Dic

Hi Italian RN,

Do you have a specific reason for asking this question??

The reasons for a patient going into DIC are many, and the outcomes are varied.

DIC is never the primary problem...........it is always the result or complication of another issue.

DIC is BOTH a bleeding and a clotting problem; often referred to as a consumptive coagulopathy

Patients I have seen in DIC.

* A pregnant patient who delivered but had retained remnants of placenta that then went into DIC

* Trauma patients especially those who received massive blood tranfustions or with significant burns who then went into DIC

* Lots of septic (usually those with gram negative sepsis) patients who went into DIC

* The one that was most memorable to me personally was a 30 something-ish man with a remote history of hepatitis C who went into fulminant liver failure and developed DIC. In less than a 24 hour period, he went from not feeling too well..........thinking he might have the flu, to coding three times, bleeding out of every orifice of his body and dying.

* Most recent patient was a gentleman with a peanut allergy who was exposed to another type of nut oil, had an anaphylactic shock reaction and then went into DIC...........he eventually made a full recovery.

The end outcome in most but not all of the above patient scenarios was death. The true way to combat DIC is BEFORE the patient goes into it.

Hope this helps.

I've seen it a few times. Usually in our Rhabdo border crossers. They usually die.

Most of the patients I have seen it in have rhabdo or end stage AIDS.

Hi Italian RN,

"Do you have a specific reason for asking this question??"

I was just brushing up on some info in preparation for my CCU interview. I noticed that DIC is hardly mentioned & I was just wondering if patients ever survived it. I was also wondering how often it is seen in ICU units. Judging by the responses, I don't think it's seen too often, Thank God.

I hope I've covered enough for my upcoming interview. I want it soooo bad!!

Thanks for responding.

The 2 i've had both died; one was 18 years old

My unit actually has cases with DIC fairly frequently. Being a MICU we get patients with sepsis, liver failure, and oncology complications. And since we are one of the regional referral centers, we get the very sick patients from smaller hospitals that are often in DIC and beyond the smaller hospital's capabilities.

Has anyone had a patient with DIC ?

What brought it on & how did it turn out?

Wow, I feel like we have a patient in DIC at least 2-5x a month! But one that comes to mind is a placental abruption. Day one she got over > 50 units PRBCs, >30 units FFP, >30 platelets, >25 cryo. Vented on APRV. CRRT. On vaso and levo. Uterus was fine.

The first day I took her I walked on the unit after report and they were opening her belly in the room. After I think it was 13 days, she was doing great and actually stuck around in our unit, because OB was hesitant to take her and there were no beds on available in progressive. She transferred out to med-surg for a couple days and as far as I know she went home with a friend. And the baby was fine and was adopted.

Cancer or AIDs patients, but then they are my fields.

Some survive, but as I usually work with "liquid tumor" patients, it is hard to separate those that die from the primary disease or from sepsis or from DIC.

Wow, I feel like we have a patient in DIC at least 2-5x a month! But one that comes to mind is a placental abruption. Day one she got over > 50 units PRBCs, >30 units FFP, >30 platelets, >25 cryo. Vented on APRV. CRRT. On vaso and levo. Uterus was fine.

The first day I took her I walked on the unit after report and they were opening her belly in the room. After I think it was 13 days, she was doing great and actually stuck around in our unit, because OB was hesitant to take her and there were no beds on available in progressive. She transferred out to med-surg for a couple days and as far as I know she went home with a friend. And the baby was fine and was adopted.

thats an insane amount of blood products

Especially considering that PRBCs do not contain 2,3 dpg.

People who are hemorrhaging still need blood products. Regardless of the lack of 2,3 dpg.

And yet, they still oxygenate with all that new blood. So either it must not be as important as some people think, or it must regenerate faster than we think. Because if this patient received 50 Units of PRBCs, and there was no 2,3 dpg for oxygenation, then what's the point?

Wow, I feel like we have a patient in DIC at least 2-5x a month! But one that comes to mind is a placental abruption. Day one she got over > 50 units PRBCs, >30 units FFP, >30 platelets, >25 cryo. Vented on APRV. CRRT. On vaso and levo. Uterus was fine.

The first day I took her I walked on the unit after report and they were opening her belly in the room. After I think it was 13 days, she was doing great and actually stuck around in our unit, because OB was hesitant to take her and there were no beds on available in progressive. She transferred out to med-surg for a couple days and as far as I know she went home with a friend. And the baby was fine and was adopted.

Wow! You take complicated patients to have just gotten out of school! Good for you. I am surprised she did not go into ARDS with that many blood products. I can't imagine giving that many in a day. One nurse would have been totally consumed with just giving blood products!!