Page 206 - Critical Care Notes

4223_Tab07_199-215 03/09/14 4:25 PM Page 200

HEMA/
ONCO
■ Palpitations
■ Angina
■ Malaise, fatigue, and weakness
■ Acidosis
■ Headache
■ Nausea and vomiting
■ Severe pain in abdomen, back, muscles, joints, and bones
■ Sudden vision changes
■ Vertigo
■ Confusion and anxiety or irritability
■ Convulsions
■ Coma
Diagnostic Tests
■ CBC (trend platelet counts)
■ BUN and creatinine, bilirubin
■ ABGs
■ PT, PTT, INR
■ Fibrinogen level
■ Fibrin degradation/split products
■ D-dimer assay
■ Thrombin time
■ Antithrombin III (AT III)
■ Blood smear (schistocytes present)
■ Factor V and factor VII
■ Protein C and protein S level
Management
■ Treat underlying cause, if it can be treated.
■ Be aware of early signs of impaired tissue perfusion in patients at high risk
for DIC (subtle mental status change, hypotension [especially orthostatic]),
dyspnea, tachypnea, syncope, decreased urine output.
■ Monitor cardiac, respiratory, and neurological status.
■ Assess for abnormal bleeding, and apply pressure to injection sites for at
least 15 min.
■ Monitor O 2 saturation and ABGs. Administer O 2 or mechanical ventilation
as indicated.
■ Administer IV fluids as needed.
■ Monitor intake and output and signs of fluid overload.
■ Consider heparin infusion.
■ Institute bleeding precautions.
■ Replace deficient clotting factors.
■ Administer vitamin K and folate.
■ Consider platelet infusions.
■ Administer fresh frozen plasma (FFP) infusion.
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