?
Uncommon syndrome characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, neurologic changes, fever (without presence of infection), and renal problems.
Thrombotic Thrombocytopenic Purpura
This condition, often caused by chronic alcohol use, viral hepatitis, or nonalcoholic fatty liver disease, leads to severe scarring and liver failure.
What is ESLD?
End-stage liver disease can result from various causes, including chronic alcohol use, chronic hepatitis B and C infections, nonalcoholic fatty liver disease (NAFLD), autoimmune diseases, and genetic conditions like hemochromatosis and Wilson's disease
Normal CVP values
2-8 mmHg
This type of burn is caused by flame, flash, scald, or contact with hot objects
What is a thermal burn injury?
Most common type of burn!
This type of care is designed to provide comfort and support to patients with terminal illnesses with life expectancy less than 6 months, focusing on quality of life rather than curative treatment.
What is hospice care?
This serious complication of heparin therapy involves the formation of antibodies against platelet factor 4 (PF4)/heparin complexes, leading to a drop in platelet count and an increased risk of thrombosis.
What is heparin-induced thrombocytopenia (HIT)?
HIT is a potentially life-threatening condition where the immune system reacts to heparin, causing excessive clotting and a significant drop in platelet level
This treatment for end-stage liver disease (ESLD) involves replacing the damaged liver with a healthy one from a donor.
What is a liver transplant?
Treating the underlying cause (e.g., antiviral therapy for hepatitis). Abstaining from alcohol and avoiding hepatotoxic medications. Managing complications like ascites, variceal bleeding, and hepatic encephalopathy. Providing palliative care to improve quality of life.
How to calculate MAP
[(SBP)+2(DBP)]/3
Normal range 70-105mmHg (note that in practice you may see acceptable parameters lower than this range).
Classifications of Burn Injury
1. Depth: 1st - 4th degree burns
2. Extent: Rule of 9s
3. Location: location of burn(s)
4. Risk Factors: poor prognosis for those with pre-existing heart or lung conditions, uncontrolled diabetes, PVD, or if generally weak.
Physical manifestations for a patient at end-of-life
What are: Metabolism reduced. Respiratory patterns change (e.g. Cheyne-Stokes, “guppy breathing”). Breath sounds may become wet & noisy (“death rattle”). Tachycardia followed by slowing then cessation. Hypotension. Gradual decrease in urine output. GI distention & nausea, loss of sphincter control/incontinence. Mottling, cold & clammy skin, cyanosis
This serious condition involves both excessive clotting and bleeding, often triggered by severe infections, trauma, or cancer, and can lead to organ damage and uncontrollable hemorrhage.
What is disseminated intravascular coagulation (DIC)?
DIC begins with the formation of small blood clots throughout the bloodstream, which depletes clotting factors and platelets, leading to excessive bleeding
These clinical manifestations of end-stage liver disease (ESLD) include fluid accumulation in the abdomen, confusion due to toxin buildup, and yellowing of the skin and eyes.
What are ascites, hepatic encephalopathy, and jaundice?
These potential complications of using this catheter include infection, arrhythmias, and, although rare, pulmonary artery rupture.
What is a Swann-Ganz (pulmonary catheter)?
Infection at the insertion site. Thrombosis (blood clot formation). Arrhythmias (irregular heartbeats). Pulmonary artery rupture due to balloon inflation. Air embolism (air bubble in the blood vessel). Pneumothorax (collapsed lung if the subclavian vein is used).
Phases of burn management
What are:
1: Emergent (Resuscitative):resolve life threatening problems caused by burn, lasts up to 72 hours, concerns for hypovolemic shock and edema, phase ends when fluid mobilization and diuresis begin.
2: Acute (Wound Healing): Begins with mobilization of extracellular fluid & subsequent diuresis, ends when partial-thickness wounds are healed or full-thickness burns are covered by skin grafts. Takes weeks to months. Diuresis from fluid mobilization. Phagocytosis occurs. Necrotic tissue begins to slough. Precursor to granulation tissue starts
3: Rehabilitative (Restorative): Heals spontaneously or by skin grafting. Keratinocytes begin rebuilding the tissue structure destroyed by the injury. Collagen fibers present in the new scar tissue & add strength to weakened areas
Ways to provide culturally competent care
What are: Avoid stereotyping. Assess & document the patient’s cultural background, concerns, health practices, & attitudes about suffering. Use open-ended questions. Make the necessary accommodations
This test, used to evaluate the viscoelastic properties of whole blood, can help diagnose and manage disseminated intravascular coagulation (DIC) by showing changes in clot formation and breakdown.
What is a thromboelastography (TEG) test?
The TEG test measures the global viscoelastic properties of whole blood clot formation and can indicate hypercoagulability or hypocoagulability in DIC
These two clinical manifestations of end-stage liver disease (ESLD) include a yellow discoloration of the skin and eyes due to bilirubin buildup, and a decline in brain function caused by the liver's inability to remove toxins from the blood.
What are jaundice and hepatic encephalopathy?
Jaundice results from the accumulation of bilirubin in the blood, leading to yellowing of the skin and eyes. Hepatic encephalopathy occurs when toxins build up in the bloodstream, affecting brain function and leading to symptoms such as confusion, altered mental status, and even coma
This invasive monitoring device is indicated for assessing hemodynamic status in critically ill patients, particularly those with complex shock states, severe heart failure, or pulmonary hypertension.
What is a pulmonary artery catheter (Swann-Ganz)?
Some other indications to use a PA catheter: Diagnosis or evaluation of pulmonary hypertension. Assessment of vascular resistance. Determination of etiology in cases of shock. Assessment of volume status in severe shock. Evaluation of pericardial illnesses such as cardiac tamponade or constrictive pericarditis. Assessment of right-sided valvular disease or congenital heart disease. Evaluation of intracardiac shunts.
How to reduce burn injuries
What are: Installing and maintaining smoke detectors on every level of your home. Setting water heaters to a safe temperature below 120°F to prevent scalding. Using back burners and turning pot handles inward when cooking. Keeping flammable items away from heat sources like space heaters and stoves. Supervising children around hot liquids and appliances. Practicing a fire escape plan with your household.
These are only some ways, there are many other ways to reduce risk of burns!
This term refers to the legal documents that allow patients to outline their preferences for end-of-life care, including decisions about life-sustaining treatments.
What are advanced directives?