How to Survive the Surgical ICU - AP_Hematology
AssessmentPlan
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PLAN
  1. Deep Venous Thrombosis is common in bed-ridden patients.
    Prophylaxis:
    1. Heparin given 500 units SQ q8-12 or Sequential compression devices (SCDs) over Thromboembolism Deterrent (TED) hose.
    2. Out of bed ambulating.

  2. Asymptomatic Anemia:Hgb <7 mg/dl or Hct < 21%)
    Symptomatic Anemia:  Angina, Tachycardia.

    Transfuse Packed RBCs 1 unit= 250-300ml

    • PRBCs consist of spun down blood with Hct of 75%
    • 1 unit of PRBC will raise Hct by 3 points
    • 1 unit of PRBC will raise Hgb by 1 point.
    • Packed RBCs are chosen over whole blood to boost blood carrying capacity
    • Whole blood 1 unit = 510 ml:
      Only stored upon request because It is more efficient to spin blood down Into plasma and RBCs and separate Out useful components.

  3. Thrombocytopenia:
    Low platelets<100,000mm3. Commonly from: drugs, uremia, sepsis.

    Give Platelets
    • One unit increases count to 5000-10000
    • Typically given as 6-10 random donor units.
    • Indications for transfusion:
    • <20, 000 platelets, as prophylaxis <50, 000 platelets and bleeding Thrombocytopenia, and any kind of bleeding

  4. Hypocoagulation:
    PT/PTT/INR elevation

    Give FFP Fresh Frozen Plasma:
    • The plasma portion of whole blood.
    • Gives the clotting factors..Fibrinogen, prothrombin, factors V, VII, VIII, IX, XIII, Antithrombin III, Protein C/S. Indications:

  5. Treatment of DVT and Pulmonary Embolism
    DVT:
    Compression Ultrasound
    Normal: no Heparin. Repeat in 7 days.
    Abnormal: no heparin.
    Pulmonary Embolism: Ventilation/Perfusion
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