Dic

[nimbex, RN]

I need your know how...

had a VERY sick DIC patient last night, from acute bowel, septic went immediately into DIC, took a hypovolemic hit on top of it which stunned the kidneys, liver and then the lungs after being 20 liters positive.

Did all the blood products 20 FFP, 20 platelets, 20 plus PRBC"s plus cryo, vitamin K, maxed on epi, norepi, and neo with many a bolus inbetween.

Does anyone give heparin anymore?? Microemboli were poping up everywhere, not just your petechi (sorry spelling is horrible).

I'm in CCU this pt. was overflow, my MICU days were 5 years ago. So my knowledge is basic on DIC. But before.... back in the old days... we used heparin to stop the intravascular coagulation that occurs....

Is this out of date? have studies proven heparin futile if not harmful? The surgeon treated me like the villiage idiot for suggesting it.... we ran out of options, and this mom of two teen's died less than 24 hrs. of the emergent surg.

Even as a last ditch effort... ph6.8 (despite an ocean of Bicarb and eliminating two hospitals supply of levophed....)

Can anyone help me understand the current treatment of DIC which (well here along with septic shock) led to multi-system organ failure?

Did I miss the boat?

thanks all

[sherbeari]

We recently treated a DIC in our ICU with blood products and no heparin. This guy was a multi-trauma MVA. I was also surprised they didn't use heparin. He got past the DIC and died of other injuries r/t the MVA.

[London88]

Nimbex

If the pt was a fresh post op, then heparin would probably be contraindicated. Also, if you were pouring in platelets, then your platelet count must be very low, which would cause problems if you anticoagulate. Many times a low platelet count in a septic pt prompts the physician to look at the fibrinogen, fibrin split product, as well as a D-Dimer. When both of the latter are significantly elevated, then you have a DIC. Be prepared to chase your tail!