D.i.c.

http://www.emedicine.com/emerg/topic150.htm

Here is a very good article describing the course and treatment of DIC.

I've seen it several times- usually in end stage AIDS or sepsis. The only patient I've seen that survived it was a 20 year old pregnant woman. She had to deliver early, had a healthy baby, and actually walked out OK several weeks later. We didn't think she would make it, but she did. She came up to our unit 6 months later to tell everybody thank you. She looked totally different, and we didn't recognize her. When she looked at her records, and looked up DIC, she said she couldn't believe we were able to save her. It was pretty surprising that she made it. She wants to be a critical care nurse now- how cool is that?

The only patient I have seen that developed DIC was a 20year old who was about 7 days post partum and sadly she passed away.

One of our hospitalists loved to teach, and would give us 'pop quizes' on a regular basis. One night he showed me labs on a patient he was caring for on another unit and asked me what I thought wrong with them. I glanced at the results and said, "Looks like DIC to me."

He was rather shocked I answered so quickly, and a little disappointed that I'd stolen his thunder, until I reminded him what floor he was on--- heme/onc.

Our doc gave a terrific inservice on heme/onc emergencies. His talk on DIC was great; it made it so easy to understand the physiology and treatment.

I've seen maybe 4-5 DIC pts in 20 years. One survived, a 40-something woman who started bleeding out postpartum. Spent several weeks in ICU, had blood poured into her, and made it. I met her about a month later when she and her husband brought the baby to the ER with a fever. She was so grateful that she kept thanking the ER staff, and we had nothing to do with it. She said "I know, but you are nurses, and the nurses saved my life. I'm grateful to all of you!"

Would you mind posting the highlights of that talk for us newbie nurses who haven't encountered (and to never encounter) DIC before? We did receive a little bit of info during our postpartum and sepsis lectures, but it sounds as though your doc gave you a nice concise way to remember the labs/symptoms associated with it. Thanks! :studyowl:

Would you mind posting the highlights of that talk for us newbie nurses who haven't encountered (and to never encounter) DIC before? We did receive a little bit of info during our postpartum and sepsis lectures, but it sounds as though your doc gave you a nice concise way to remember the labs/symptoms associated with it. Thanks! :studyowl:

http://www.emedicine.com/med/topic577.htm

http://www.emedicine.com/ped/topic2590.htm#targetHE

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=cmed.chapter.41500

He explained what labs to watch--- elevated FSP and D-Dimer, decreased Fibrinogen specifically. How to assess the patient for signs of bleeding (one thing he mentioned as a cardinal sign for our patients is that they will begin to bleed in areas that have previously clotted, springing leaks in old venipuncture sites for example).

An important point he said to remember is that as the patient goes into DIC, they are simultaneously clotting while bleeding, so that you may be treating them with anticoagulants as well to break the coagulation cascade. Starting a patient who has active bleeding on a heparin drip goes against what we've been taught, but it can be beneficial in treatment particularly for cancer patients, as the tissue injury associated with the widespread microvascular clotting only perpetuates the coagulopathy. The key is to remove the trigger, if possible.

I have seen one patient survive DIC, a 30-week preemie who intially had a smooth course in the NICU, then suddenly went downhill. He did not have NEC, which was our first thought, and I don't know what brought on his DIC. He was the sickest patient I have ever seen survive. I went on a 2-week vacation at the peak of his illness, and was so certain he was going to die, that I refused to call the unit to check on him. Imagine my surprise when I came back, and found that he was improving! He went home about 3 months later, and had some residual liver damage that needed to be monitored, but never caused him any problems that I know of. I last saw him as a chubby toddler with a healthy newborn brother.

we get a lot of DIC none have survived long term. Xigris can actually make them bleed and sometimes has to be shut off

I see lots of DIC-pts in rhabdo usually border crossers in the summer. They never survive...

RHABDO? What is rhabdo? :doh:

RHABDO? What is rhabdo? :doh:

Rhabdomylosis (spell check?) is residual soft tissue breakdown, often from immobility. Example, had a young adult male hiker who took a tumble, broke his leg and was immobile on a hillside while waiting for help to arrive. His labs were specific to rhabdo and he was monitored hemotologically for a few days before he was discharged.