05 hematology

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<ul><li> 1. HematologyDutchess Community College EMS</li></ul><p> 2. Sections Anatomy, Physiology, and Pathophysiology General Assessment and Management Managing Specific Patient ProblemsDutchess Community College EMS 3. Hematology The Study of Blood and Blood-Forming Organs Includes study of blood disorders. Red blood cell disorders White blood cell disorders Platelet disorders Coagulation problems Dutchess Community College EMS 4. Anatomy, Physiology, and PathophysiologyDutchess Community College EMS 5. Blood Viscosity greater than that of water Temperature, 380C (100.4'F) pH of 7.35 to 7.45.Dutchess Community College EMS 6. Blood Components Red Blood Cells White Blood Cells Platelets Hematopoiesis Pluripotent stem cell Erythropoietin Dutchess Community College EMS 7. Components of Blood Plasma Water Proteins 9092% by volume 67% by volumeOther 23% by volume Fats, carbohydrates, electrolytes, gases, and chemical messengers Dutchess Community College EMS 8. Components of Blood Red Blood Cells Hemoglobin Oxygen transport Bohr effect 2,3 DPG Oxygenhemoglobin dissociation curve Dutchess Community College EMS 9. Red Blood Cells Average life-span of Red Blood Cells ~120 days Due to wear and tear on plasma membranes as they squeeze through capillaries.A healthy male has about 5.4 million RBCs/mm3 A healthy female has about 4.8 million/mm3.Dutchess Community College EMS 10. Red Blood Cells Red blood cell production Erythropoiesis Hemolysis Sequestration Dutchess Community College EMS 11. inhibitionstimulation Kidney and Liver form:MoreLessErythropoietin increases Blood Oxygen levels updecreasesRBC production (Hemopoiesis) in Bone Marrow MORE RBCFEWER RBCDutchess Community College EMSBlood Oxygen levels down 12. Components of Blood Laboratory analysis of red blood cells Red blood cell count Hematocrit Hemoglobin Dutchess Community College EMS 13. Components of Blood White Blood Cells Margination Phagocytosis White blood cell count Dutchess Community College EMS 14. PhagocytosisDutchess Community College EMS 15. White Blood Cells Leukopoiesis Granulocytes Neutrophil Basophil Eosinophil Lymphocytes Monocytes Dutchess Community College EMS 16. White Blood Cells Immunity Subpopulation of lymphocytes known as T cells and B cells T cells develop cellular immunity. B cells produce humoral immunity. Autoimmune disease Alterations in the immune process Inflammatory process Dutchess Community College EMS 17. Components of Blood Platelets Megakaryocytes Thrombocytopenia Thrombocytosis Dutchess Community College EMS 18. Blood Forming Organs Bone marrow Liver SpleenDutchess Community College EMS 19. Hemostasis Controlling Blood Loss Vascular spasms Platelet plugs Stable fibrin blood clots Dutchess Community College EMS 20. Dutchess Community College EMS 21. Hemostasis Fibrinolysis Thrombosis Thrombolytics Medications affecting clot formation Alter the enzyme on the platelet. Affect the coagulation cascade. Enhance clotting. Dutchess Community College EMS 22. Dutchess Community College EMS 23. Blood Products and Blood Typing Blood Types Antigens A, B, AB, OUniversal donors Rh factor Dutchess Community College EMS 24. Transfusion Reactions Donors RBC and Recipients PlasmaRecipientType A Donor - RBC A antigens B antibodiesType B B antigens A antibodiesType A A antigens B antibodies Type B B antigens A antibodies Type AB A+B antigens O antibodies Type O O antigens A+B antibodiesNo reactionMajor reactionMajor reactionNo reactionMinor reactionMajor reactionMajor reactionMajor reactionNo reactionMajor reactionMinor reactionMinor reactionMinor reactionNo reactionDutchess Community College EMSType AB Type O A+B antigens O antigens O antibodies A+B antibodies Minor Major reaction reaction 25. Blood ProductsDutchess Community College EMS 26. Transfusion Reactions Hemolytic Reactions Signs &amp; Symptoms Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, fever, chills, and cyanosisTreatment Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringers. Consider furosemide, dopamine, and diphenhydramine. Dutchess Community College EMS 27. Transfusion Reactions Febrile Nonhemolytic Reactions Signs &amp; Symptoms Headache, fever, and chillsTreatment Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringers. Consider diphenhydramine and an antipyretic. Observe closely to ensure reaction is nonhemolytic. Dutchess Community College EMS 28. General Assessment and Management Scene Size-up Initial Assessment Focused History and Physical Exam SAMPLE history Hematological disorders are rarely the chief complaint.Physical exam Evaluate nervous system function. Dutchess Community College EMS 29. Detailed Physical Examination Levels of consciousness Vertigo Fatigue Syncopal episode(s)Skin Prolonged bleeding Bruising Itching Pallor Jaundice Dutchess Community College EMS 30. Detailed Physical Examination Visual disturbances Gastrointestinal Epistaxis Bleeding gums / Infections of the gums Ulcerations Melena Liver disease PainSkeletal Arthralgia Nuchal rigidity Dutchess Community College EMS 31. Detailed Physical Examination Cardiorespiratory Dyspnea Chest pain Hemoptysis Tachycardia Genitourinary Hematuria Menorrhagia Infections Dutchess Community College EMS 32. General Management General Treatment Guidelines Maintain ABCs. High-flow oxygen Assist ventilations as indicated Consider volume replacement. Monitor cardiac rhythm and vital signs. Treat rhythm disturbances. Dutchess Community College EMS 33. General Management Pharmacological Non-pharmacological Oxygen Platelet aggregate inhibitor Alkalinizing agents Narcotic/ analgesic Diuretic Provide reassurance, comfort care, and transport.Transport considerations Appropriate mode / facility Dutchess Community College EMS 34. Managing Specific Patient Problems Diseases of the Red Blood Cells Diseases of the White Blood Cells Diseases of the Platelets/Blood Clotting Abnormalities Other Hematopoietic DisordersDutchess Community College EMS 35. Anemias Epidemiology Reduction below normal levels of hemoglobin or erythrocytes, and is a symptom of an underlying disease processDutchess Community College EMS 36. Anemias Pathophysiology Morbidity/ mortality Can be self-limiting disease Must be confirmed by laboratory diagnosis Precipitating causes Blood loss (acute or chronic) Decreased production of erythrocytes Increased destruction of erythrocytes Dutchess Community College EMS 37. Anemias Pathophysiology cont. Hemolytic HereditarySickle cell Thalassemia Glucose-6-phosphate dehydrogenase deficiency AcquiredImmune Drug Dutchess Community College EMS 38. Anemias Signs and symptoms may not be present until the body is stressed. Treat signs and symptoms. Maximize oxygenation and limit blood loss. Establish IV therapy if indicated. Dutchess Community College EMS 39. Anemias Initial assessment findings Airway/ breathing Labored breathing may or may not be presentCirculation Peripheral pulses Quality RhythmChanges in skin Color Temperature MoistureDutchess Community College EMS 40. Anemias Focused History Complaints Complaints secondary to anemiaFatigue Lethargy Hypoxia Dyspnea Dutchess Community College EMS 41. Anemias Focused History Complaints Complaints secondary to leukopenia Infections Fevers Complaints secondary to thrombocytopenia Cutaneous bleeding Bleeding from mucous membranesDutchess Community College EMS 42. Anemias Management Airway and ventilation Circulatory support Pharmacological Analgesics Fluid volume replacement Control of bleeding Non-pharmacological Position of comfort Dutchess Community College EMS 43. Anemias Transport considerations Appropriate mode Indications for rapid transport Significant changes in LOC Hypotension/ hypoperfusionAppropriate facilitySupport and communication strategies Explanation for patient, family, significant others Communications and transfer of data to the physician Dutchess Community College EMS 44. Types of AnemiaDutchess Community College EMS 45. Sickle Cell DiseaseDutchess Community College EMS 46. Sickle Cell Disease Epidemiology Highest incidence in blacks, Puerto Ricans and persons of Spanish, French, Italian, Greek and Turkish originPathophysiology A congenital hemolytic anemia A chemical defect within the hemoglobin of red blood cells Morbidity/ mortality Sepsis Shock Death Dutchess Community College EMS 47. Sickle Cell Disease Initial assessment findings Levels of consciousness Airway/ breathing Circulation Peripheral pulses Changes in skin Pallor, Cool, Clammy Hypotension/ hypoperfusion Dutchess Community College EMS 48. Sickle Cell Disease Focused history Chief complaint Sudden onset develops into a condition calledcrisis Thrombotic crisis (painful) Aplastic Hemolytic Dutchess Community College EMS 49. Sickle Cell Disease Detailed physical exam Airway / Breath sounds Circulation SkinAs above Temperature may vary ECG findingsTachycardia Ectopy Dutchess Community College EMS 50. Sickle Cell Disease Detailed physical exam continued Increased weakness Aching Chest pain Sudden, severe abdominal pain Bony deformities Icteric sclera Abdominal pain Fever Arthralgia Dutchess Community College EMS 51. Sickle Cell Disease Management Position of comfort Pharmacological Analgesia Fluid volume replacement Transport for reperfusion Indications for no transport Refusal Support and communication strategies Explanation for patient, family, significant others Communications and transfer of data to the physician Dutchess Community College EMS 52. Polycythemia Epidemiology Overabundant production of red blood cells, white blood cells and platelets Rare disorder seen in persons over 50 years of age Pathophysiology Thrombosis Death from thrombosis Dutchess Community College EMS 53. Polycythemia Initial assessment findings Levels of consciousness Airway/ breathing Labored breathing is commonCirculation Peripheral pulses Quality TachycardiaChanges in skin Color - red-purple complexion Red hands and feet PruriticDutchess Community College EMS 54. Polycythemia Focused history Dyspnea Generalized pruritus Detailed physical exam Airway / Breath sounds Circulation Skin As above Temperature may varyECG findings TachycardiaDutchess Community College EMS 55. Polycythemia Management Position of comfort Pharmacological Analgesia Increase or decrease heart rate Non-pharmacological PhlebotomyDutchess Community College EMS 56. Polycythemia Transport Indications for no transport Refusal Referral Support and communication strategies Explanation for patient, family, significant others Communications and transfer of data to the physician Dutchess Community College EMS 57. Diseases of the White Blood Cells Leukopenia/Neutropenia Too few white blood cells or neutrophils. Follow general treatment guidelines and provide supportive care. Leukocytosis An increase in the number of circulating white blood cells, often due to infection. Leukemoid reaction Dutchess Community College EMS 58. Leukemia Pathophysiology Morbidity/ mortality Neoplastic disease Blood loss Death Acute versus chronicPrecipitating causes Radiation exposure Viral infections Chemicals Immune defects Chromosomal changesDutchess Community College EMS 59. Leukemia Initial assessment findings Levels of consciousness Airway/ breathing Labored breathing may or may not be presentCirculation Peripheral pulses Quality TachycardiaChanges in skin Color Temperature MoistureDutchess Community College EMS 60. Leukemia Focused history Complaints Fatigue, bone pain, diaphoresis Elevated body temperature Sternal tenderness Heat intolerance Abdominal fullness Bleeding Contributing history Recurrent bleeding Increasing frequency and/ or duration Dutchess Community College EMS 61. Leukemia Detailed physical exam Airway Breath sounds Circulation Skin Blood pressure may low ECG findings Tachycardia Ectopic Dutchess Community College EMS 62. Leukemia Management Position of comfort Pharmacological Analgesia Increase or decrease heart rate Fluid volume replacement Electrical Constant ECG monitoring Dutchess Community College EMS 63. Leukemia Transport Criteria for rapid transport No relief with medicationsHypotension/ hypoperfusion Significant changes in ECG Indications for no transport Refusal Referral Dutchess Community College EMS 64. Lymphomas Epidemiology Hyperplasia of the lymphoreticular systemPathophysiology Morbidity/ mortality Blood loss Pain DeathDutchess Community College EMS 65. LymphomasInitial assessment findings Levels of consciousness Airway/ Breathing Circulation Focused history Complaints Fever Night sweats Generalized pruritus Anorexia Weight loss Fatigue, bone pain, diaphoresis Dutchess Community College EMS 66. Lymphomas Detailed physical exam Airway / Breath sounds May be clear to auscultation Congestion in bases may be present Circulation Skin Pallor during the episode Temperature may vary Diaphoresis is usually presentBlood pressure may low ECG findings Tachycardia EctopyDutchess Community College EMS 67. Lymphomas Management Position of comfort Pharmacological Analgesia Increase or decrease heart rate Fluid volume replacement Electrical Constant ECG monitoringDutchess Community College EMS 68. Lymphomas Transport Criteria for rapid transport No relief with medicationsHypotension/ hypoperfusion Significant changes in ECG Dutchess Community College EMS 69. Diseases of the Platelets Thrombocytosis and Thrombocytopenia Thrombocytosis Thrombocytopenia An abnormal increase in the number of platelets An abnormal decrease in the number of plateletsManagement Provide supportive care and follow general treatment guidelines.Dutchess Community College EMS 70. Hemophilia Epidemiology A hereditary disorder transmitted by the female to the male In true hemophilia A factor VIII is nearly absent In hemophilia B there is a deficiency in factor IX The ability to produce thrombin is severely impaired by deficiency or absence of these factors Dutchess Community College EMS 71. Hemophilia Pathophysiology Morbidity/ mortality Uncontrolled bleeding Shock DeathDutchess Community College EMS 72. Hemophilia Initial assessment findings Levels of consciousness Airway/ breathing Labored breathing is common Circulation Peripheral pulses Weak and thready Tachycardia Dutchess Community College EMS 73. Hemophilia Changes in skin Pallor, Cool, clammy Bleeding From body orifices Knees, Wrists, Elbows Hematuria Epistaxis Hemoptysis Hematemesis Melena Hypotension/ hypoperfusion Dutchess Community College EMS 74. Hemophilia Focused history Dyspnea Bleeding Detailed physical exam Airway / Breath sounds May be clear to auscultation Con...</p>