ICU Flashcards
what is rotem
rotational thromboelastometry
(TEG)
Thromboelastography (TEG)
basics of normal clotting
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
what represents thrombin?
ct on Rotoem
r on TEG
treatment is FFP
what represents clot propgation time
CFT or A10 on rotem
K on TEG
treatment is platelets or cryo
what is cloth strength
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
what is a normal clotting time (CT)?
<80 seconds
why does aspirin/plavix/xarelto not show up on rotem?
rotem analysing is fibrinogen and gpIIbIIIa on platelets, however aspirin and plavix act on different receptors
Two major rotem families
Intem (bottom on rpa printout)
1.intem
2heptem
extem
1. extem
2 fibtem
3. aptem
how to tell if someone on heparin?
look at heptem which has heparinase which breaks up heparin
if it goes to normal then you know its heparin causing the issue
if you get extem and it looks like a sideways tear
too much clot lysis
below is different video
https://www.youtube.com/watch?v=OgH35WKpYy8
inr measures
extrinsic
Remember inr is just normalized PT (Prothrombin time (PT))
aptt measures
Activated Partial Thromboplastin Clotting Time
intrinsic pathway
one of the modified base tests is fibtem which measures
it is extrinsically activated but it excludes platelets activation so it just measures fibrin activation
indirectly fibrinogen availability
heptem is
heptem is a modification of the intrinsic pathway and adds heparinase which removes heparin from sample
fibtem is
addds cytochalasin D to inhibit platelet contribution
The CFT represents the rates of
fibrin polymerization or rate of clot formation
2-20 mm
terms to describe clots
firm and stable
unstable or unstainable
weak or fragile
example
ddx for normal intem, extem, fibtem for a dropping hb
possible surgical bleeding
examlpe
prlonged intem aka prolonged CT
normal extem and fibtem
heptem is normal
heparin effect
example
prolongeod CFT and lower A10 intem and extem
fibtem adequate fibrem contribuation
suggestion platlets are needed
example
prolongeod CFT and lower A10 intem and extem
fibtem inadequate
suggestion cryo are needed
what is CT
onset of clotting time
deomstrates onset of clot formation
what is CFT
clot formation time
alpha angle
tangent to the clotting curve from 2mm (degrees)
provides an overall pictures of hypercoaguable or hypocoaguable picture
A10, A20
amplitude 10, 20 minutes after CT
MCF
maximum clot firmness (mm)
LI30
Lysis index (% of clot remaining 30 minutes after CT)
ML
maximum lysis (% of lysis at any time)
which are the most important?
CT
A10
and ML
