welcome to nursing school explained in this video on disseminated intravascular coagulopathy or sometimes also abbreviated as dic again we can look at the terminology here to really almost get a better understanding of what's the underlying pathophysiology so disseminated basically just means widespread throughout an organ or the body intravascular within the blood vessels and coagulopathy so a disease or a problem with the coagulation and really what it is is an abnormal response of the normal coagulation cascade and you may remember from physiology all the different steps that happen in the coagulation cascade and the different factors that are involved and so dic just involves a very abnormal response to the coagulation cascade as it should naturally occur now several things can cause dic and all of those um are similar get very different but they all lead to the same end result which just this complication that can be life-threatening so very common causes are any kind of shock states that the patient can be in so neurogenic shock hypovolemic shock cardiogenic shock any kind of shock that you can imagine and then sepsis is a very common cause of dic as well as transfusion reactions can lead to coagulation problems and dic and then there are several gynecological or obstetrical things that can lead to dic first of all is help syndrome then we have amniotic fluid emboli or an abruption of the placenta can all lead to abnormal clotting and dic now certainly blood disorder such as leukemia or metastatic tumors can also lead to dic burns as well as trauma can cause a problem and snake bites that are poisonous can lead to issues with coagulation and dic and acute anoxia such as would occur after a patient returns to spontaneous circulation after a cardiac arrest or maybe after an acute drowning when the patient is revived and has acute anoxia it can also lead to dic so as you can see most of these are already kind of very high risk events that can lead to this complication that then exasperates the problem so the pathophysiology there are basically two things that occur here so first of all we have the thrombotic stage which is the problem with the clotting so if you recall from your physiology classes that thrombin is needed to convert fibrin to fibrinogen to actually build the blood clot and this leads to increased platelet aggregation because the platelets want to solve the problem of um this uh whatever needs to be fixed and then a thrombus occurs which is usually a good thing but in this case it's just too much of a good thing so now we have thrombi everywhere in the body and they can settle and then cause a lot of complications and then number two we have the bleeding stage or the bleeding phase where now these clots are broken down by something called fibrin split products or fsp and then the body is unable to clot because all everything is used up all these platelets are used up and whatever clots we have they're broken down and the body cannot clog which then will lead to hemorrhage so it's kind of a conundrum we have clotting and bleeding at the same time and we know that either one of them can be very complicated to manage but now we have these two problems that can sometimes occur at the very same time in the same patient so signs and symptoms that we might see and i have distinguished here between bleeding and clotting issues so in the skin when the patient is bleeding there might be power because there might be blood loss as well as petikei and purpura as the blood vessels underneath the skin start to leak and we can see the the blood basically accumulating there and petechiae are just small dogs where purpura can be kind of more blotchy as that blood leaks underneath the skin now in clotting under the skin we might see cyanosis because now there's a clog preventing the blood flow to get to a certain area but it can also lead to gangrenous issues such as lost toes lost fingers or maybe even limbs in the respiratory system when there's a problem with bleeding we will see an increase in respiratory rate maybe hemoptysis as the patient as the patient's lungs get affected and certainly they can be short of breath but if we have a problem with clawing it can lead to pe pulmonary emboli that can settle in the lung and also ards acute respiratory distress syndrome in the cardiovascular system when there is bleeding the heart rate will usually go up as the blood pressure drops and the patient loses the blood volume and then when there's clotting we can see ekg changes because clotting affected the heart can lead to myocardial infarction but then also to heart failure and jbd that we can see in the bleeding phase the patient might have gi bleeding so blood and the vomiting so coffee ground embassies as well as rectal bleeding but in the clotting phase the patient might be complaining of abdominal pain and because of the lack of blood that's the blood flow that's caused to the gi system now there might be a paralytic ileus because we just don't have the blood to feed the gi system to do its normal function in the gu system we might have hematurias of bleeding in the urinary tract and that can lead to oliguria as well as renal failure now in the neurologic system when there is bleeding we may have altered level of consciousness or the patient might be complaining of vision changes and then in the clothing phase of course blood clots in the brain will lead to tias and cvas and then also in the musculoskeletal system [Music] a phenomenon occurs that is called heme arthrosis so now the blood will kind of settle in the joints that can be very become very swollen as they become inundated with the blood and then cause a lot of pain there in the joints so now looking at diagnostic tests certainly we want to look at their cbc to see how their blood count is doing cmp to look at their kidney liver function as well as electrolytes and then everything that pertains to the coagulation cascade so we want to look at their bleeding times pti and r and their fibrinogen level plasminogen level their platelets are certainly going to be important to measure as well as their d dimer but keep in mind that's a very non-specific marker of clotting and then we can actually measure these vibrance fit products that we worry about so much here in their blood system as well and there might be other special clotting tests that the provider might order as for treatment we need to treat the underlying cause there's nothing we can do unless we treat the underlying cause of the patient the septic we need to give them antibiotics determine the cause of the sepsis uh give them lots and lots of fluids um if they had a snake bite certainly we're gonna we're gonna treat that because those are very different causes all leading to the same problem but the treatment will be very different depending on where the origin of this dic is and then we certainly will always worry about oxygen administration and the patient's airway because we saw over here what can happen if there's beating the respiratory tract or they might be developing the pe or arts and then certainly we want to replace their volume because as they bleed and clot um they might as they as they bleed more so they will lose their volume so we might need to replace it with crystalloids to begin with so iv solutions that will stay in that intravascular space helping to maintain their blood pressure and then we will need to administer blood products and those are anything that you can think of that we can give to the patient so anything from packed red blood cells if they've lost a lot of their blood volume as well as platelets fresh frozen plasma and then we can also give them certain coagulation factors if they are lacking in certain coagulation factors so this is probably the most important part here and then if there's clotting if we see a lot of evidence of sense and symptoms of clotting here the patient might be on a heparin drip to prevent the clotting and then or be on loganox and as you can see here it's a little bit of a conundrum because we want to prevent the clotting but we also want to give the patient these products so there's a there's a fine line between the bleeding and the clotting and depending on what the lab sure how the patient looks is what they are um what kind of a treatment that they'll need whether they'll need one or the other or maybe a very careful administration of both now for nursing care certainly all the treatments that would happen for these other this underlying disorders or causes of dic but it's very important to identify patients at risk so to be familiar with these disorders and know that if you have an obstetrical patient who had an amniotic fluid envelope embolus that they are at high risk for developing dic and to really monitor them very very carefully for bleeding from the iv sites for example for starting to the bleeding gums gi bleeding just a pink tinge urine anything that would hint to the fact that there might be some dic developing because of course the sooner you recognize the symptoms the sooner the patient can be treated and the better their outcome will be um with this careful monitoring and intervening early so thank you for watching on this video on dic please also watch the other videos about any of these disorders that can lead to dic so you have a better understanding of how it really all relates together thanks for watching nursing school explains see you soon