A. Antifibrinolytics B. Transfusing FFP C. Transfusing cryoprecipitate D. Hemodialysis
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1 A TEN YEAR OLD BOY WITH NO SIGNIFICANT PMH PRESENTS TO THE EMERGENCY DEPARTMENT WITH A FEVER OF 103, RR IN THE 40S, HR OF 110, AND A BP OF 80/50. HE S ILL APPEARING AND PALE, WITH DELAYED CAPILLARY REFILL OF >3 SECONDS AND 1+ PULSES. TWO LARGE BORE IVS ARE PLACED AND FLUID RESUSCITATION IS STARTED, LAB AND CULTURES ARE DRAWN, ANTIBIOTICS STARTED. A FEW MINUTES AFTERWARD THE NURSE CALLS YOUR ATTENTION TO PERSISTENT OOZING OF BLOOD FROM BOTH C ATHETER SITES. YOU NOTICE NEW SCATTERED PETECHIAE ON THE PATIENT S SKIN. THE LAB CALLS WITH CRITICAL VALUES FOR SOME OF THE LABS YOU ORDERED: PT 18 PTT 121 INR 1.7 D DIMER 3 FIBRINOGEN 120 PLATELETS 75,000. YOU KNOW THE PATIENT IS MANIFESTING DISSEMINATED INTRAVASCULAR COAGULATION. THE NEXT BEST STEP IN TREATING THIS PATIENT S DIC IS: A. Antifibrinolytics B. Transfusing FFP C. Transfusing cryoprecipitate D. Hemodialysis
2 A TEN YEAR OLD BOY WITH NO SIGNIFICANT PMH PRESENTS TO THE EMERGENCY DEPARTMENT WITH A FEVER OF 103, RR IN THE 40S, HR OF 110, AND A BP OF 80/50. HE S ILL APPEARING AND PALE, WITH DELAYED CAPILLARY REFILL OF >3 SECONDS AND 1+ PULSES. TWO LARGE BORE IVS ARE PLACED AND FLUID RESUSCITATION IS STARTED, LAB AND CULTURES ARE DRAWN, ANTIBIOTICS STARTED. A FEW MINUTES AFTERWARD THE NURSE CALLS YOUR ATTENTION TO PERSISTENT OOZING OF BLOOD FROM BOTH C ATHETER SITES. YOU NOTICE NEW SCATTERED PETECHIAE ON THE PATIENT S SKIN. THE LAB CALLS WITH CRITICAL VALUES FOR SOME OF THE LABS YOU ORDERED: PT 18 PTT 121 INR 1.7 D DIMER 3 FIBRINOGEN 120 PLATELETS 75,000. YOU KNOW THE PATIENT IS MANIFESTING DISSEMINATED INTRAVASCULAR COAGULATION. THE NEXT BEST STEP IN TREATING THIS PATIENT S DIC IS: A. Antifibrinolytics B. Transfusing FFP C. Transfusing cryoprecipitate D. Hemodialysis
3 DIC: BLEEDING AND CLOTTING
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8 COMMON CAUSES OF DIC IN KIDS Sepsis Trauma (ie severe brain injuries) Malignancies (ie AML) Newborns especially preterm - are vulnerable to DIC because the anticoagulants (antithrombin and protein C) are normally low at this age sepsis birth asphyxia respiratory distress syndrome (RDS) necrotizing enterocolitis (NEC)
9 COMMON THINGS THAT LOOK LIKE DIC IN KIDS Liver failure HELLP syndrome pregnant teens with HTN Massive transfusion replacement of more than 1 blood volume in 24 hours or the replacement of 50% of the total blood volume within 3 hours. TTP fever, thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurologic signs. Screening coagulation tests (PT,PTT) are usually normal HUS microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency in a kid <3 years
10 TREATMENT: 1. Treat underlying cause 2. Supportive care: transfuse for: 1. platelet counts <50,000/microL 2. fibrinogen concentration <100 mg/dl 3. prolonged APTT or PT (greater than 1.5 times the normal value)
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12 TAKE HOME POINTS 1. Number one treatment for DIC is to aggressively treat the underlying cause 2. Key labs to get: Coags, Platelets, Ddimer, Fibrinogen 3. Multiple Scoring Systems to dx References:
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