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What is the primary aim when assessing a seriously ill patient?
Which of the following is typically NOT a part of the initial assessment of a seriously ill patient?
During the assessment of a seriously ill patient, what must be routinely reassessed?
Which of the following is considered a warning sign of a severely ill patient?
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What is one of the complications of massive blood transfusion?
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What is the effect of storage on whole blood related to potassium levels?
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Which statement regarding acute hemolytic reactions is NOT true?
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Which factor is least likely to be reduced due to storage of blood?
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Which of the following best describes a massive blood transfusion?
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What is a common characteristic of Transfusion-Related Acute Lung Injury (TRALI)?
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What immediate action should be taken in the event of a hemolytic reaction during a transfusion?
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Which situation is NOT an indication for plasma transfusion?
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Which of the following statements regarding the management of a hemolytic reaction is incorrect?
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Which of the following is NOT a requirement for recognizing acute intravascular hemolysis?
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When considering red blood cell transfusion guidelines, which condition would categorize a patient differently?
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Which component may also be implicated in Transfusion-Related Acute Lung Injury (TRALI)?
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Study Notes
Seriously Ill Patient Assessment
- Aim: Identify physiological abnormalities, determine appropriate correction methods, and diagnose the underlying cause.
- Urgent Process: Treatment initiation often precedes a full history, detailed examination, and extensive investigations due to the urgency of the situation.
- Parallel Tasks: History taking, examination, and initial resuscitation frequently occur concurrently.
- Initial Focus: Prioritize essential information for guiding immediate treatment decisions, with the remaining details filled in later.
- Re-Assessment: Regularly reassess the working diagnosis based on new information and the patient's response to treatment.
Warning Signs of a Severely Ill Patient
- Blood Pressure: Systolic blood pressure under 90 mmHg.
- Pulse: Greater than 100 beats per minute.
- Respiratory Rate: Over 20 breaths per minute.
- Temperature: Above 38 degrees Celsius or below 36 degrees Celsius.
- Mental Status: Confusion or disorientation.
- Oxygen Saturation: Less than 90% on room air.
- Urine Output: Less than 0.5 ml/kg/hour.
Massive Blood Transfusion
- Definition: Replacement of 50% of total blood volume (TBV) within 3 hours.
- Threshold for Concern: Transfusion of more than 4 units of packed red blood cells (PRBCs) within 1 hour, suggesting a potential need for further transfusion.
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Complications of Massive Transfusion:
- Coagulopathy
- Hypothermia
- Citrate Toxicity
- Acid-Base Imbalance
- High Serum Potassium Concentration
Blood Storage Effects
- Increased Acidity: Blood becomes more acidic during storage.
- Elevated Plasma Potassium: Plasma potassium levels increase with storage.
- Decreased Platelet Function: Platelet function diminishes during storage.
- Reduced Factor VIII Levels: Factor VIII levels decrease.
- Plasma Calcium Levels: Plasma calcium levels do not rise during storage.
Acute Hemolytic Reaction
- Timeframe: Occurs within hours after transfusion.
- Severity: More severe than delayed hemolytic reactions.
- Cause: ABO incompatibility.
- Management: Requires immediate supportive treatment.
- Mechanism: Acute intravascular hemolysis.
Transfusion Related Acute Lung Injury (TRALI)
- Presentation: Acute hypoxia and noncardiac pulmonary edema.
- Timeframe: Develops within 6 hours of blood product transfusion.
- Product: Can occur with any blood component transfusion.
- Management: Similar to acute respiratory distress syndrome.
- Resolution: May resolve within a few days with supportive therapy.
Management of Hemolytic Reaction
- Immediate Action: Stop the transfusion immediately and notify the blood bank.
- Blood Samples: Obtain blood samples for plasma hemoglobin assessment and repeat compatibility testing.
- Urinary Catheter: Insert a urinary catheter to monitor urine output.
- Urine Analysis: Examine urine for albumin presence.
- Osmotic Diuresis: Initiate osmotic diuresis with mannitol and intravenous fluids.
Plasma Transfusion Indications
- Elevated INR: International normalized ratio (INR) greater than 1.5.
- Invasive Procedures or Surgery: Anticipated invasive procedures or surgeries.
- Massive Hemorrhage: Hemorrhage exceeding one blood volume.
- Muscle Relaxant Reversal: Emergent reversal of muscle relaxant drug effects.
- Factor Deficiences: Treatment of isolated factor deficiencies.
Red Blood Cell Transfusion Guidelines
- Hemodynamic Instability: Consider transfusion for ongoing, unresponsive bleeding associated with hemodynamic instability.
- Hemodynamically Stable ICU Patients: Transfusion may be indicated for ICU patients with hemoglobin levels below 7 g/dL.
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Description
Test your knowledge on assessing severely ill patients. This quiz covers key physiological abnormalities, urgent treatment processes, and the critical warning signs to look out for. Ensure you're prepared to make fast and effective clinical decisions in emergency situations.
