Disseminated Intravascular Coagulation

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Disseminated Intravascular Coagulation

• Paramedic Program
• Chemeketa Community College

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Stage 1Vasoconstriction

• Anaerobic metabolism replaces aerobic metabolism
• Lactate and hydrogen ion production increases
• Leaky capillary syndrome occurs

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Stage 2Capillary 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

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

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Stage 3Disseminated Intravascular Coagulation

• A complication of severe injury, trauma, or
  disease
• May occur in 30-50 of patients with sepsis

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Mortality/morbidity

• In general 18
• Septic abortion 50
• Major trauma DIC approximately doubles mortality
  rate

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

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• 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

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Two phases of DIC

• 1)
• free thrombin in blood
• Fibrin deposits
• Aggregation of platelets

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• 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

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Common causes of DIC

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

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Other causes

• Liver disease
• Infant and adult RDS
• Thermal injury Burns
• Massive transfusion
• MI
• Crohns disease
• Aortic aneurysms

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Risk factors

• Pregnancy
• Prostatic surgery
• Head injury
• Inflammatory states

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DDX

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

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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

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Management of DIC

• Reverse underlying cause
• Replace platelets
• Replace coagulation factors
• Replace blood

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Medications

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

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