Patient and Doctor Induced Emergencies

by Brian Warriner, MD

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    Massive Hemorrhage is a amazingly common event in the operating room. It could be due to trauma or assault. It may be the result of vascular disease, such as a rupture of an abdominal aortic aneurysm or a dissection of a thoracic aortic aneurysm. It may be the result of a genetic disorder such as hemophilia. It may be drug induced, when it's secondary to anticoagulants or secondary to non-steroidal anti-inflammatories, such in the case of gastric hemorrhage induced by Diclofenac or any of the other end sets that are out there. It may be due to a surgical error when a major vessel is damaged during surgery. The treatment of massive bleeding has changed over the last 10 years. From a fairly cautious approach where red blood cells were given and then, over a period of time, if there was evidence of ongoing micro bleeding or if clotting didn't seem to be occurring, you would call for additional substances such as plasma, which has clotting factors in it, or platelets which help form clot. We're now much more aggressive in our treatment of massive hemorrhage. And these are sometimes predictable situations such as cardiac surgery, vascular surgery, spine surgery. Or it may be hemorrhage that's completely unexpected such as when a bleeding disorder is not diagnosed prior to surgery. Your hospital should have a Massive Transfusion Protocol that is developed jointly by anesthesiologists, surgeons, emergency physicians, intensive care physicians, and blood bank physicians. When the massive transfusion protocol is activated, the blood bank should provide product as quickly as possible. In my hospital, when we activate this protocol, the blood bank immediately sends up 5 units of red blood cells, 5 units of platelets and 2 units of frozen plasma. These can be administered together, all at one time...

    About the Lecture

    The lecture Patient and Doctor Induced Emergencies by Brian Warriner, MD is from the course Anesthesiology: Advanced. It contains the following chapters:

    • Massive Hemorrhage
    • Increased Intra-Cranial Pressure
    • Cardiac Diseases
    • Wrong Drug - Wrong Dose
    • Surgical Errors

    Quiz for lecture

    Test your knowledge with our quiz for lecture Patient and Doctor Induced Emergencies.

    1. Declaring a massive transfusion emergency and initiating the massive transfusion policy.
    2. Giving enough to stop the bleeding.
    3. By giving platelets after each unit of transfused red cells.
    4. Warning the surgeon that s/he is responsible for stopping the hemorrhage.
    1. Uncommon but usually seen in patient with pre-existing cardiac disease.
    2. Needs to be managed in a non-ACLS fashion.
    3. Most often seen after minor atrial arrhythmias occur.
    4. Always secondary to pre-existing cardiac disease.
    1. Are the most common medical errors made in hospital.
    2. Are rare and usually not dangerous.
    3. Are most commonly caused by clerical error in labelling drugs.
    4. Are easily recognized and reversed.

    Author of lecture Patient and Doctor Induced Emergencies

     Brian Warriner, MD

    Brian Warriner, MD

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