Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FACEM > Coagulation and TEG > Flashcards

Coagulation and TEG Flashcards

1
Q

Discuss the intrinsic pathway

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
A

Discuss the intrinsic pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Discuss the extrinsic pathway

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A

Discuss the extrinsic pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Discuss the commonpathway

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
A

Discuss the commonpathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe components of the TEG

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A

Describe components of the TEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the “R time”?

A

It is the time taken to form 2mm of clot on the sensor.- Normal R time is 5-10 minutes- A long R time indicates a clotting factor deficiency or the presence of heparin- A short R time is of no clinical significance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

It is the time taken to form 2mm of clot on the sensor.- Normal R time is 5-10 minutes- A long R time indicates a clotting factor deficiency or the presence of heparin- A short R time is of no clinical significance

A

What is the “R time”?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is th angle⍺?

A

The measure of the rapidity of fibrinogen build up and crosslinking- normal angle ⍺ is 50o-70o

  • low angle ⍺ indicated low fibrinogen but may also represent thrombocytopenia and/or thrombocytopathia- high angle ⍺ is of no clinical significance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The measure of the rapidity of fibrinogen build up and crosslinking- normal angle ⍺ is 50o-70o

  • low angle ⍺ indicated low fibrinogen but may also represent thrombocytopenia and/or thrombocytopathia- high angle ⍺ is of no clinical significance
A

What is th angle⍺?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the maximal angle (MA)?

A

MA is a measure of clot strenght- normal is 50 - 70mm- low MA represents thrombocytopenia and/or thrombocytopathia- high values are of no clinical significance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MA is a measure of clot strenght- normal is 50 - 70mm- low MA represents thrombocytopenia and/or thrombocytopathia- high values are of no clinical significance

A

What is the maximal angle (MA)?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the Ly30?

A

It denotes the amout of fibrinolysis that has taken place after the MA

  • normal value is 0-8%
  • high valuses indicate excess fibrinolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

It denotes the amout of fibrinolysis that has taken place after the MA

  • normal value is 0-8%
  • high valuses indicate excess fibrinolysis
A

What is the Ly30?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the clot index (CI)?

A

a numerical value from a mathamatical equation taking into account TEG peramaters.- Normal CI is -3.0 to +3.0- a low CI < -3.0 indicates hypOcoagulatable state- a highCI > +3.0 indicates a hypERcoagulatable state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

a numerical value from a mathamatical equation taking into account TEG peramaters.- Normal CI is -3.0 to +3.0- a low CI < -3.0 indicates hypOcoagulatable state- a highCI > +3.0 indicates a hypERcoagulatable state

A

What is the clot index (CI)?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What results would you expect to see with primaryfibrinolysis?

A

HighLy30 and a low CI & MA- indicates circulating fibrinogen is being lysed due to an underlying pathological state thus there is poor clot formation and the patient has a tendence to bleed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HighLy30 and a low CI & MA- indicates circulating fibrinogen is being lysed due to an underlying pathological state thus there is poor clot formation and the patient has a tendence to bleed.

A

What results would you expect to see with primaryfibrinolysis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What results would you expect to see withsecondaryfibrinolysis?

A

There is adequate clot formation but it is followed by excessive fibrinolysis (i.e. DIC)- only the Ly30 will be low, but the value of the CI & MA may be normal or even high
» redwine glass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

There is adequate clot formation but it is followed by excessive fibrinolysis (i.e. DIC)- only the Ly30 will be low, but the value of the CI & MA may be normal or even high
» redwine glass

A

What results would you expect to see withsecondaryfibrinolysis?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does aspirin and ADP receptor blockers affect TEG?

A

These individuals will have throbocytopathia in VIVO but not in VITRO, so thes effects are not being detected by TEG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

These individuals will have throbocytopathia in VIVO but not in VITRO, so thes effects are not being detected by TEG.

A

How does aspirin and ADP receptor blockers affect TEG?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How doesheparinaffect TEG?

A

The R time will be prolonged and can artifictually lower values of angle ⍺ and MA.- this can be resolved by repeating the TEG with heparinase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The R time will be prolonged and can artifictually lower values of angle ⍺ and MA.- this can be resolved by repeating the TEG with heparinase.

A

How doesheparinaffect TEG?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

With respect to ROTEM, what is the CT?

A

The clotting time (CT) is the time from the beginning of the test by adding the clotting activator until the time when an amplitude of 2 mm is achieved.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The clotting time (CT) is the time from the beginning of the test by adding the clotting activator until the time when an amplitude of 2 mm is achieved.

A

With respect to ROTEM, what is the CT?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

With respect to ROTEM, what does theCT describe?

A

The CT describes how fast the formation of fibrin starts.- This parameter is analogical to the clotting time in a classical clotting test in a laboratory.- However, they are not identical, as more fibrin is created and has to be stabilised in order to achieve a certain firmness of the clot that is sufficient to connect the two moving parts of the measuring cell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

The CT describes how fast the formation of fibrin starts.- This parameter is analogical to the clotting time in a classical clotting test in a laboratory.- However, they are not identical, as more fibrin is created and has to be stabilised in order to achieve a certain firmness of the clot that is sufficient to connect the two moving parts of the measuring cell.

A

With respect to ROTEM, what does theCT describe?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the main influencing factors of CT?

A

Clotting factors and anticoagulants (sensitivity is dependent on the test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Clotting factors and anticoagulants (sensitivity is dependent on the test)

A

What are the main influencing factors of CT?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the clinical implication of CT?

A

The CT parameter facilitates the decision to substitute clotting factors (e. g. through fresh frozen plasma, factor concentrates, activated factor concentrates or anticoagulant inhibitors (e. g. Protamine)).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

The CT parameter facilitates the decision to substitute clotting factors (e. g. through fresh frozen plasma, factor concentrates, activated factor concentrates or anticoagulant inhibitors (e. g. Protamine)).

A

What is the clinical implication of CT?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

With respect to ROTEM, what is CFT?

A

The CFT is the time between a 2 mm amplitude and a 20 mm amplitude of the clotting signal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The CFT is the time between a 2 mm amplitude and a 20 mm amplitude of the clotting signal.

A

With respect to ROTEM, what is CFT?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does the CFT describe?

A

The CFT describes the next phase of the clotting: the kinetics of the formation of a stable clot through both activated thrombocytes and fibrin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The CFT describes the next phase of the clotting: the kinetics of the formation of a stable clot through both activated thrombocytes and fibrin.

A

What does the CFT describe?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the main influencing factors of the CFT?

A

The amount of thrombocytes and their contribution to the clot firmness as well as fibrinogen level and its ability to polymerise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

The amount of thrombocytes and their contribution to the clot firmness as well as fibrinogen level and its ability to polymerise.

A

What are the main influencing factors of the CFT?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

With respect to ROTEM, what is MCF?

A
  • The MCF is the measure for the firmness of the clot and therefore the clot quality.- It is the maximum amplitude that is reached before the clot is dissolved by fibrinolysis and the clot firmness falls again.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q
  • The MCF is the measure for the firmness of the clot and therefore the clot quality.- It is the maximum amplitude that is reached before the clot is dissolved by fibrinolysis and the clot firmness falls again.
A

With respect to ROTEM, what is MCF?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the main influencing factors of MCF?

A
  1. Thrombocytes2. Fibrinogen (concentration and the ability to polymerise)3. F XIII4. The status of fibrinolysis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q
  1. Thrombocytes2. Fibrinogen (concentration and the ability to polymerise)3. F XIII4. The status of fibrinolysis.
A

What are the main influencing factors of MCF?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the clinical appliation of a LOW MCF?

A
  • A low MCF indicates a low clot firmness and therefore a potential bleeding risk. - The MCF value is used to facilitate the decision for substitution therapy with thrombocyte concentrate or fibrinogen (concentrate, cyroprecipitate or fre
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q
  • A low MCF indicates a low clot firmness and therefore a potential bleeding risk. - The MCF value is used to facilitate the decision for substitution therapy with thrombocyte concentrate or fibrinogen (concentrate, cyroprecipitate or fre
A

What is the clinical appliation of a LOW MCF?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the clinical implication for a HIGHMCF?

A

A high MCF value may indicate a hypercoagulable state.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

A high MCF value may indicate a hypercoagulable state.

A

What is the clinical implication for a HIGHMCF?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What needs to be ruled out before treating with fibrinogen?

A

Hyperfibrinolysis should necessarily be ruled out before treating with a fibrinogen source, because hyperfibrinolysis may lead to an unstable clot.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Hyperfibrinolysis should necessarily be ruled out before treating with a fibrinogen source, because hyperfibrinolysis may lead to an unstable clot.

A

What needs to be ruled out before treating with fibrinogen?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the definition of maximal lysis %?

A

The parameter of maximum lysis (ML) describes the degree of fibrinolysis relative to maximum clot firmness (MCF) achieved during the measurement. (% clot firmness lost).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

The parameter of maximum lysis (ML) describes the degree of fibrinolysis relative to maximum clot firmness (MCF) achieved during the measurement. (% clot firmness lost).

A

What is the definition of maximal lysis %?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What does ML 5% describe?

A

A ML of 5% means that, at the period of observation, the MCF has decreased by 5%. As the maximum lysis is not calculated at a fixed time point, but is defined as % lysis at the end of the measurement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

A ML of 5% means that, at the period of observation, the MCF has decreased by 5%. As the maximum lysis is not calculated at a fixed time point, but is defined as % lysis at the end of the measurement.

A

What does ML 5% describe?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Describe the component parts of a ROTEM diagram

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q
A

Describe the component parts of a ROTEM diagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What would you do with a ROTEM like this?

brandy glass

A

Nothing, no products required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Nothing, no products required

A

What would you do with a ROTEM like this?

brandy glass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What would you do with a ROTEM that looked like this?

(red wine glass)

A

Give FFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Give FFP

A

What would you do with a ROTEM that looked like this?

(red wine glass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What would you do with a ROTEM that looked like this?

(test tube)

A

Give platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Give platelets

A

What would you do with a ROTEM that looked like this?

(test tube)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What would you do with a ROTEM that looked like this?

(Champagne flute)

A

give cryo

64
Q

give cryo

A

What would you do with a ROTEM that looked like this?

(Champagne flute)

65
Q

What would you do with a ROTEM that looked like this?

(martini glass)

A

Give TXA

66
Q

Give TXA

A

What would you do with a ROTEM that looked like this?

(martini glass)

67
Q

What is the A10?

A

The A10 is measured in mm and demonstres the firmness of a clot 10min after CT.- it is important as an early and highly predictive overall clot firmness and strenght

68
Q

The A10 is measured in mm and demonstres the firmness of a clot 10min after CT.- it is important as an early and highly predictive overall clot firmness and strenght

A

What is the A10?

69
Q

What factors influence A10?

A
  1. platelets2. fibrinogen3. F XIII
70
Q
  1. platelets2. fibrinogen3. F XIII
A

What factors influence A10?

71
Q

What are the primary factors influencing MCF?

A
  1. platelets2. fibrinogen3. F XIII
72
Q
  1. platelets2. fibrinogen3. F XIII
A

What are the primary factors influencing MCF?

73
Q

What would a MCF <9mm suggest?

A

decreased fibrinogen or disturbed clot polymerisation

74
Q

decreased fibrinogen or disturbed clot polymerisation

A

What would a MCF <9mm suggest?

75
Q

What would a MCF >25mm suggest?

A

NAME?

76
Q

NAME?

A

What would a MCF >25mm suggest?

77
Q

What would suggest a heparin effect on a ROTEM?

A

A CT that is considerably shorter in HAPTEM than INTEM.

78
Q

A CT that is considerably shorter in HAPTEM than INTEM.

A

What would suggest a heparin effect on a ROTEM?

79
Q

What might be an early indication of hyperfibrinolysis on a ROTEM and what does this mean clinically?

A
  • Where the APTEM corrects in comparison to the EXTEM- suggestion that anti-fibrinolytics will have a positive effect.
80
Q
  • Where the APTEM corrects in comparison to the EXTEM- suggestion that anti-fibrinolytics will have a positive effect.
A

What might be an early indication of hyperfibrinolysis on a ROTEM and what does this mean clinically?

81
Q

what is EXTEM?

A

A test to activate the extrinsic pathway using tissue factor

82
Q

A test to activate the extrinsic pathway using tissue factor

A

what is EXTEM?

83
Q

what is INTEM?

A

a test of the contact or intrisic pathway with the addition of Ellagic acid

84
Q

a test of the contact or intrisic pathway with the addition of Ellagic acid

A

what is INTEM?

85
Q

What differentiate the FIBTEM and APTEM?

A

Both are tests of extrinsic function using TF as the activator, however in the FIBTEM the platelet contribution is blocked by adding Cytochalasin D.

86
Q

Both are tests of extrinsic function using TF as the activator, however in the FIBTEM the platelet contribution is blocked by adding Cytochalasin D.

A

What differentiate the FIBTEM and APTEM?

87
Q

What does FIBTEM demonstrate?

A

The specific contribution of fibrinogen availabiltiy and function related to fibrin polymerisation

88
Q

The specific contribution of fibrinogen availabiltiy and function related to fibrin polymerisation

A

What does FIBTEM demonstrate?

89
Q

What does APTEMdemonstrate?

A

In the APTEM, potential fibrinolysis is inhibited by adding Aprotinin or TXA, so when compared to EXTEM you can confirm hyperfibrinolysis and determine the efficacy of antifibrinolytic therapy

90
Q

In the APTEM, potential fibrinolysis is inhibited by adding Aprotinin or TXA, so when compared to EXTEM you can confirm hyperfibrinolysis and determine the efficacy of antifibrinolytic therapy

A

What does APTEMdemonstrate?

91
Q

What does HEPTEM indicate?

A

The effect of the intrinsic pathway after the heparin effect is eliminated by the addition of heparinase

92
Q

The effect of the intrinsic pathway after the heparin effect is eliminated by the addition of heparinase

A

What does HEPTEM indicate?

93
Q

What should be looked for with a low amplitude MCF?

A

low ampluted may be from either platelets or fibrinogen so assessing the FIBTEM will indicate either a platelet or fibrinogen effect

94
Q

low ampluted may be from either platelets or fibrinogen so assessing the FIBTEM will indicate either a platelet or fibrinogen effect

A

What should be looked for with a low amplitude MCF?

95
Q

How can hyperfibrinolysis can be excluded on a ROTEM?

A

If1. APTEM and EXTEM are the sameand2. EXTEM does not exhibit any signs of clot lysis.

96
Q

If1. APTEM and EXTEM are the sameand2. EXTEM does not exhibit any signs of clot lysis.

A

How can hyperfibrinolysis can be excluded on a ROTEM?

97
Q

What would suggest a heparin effect on ROTEM?

A

A normal EXTEM and FIBTEM but an1. EXTENDED CT value and small reduction in amplitude on the INTEM2. an normal HEPTEM values

98
Q

A normal EXTEM and FIBTEM but an1. EXTENDED CT value and small reduction in amplitude on the INTEM2. an normal HEPTEM values

A

What would suggest a heparin effect on ROTEM?

99
Q

A normal CT value on an INTEM and EXTEM indicates what?

A

no deficiency in coagulation factors and no heparin influence

100
Q

no deficiency in coagulation factors and no heparin influence

A

A normal CT value on an INTEM and EXTEM indicates what?

101
Q

An EXTEM and INTEM that shows normal CT values but slightly low amplitude and a clear clot degredation could suggest what?

A
  • fibrinogen deficiency- platelet deficiency- hyperfibrinolysis
102
Q
  • fibrinogen deficiency- platelet deficiency- hyperfibrinolysis
A

An EXTEM and INTEM that shows normal CT values but slightly low amplitude and a clear clot degredation could suggest what?

103
Q

What does APTEM do?

A

Blocks fibrinolysis in the clot sample

104
Q

Blocks fibrinolysis in the clot sample

A

What does APTEM do?

105
Q

What do you expect to see on a ROTEM with hyperfibrinolysis?

A
  1. Normal EXTEM and INTEM CT values but slightly low amplitude and a clear clot degredationAND2. a FIBTEM with clot degredation and a borderline amplitudeBUT3. a normal APTEM.
106
Q
  1. Normal EXTEM and INTEM CT values but slightly low amplitude and a clear clot degredationAND2. a FIBTEM with clot degredation and a borderline amplitudeBUT3. a normal APTEM.
A

What do you expect to see on a ROTEM with hyperfibrinolysis?

107
Q

What do you expect to see on a ROTEM with thrombocytopenia?

A
  1. Normal EXTEM and INTEM CT values but with a low amplitude
    AND
  2. a normal aplitude on the FIBTEM
    (with an equal APTEM and EXTEM for hyperfibrinlysis)
108
Q
  1. Normal EXTEM and INTEM CT values but with a low amplitude
    AND
  2. a normal aplitude on the FIBTEM
    (with an equal APTEM and EXTEM for hyperfibrinlysis)
A

What do you expect to see on a ROTEM with thrombocytopenia?

109
Q

What is the normal CT in EXTEM and what does a long CT indicate?

A
  • normal is >80sec- deficiency in Vit K depent factors
110
Q
  • normal is >80sec- deficiency in Vit K depent factors
A

What is the normal CT in EXTEM and what does a long CT indicate?

111
Q

What does a proloned CT in the INTEM and HEPTEM indicate.

A
  • a deficiency in enzymatic clotting factorsand/or- the final common pathway of coagulation
112
Q
  • a deficiency in enzymatic clotting factorsand/or- the final common pathway of coagulation
A

What does a proloned CT in the INTEM and HEPTEM indicate.

113
Q

What does the MCF indicate?

A

the maximal clot firmness indicates the overall quality and firmness of the clot.- >72mm indicates a hypercoagulatable state (norm. 50-72mm)- MCF 40-45mm moderate bleeding risk- MCF 30-40mm significant bleeding risk- MCF <30mm critical bleeding risk

114
Q

the maximal clot firmness indicates the overall quality and firmness of the clot.- >72mm indicates a hypercoagulatable state (norm. 50-72mm)- MCF 40-45mm moderate bleeding risk- MCF 30-40mm significant bleeding risk- MCF <30mm critical bleeding risk

A

What does the MCF indicate?

115
Q

What are the predicive values of the A10?

A
  • EXTEM, INTEM & ATEM = MCF + 10mm- FIBTEM = MCF + 3mm
116
Q
  • EXTEM, INTEM & ATEM = MCF + 10mm- FIBTEM = MCF + 3mm
A

What are the predicive values of the A10?

117
Q

What steps (in order) need to be considered for the bleeding patient?

A
  1. surgical haemostasis2. correct basic conditions- T>35C, pH >7.2, Ca >1.0,- Hb >80g/L, PLT >75,3. inhibitors of platelet aggregation (ASA, clopidogrel, warfarin or heparin)- INR <1.54. hyperfibrinolysis- Fib>1.05. fribrinogen / cryoprecipitate6. Prothrombin complex (PCC) or FFP7. platelets8. rF VIIa or F XIII
118
Q
  1. surgical haemostasis2. correct basic conditions- T>35C, pH >7.2, Ca >1.0,- Hb >80g/L, PLT >75,3. inhibitors of platelet aggregation (ASA, clopidogrel, warfarin or heparin)- INR <1.54. hyperfibrinolysis- Fib>1.05. fribrinogen / cryoprecipitate6. Prothrombin complex (PCC) or FFP7. platelets8. rF VIIa or F XIII
A

What steps (in order) need to be considered for the bleeding patient?

119
Q

What early indicators might suggest a trauma induced coagulopathy on a ROTEM?

A

An clearly reduced clot firmness- A10EX<25mm at 5 mins or FIBTEM <8mm at 10minsAND- CTEX >80sec

120
Q

An clearly reduced clot firmness- A10EX<25mm at 5 mins or FIBTEM <8mm at 10minsAND- CTEX >80sec

A

What early indicators might suggest a trauma induced coagulopathy on a ROTEM?

121
Q

What does a proloned PT and a normal PT indicate?

A

A problem in the extrinsic pathway (F III & F VII) but as thromboplastin (F III) is added the problem is isolated to F VII.

122
Q

A problem in the extrinsic pathway (F III & F VII) but as thromboplastin (F III) is added the problem is isolated to F VII.

A

What does a proloned PT and a normal PT indicate?

123
Q

What are the causes of F VII dysfunction?

A

INHIBITION1. VIt K deficiency2. Warfarin (blocks Vit K reductase stopping Vit K epoxide to forming the active form of Vit K)3. liver diseaseF VII DEFICIENCY
- rare

124
Q

INHIBITION1. VIt K deficiency2. Warfarin (blocks Vit K reductase stopping Vit K epoxide to forming the active form of Vit K)3. liver diseaseF VII DEFICIENCY
- rare

A

What are the causes of F VII dysfunction?

125
Q

What would an isolated increased PTT time indicate?

A

a defect in the intrinsic pathway

126
Q

a defect in the intrinsic pathway

A

What would an isolated increased PTT time indicate?

127
Q

What factor deficiencies are assoc. with haemophillia?

A

Haemophillia A - F VIIIHaemophillia B - F IXHaemophillia C - F XI

128
Q

Haemophillia A - F VIIIHaemophillia B - F IXHaemophillia C - F XI

A

What factor deficiencies are assoc. with haemophillia?

129
Q

What is Von Willebrand disease

A

a low level of F VIII

130
Q

a low level of F VIII

A

What is Von Willebrand disease

131
Q

What can cause a proloned PTT?

A

-Von Willebrand disease- heparin- lupus anti-coagulant- inhibitors to F VIII, IX, & XI

132
Q

-Von Willebrand disease- heparin- lupus anti-coagulant- inhibitors to F VIII, IX, & XI

A

What can cause a proloned PTT?

133
Q

Discuss fibrinogen in trauma

A
  1. Up to 50% of patients suffering major trauma have trauma-induced coagulopathy on presentation to the Emergency Department2. Fibrinogen is integral to clot formation and haemostasis.3. In major trauma, fibrinogen is the first coagulation factor to deplete, and also becomes dysfunctional and ineffective during trauma-induced coagulopathy and trauma-induced haemorrhage4. There is an association between low fibrinogen levels on presentation and increased mortality.
  2. Trauma-induced coagulopathy will not resolve despite high FFP:PRBC ratios in the absence of additional fibrinogen
134
Q
  1. Up to 50% of patients suffering major trauma have trauma-induced coagulopathy on presentation to the Emergency Department2. Fibrinogen is integral to clot formation and haemostasis.3. In major trauma, fibrinogen is the first coagulation factor to deplete, and also becomes dysfunctional and ineffective during trauma-induced coagulopathy and trauma-induced haemorrhage4. There is an association between low fibrinogen levels on presentation and increased mortality.
  2. Trauma-induced coagulopathy will not resolve despite high FFP:PRBC ratios in the absence of additional fibrinogen
A

Discuss fibrinogen in trauma

135
Q

What is the differences between cryoprecipitate and fibrinogen concentrate?

A

Cryoprecipitate- is a stored frozen blood product held by blood bank- it requires thawing which potentitates delays in administration.

Fibrinogen Concentrate

  • is a pasteurised, freeze-dried product that can be stored in ED for when fibrinogen is required.
  • It does not require thawing or cross-match, and can be stored for up to 5 years under appropriate conditions.
  • Fibrinogen concentrate does not contain vWF and FVIII both of which are contained in cryoprecipitate.
136
Q

Cryoprecipitate- is a stored frozen blood product held by blood bank- it requires thawing which potentitates delays in administration.

Fibrinogen Concentrate

  • is a pasteurised, freeze-dried product that can be stored in ED for when fibrinogen is required.
  • It does not require thawing or cross-match, and can be stored for up to 5 years under appropriate conditions.
  • Fibrinogen concentrate does not contain vWF and FVIII both of which are contained in cryoprecipitate.
A

What is the differences between cryoprecipitate and fibrinogen concentrate?

137
Q

When would you administer fibrinogen concentrate or cryoprecipitate?

A

Traumaa. Major Trauma Patients with ongoing haemorrhage requiring activation of the Massive Transfusion Protocol; andb. FIBTEM A5 < 8 mm on ROTEMHyperfibrinolysis- pt with a FIBTEM A5 that is a flat line (no FIBTEM A5 value reported) and a FIBTEM CT > 600

Non-trauma patients- with active haemorrhage who require massive transfusion and have a FIBTEM A5 < 8 may be candidates for fibrinogen concentrate

138
Q

Traumaa. Major Trauma Patients with ongoing haemorrhage requiring activation of the Massive Transfusion Protocol; andb. FIBTEM A5 < 8 mm on ROTEMHyperfibrinolysis- pt with a FIBTEM A5 that is a flat line (no FIBTEM A5 value reported) and a FIBTEM CT > 600

Non-trauma patients- with active haemorrhage who require massive transfusion and have a FIBTEM A5 < 8 may be candidates for fibrinogen concentrate

A

When would you administer fibrinogen concentrate or cryoprecipitate?

139
Q

What is the dosing for cryoprecipitate and fibrinogen concentrate?

A

Fibrinogen concentrate-One-off dose of 4g (4 ampoules)for either FIBTEM A5 < 8 OR massive hyperfibrinolyis with FIBTEM CT > 600 (flatline).Cryoprecipitate

  • 20U for FIBTEM A5 < 8
  • 10U for FIBTEM A5 8-10
  • repeat Rotem 10 mins after each intervention
140
Q

Fibrinogen concentrate-One-off dose of 4g (4 ampoules)for either FIBTEM A5 < 8 OR massive hyperfibrinolyis with FIBTEM CT > 600 (flatline).Cryoprecipitate

  • 20U for FIBTEM A5 < 8
  • 10U for FIBTEM A5 8-10
  • repeat Rotem 10 mins after each intervention
A

What is the dosing for cryoprecipitate and fibrinogen concentrate?

141
Q

Interpret this ROTEM

A

Fibrinogen deficiency or fibrinogen polyermisation disorder1. EXTEM and APTEM are normal with only slight reduction in amplitude2. FIBTEM has clearly low amplitude3. APTEM is equal to EXTEM and neither exhibit any signs of clot lysis (so not hyperfibrinolysis)

142
Q

Fibrinogen deficiency or fibrinogen polyermisation disorder1. EXTEM and APTEM are normal with only slight reduction in amplitude2. FIBTEM has clearly low amplitude3. APTEM is equal to EXTEM and neither exhibit any signs of clot lysis (so not hyperfibrinolysis)

A

Interpret this ROTEM

143
Q

Interpret this ROTEM

A

Heparin effect- all parameters of the EXTEM are normal- the INTEM shows an extended CT value and slight reduction in amplitude- FIBTEM is normal- HEPTEM is improved in comparison to the INTEM test (due to heparinase in HEPTEM)

144
Q

Heparin effect- all parameters of the EXTEM are normal- the INTEM shows an extended CT value and slight reduction in amplitude- FIBTEM is normal- HEPTEM is improved in comparison to the INTEM test (due to heparinase in HEPTEM)

A

Interpret this ROTEM

145
Q

Interpret this ROTEM

A

Hyperfibrinolysis- EXTEM and INTEM both have normal CT values (so no def. in coag factors or heparin influence) BUT there is clear evidence of clot degredation- FIBTEM also shows a clot degredation and a borderline amplitude- APTEM is normal

146
Q

Hyperfibrinolysis- EXTEM and INTEM both have normal CT values (so no def. in coag factors or heparin influence) BUT there is clear evidence of clot degredation- FIBTEM also shows a clot degredation and a borderline amplitude- APTEM is normal

A

Interpret this ROTEM

147
Q

Interpret this ROTEM

A

Low platelet count- EXTEM and INTEM both show normal CT values (so no def. in coag factors or heparin influence), but there is reduce amplitude (decrease in PLT and fibrinogen)- FIBTEM amplitude is normal (so low PLT not low fibrinogen)- APTEM = EXTEM and there is no signs of clot lysis (so not not hyperfibrinolysis)

148
Q

Low platelet count- EXTEM and INTEM both show normal CT values (so no def. in coag factors or heparin influence), but there is reduce amplitude (decrease in PLT and fibrinogen)- FIBTEM amplitude is normal (so low PLT not low fibrinogen)- APTEM = EXTEM and there is no signs of clot lysis (so not not hyperfibrinolysis)

A

Interpret this ROTEM

149
Q

A CT time > 80 sec in an EXTEM indicates what?

A

A deficiency in Vit K dependent factors

150
Q

A deficiency in Vit K dependent factors

A

A CT time > 80 sec in an EXTEM indicates what?

151
Q

What does a proloned CT in the INTEM and HEPTEM test indicate?

A

A deficiency in the enzymatic clotting factors of the intrinsic pathway and/or the final common pathway of coagulation

152
Q

A deficiency in the enzymatic clotting factors of the intrinsic pathway and/or the final common pathway of coagulation

A

What does a proloned CT in the INTEM and HEPTEM test indicate?

153
Q

What does the MCF indicte?

A

The maximal clot firmness indicates the mechanical stability and overall quality of the clot

154
Q

The maximal clot firmness indicates the mechanical stability and overall quality of the clot

A

What does the MCF indicte?

155
Q

What is the A10?

A

an opportunity to estimate the MCF at an eariler stage to begin a targeted therapeutic interventionMCF
= A10 (for EXTEM, INTEM ATEM) + 10mm
or
= A10 (FIBTEM) + 3mm

156
Q

an opportunity to estimate the MCF at an eariler stage to begin a targeted therapeutic interventionMCF
= A10 (for EXTEM, INTEM ATEM) + 10mm
or
= A10 (FIBTEM) + 3mm

A

What is the A10?

FACEM (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions