ICU

Question 1

what is rotem

Answer 1

rotational thromboelastometry

Question 2

(TEG)

Answer 2

Thromboelastography (TEG)

Question 3

basics of normal clotting

Answer 3

when you get a cut, first thing is platelet plug
then clotting cascade to convert fibrinogen to fibrin which forms mesh

note; but for rotem, the first thing is clotting time which presents pt and appt

Question 4

what represents thrombin?

Answer 4

ct on Rotoem

r on TEG

treatment is FFP

Question 5

what represents clot propgation time

Answer 5

CFT or A10 on rotem

K on TEG

treatment is platelets or cryo

Question 6

what is cloth strength

Answer 6

MCF (max clot firmness) on rotem

or MA on TEG

note; he recommended platlets but I think it could be cryo too
note if its fibtem its cryo, if its extem At10 it could be either plaetles or fibtem

Question 7

what is a normal clotting time (CT)?

Answer 7

<80 seconds

Question 8

why does aspirin/plavix/xarelto not show up on rotem?

Answer 8

rotem analysing is fibrinogen and gpIIbIIIa on platelets, however aspirin and plavix act on different receptors

Question 9

Two major rotem families

Answer 9

Intem (bottom on rpa printout)
1.intem
2heptem

extem
1. extem
2 fibtem
3. aptem

Question 10

how to tell if someone on heparin?

Answer 10

look at heptem which has heparinase which breaks up heparin
if it goes to normal then you know its heparin causing the issue

Question 11

if you get extem and it looks like a sideways tear

Answer 11

too much clot lysis

Question 12

below is different video

https://www.youtube.com/watch?v=OgH35WKpYy8

Question 13

inr measures

Answer 13

extrinsic
Remember inr is just normalized PT (Prothrombin time (PT))

Question 14

aptt measures

Answer 14

Activated Partial Thromboplastin Clotting Time
intrinsic pathway

Question 15

one of the modified base tests is fibtem which measures

Answer 15

it is extrinsically activated but it excludes platelets activation so it just measures fibrin activation

indirectly fibrinogen availability

Question 16

heptem is

Answer 16

heptem is a modification of the intrinsic pathway and adds heparinase which removes heparin from sample

Question 17

fibtem is

Answer 17

addds cytochalasin D to inhibit platelet contribution

Question 18

The CFT represents the rates of

Answer 18

fibrin polymerization or rate of clot formation

2-20 mm

Question 19

terms to describe clots

Answer 19

firm and stable

unstable or unstainable

weak or fragile

Question 20

example

ddx for normal intem, extem, fibtem for a dropping hb

Answer 20

possible surgical bleeding

Question 21

examlpe

prlonged intem aka prolonged CT
normal extem and fibtem

heptem is normal

Answer 21

heparin effect

Question 22

example

prolongeod CFT and lower A10 intem and extem
fibtem adequate fibrem contribuation

Answer 22

suggestion platlets are needed

Question 23

example

prolongeod CFT and lower A10 intem and extem
fibtem inadequate

Answer 23

suggestion cryo are needed

Question 24

what is CT

Answer 24

onset of clotting time
deomstrates onset of clot formation

Question 25

what is CFT

Answer 25

clot formation time

Question 26

alpha angle

Answer 26

tangent to the clotting curve from 2mm (degrees)

provides an overall pictures of hypercoaguable or hypocoaguable picture

Question 27

A10, A20

Answer 27

amplitude 10, 20 minutes after CT

Question 28

MCF

Answer 28

maximum clot firmness (mm)

Question 29

LI30

Answer 29

Lysis index (% of clot remaining 30 minutes after CT)

Question 30

ML

Answer 30

maximum lysis (% of lysis at any time)

Question 31

which are the most important?

Answer 31

CT
A10
and ML