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Opzet Hemostase

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by

Maxim de Rooij

on 29 October 2013

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Transcript of Opzet Hemostase

Stolling
Tissue factor
Plasma prekallikrein
Desmopressine (DDAVP / Minrin)
Fibrinolyse
Plasminogeen
Plasmine
Plasminogeen-
activatie door:
t-PA
u-PA
streptokinase
Fibrine
Fibrineafbraak producten
Tranexaminezuur
Hemorragische shock
Desmopressine (DDAVP / Minrin)
aPTT
geen antidotum
(geen bewijs effect
VVP, Cofact, rFVIIa)
Bind en neutraliseerd ongefractioneerd heparine (100%) en LMWH (~50-60%)
Neutralisatie in 5 min
Protamine
Vit. K
Cofact (II, VII, IX en X)
PT
1. Primaire hemostase
locale vasoconstrictie & trombocyten plug formatie

2. Stollingscascade
Vorming van fibrine netwerk

3. Fibrinolyse
Het stolsel wordt opgeruimd
3 stappen:
Stolling
Plasmine
Salicylaten
Ticagrelor
Clopidogrel
Beïnvloeden van de stolling
1. Trombocyten aggregatie remming

2. Coumarine derivaten, Heparine

3. Trombolyse
1. Trombocyten, Desmopressine, VVP

2. Vit K, 4-factoren concentraat (Cofact), VVP

3. VVP, tranexaminezuur

- Calcium
Anti-coagulantia:
Pro-coagulantia:
Plasmine
Definitie Shock
"A condition where tissue oxygenation is inadequate for the needs of aerobic metabolism."
Zuurstof
consumptie
(VO2)
Casus
54-jarige patiënt (60kg)

bleek, koud, zwetend
P 108/min
RR 110/70 mmHg
Ademfreq 26/min
UP 35ml/u
T 36,7

Hb 7.1 mmol/l
Tr 0.37 l/l
aPTT 33 s; PT 15.4 s
Lactaat 3,2 mmol/l
SaO2 99% (2L 02)
SvO2 54%
zwakke correlatie met bloedvolume tekort
Daling Hb/Ht geen maat voor ernst bloeding
Hb/Ht reflecteert de volumetoediening
Hematocriet / Hemoglobuline
VO2 =
CO
x
Hb x 21
x
(SaO2 - SvO2)
O2-extractie (%) = (SaO2 - SvO2)/SaO2
Principe van Fick
1870
Progressief bloedverlies:
O2-aanbod (DO2) daalt
Initeel compensatie O2-consumptie (VO2)
VO2 =
CO
x
Hb x 21
x
(SaO2 - SvO2)
Decompensatie indien
bloedverlies >30%
O2-extractie > 50%
Guillermo Gutierrez; Clinical review: Hemorrhagic shock; Crit Care. 2004
Classificatie
Full transcript