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Transfusion alternatives - Coggle Diagram
Transfusion alternatives
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Hypotension
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Anesthesiologists urge caution when combinig
hypotension with hemodilution because hypotension can interfere with th normal redistribution of blood flow
Microsampling
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The amount taken is not millilitres anymore, are microliters
Using a microtubial type of analysis, can markedly reduce the number of ccs of blood loss today for sampling.
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Meticulous Surgery
Gently score the skin and open it, use th cautery to ges all the blood vessels
The basic tecnique for a surgeon to control bleeding
is to ligate the vessels
That Is true for all the vessels, down to 1mm in diameter
If there is some bleeding persisting, there are coagulation techniques, best of which is, at the moment, argon-beam coagulation.
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Hemodilution
Principle
If blood is removed from the patient immediately prior to or immediately after induction of anesthesia and replace with acellular fluids, then when the patient bleeds intraoperatively thered cell loss is less
It is beneficial for the patient, as it improves blood rheology
Cell salvage
If intraoperative bleeding becomes heavy, a cell salvage machine, often kept on standby, is able to recover the shed blood
The blood flows through the device, some machines simply filter out any debris
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It is a very important technique, when it is used the blood lost by the surgeon is not lost by the patient
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Normothermia
If a patient is cold by 1 or 2 degrees´temperature, it is seen a loss in ability to platelets and coagulation factors to work
To mantain it, operating theater temperature is 27 degrees
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Hemostatic Agents
General agents
These could be administered intravenously, such as tranexamic or aprotinin
Topical gules
surgeons have also the possibility to use topical glues in order to better control the bleeding in the surgical field
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Rapid rewarming
During advanced hypothermia blood coagulation does not function properly and therefore, the blood loss is larger
Quick trauma response
damage control surgery
Once it is opened the patient´s abdomen or chest and it is noted that the patient is unable to coagulate, surgeons address the major bleeding vessels, then control the surface with pads and close the patient temporarily, allowing them to be taken to the intensive care unit where their resuscitation is continued and efforts to reverse those adverse effects on coagulation like hipotermia, are specifically addressed.
EPO and Iron
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In the more complex problems, the use of EPO becomes even more compelling in the trauma patient
Patient positioning
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With pressure in the abdomen and thus in the paravertebral veins, blood loss increases.
Avoiding abdominal compression, blood loss decreases
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