TEG article Flashcards
What is a major cause of preventable death in trauma patients?
uncontrolled coagulopathic hemorrhage
What are the 3 phases of hemorrhagic shock due to coagulopathy?
- Compensated shock
- uncompensated but reversible
- irreversible hemorrhagic shock
- once this phase is entered, fluid replacement or inotropic agents will not improve BP, tissue oxygenation or perfusion
- goal of resuscitative care is to delay or prevent transition to irreversible hemorrhagic shock
What are factors that contribute to coagulopathy in trauma patients?
- blood loss
- hemodilution by physiologi vascular refill
- consumption of platelets
- hypothermic plt dysfunction
- reduction enzyme activity
- acidosis-induced reduction in coag factor activity
- unopposed fibrinolysis
What is a teg?
- real-time viscoelastic assay
- measures strength of fibrin-plt bonds in whole blood
- result of this process is functional hemostatic plug
- 0.36mL of whole blood placed in cup and heated to 37 degrees
- cup rotated back and forth at constant set speed, through and arc
- sluggish flow mimics venous circulation and activates coag process
- pin attached to torsion wire inserted into cup
- speed and strength of clot formation converted to mechanical-electrical transducer and electrical signal is analyzed by computer
- converted to numeric values
What is the R value?
Normal?
Intervention if low or high?
start of clot or fibrin formation
- Normal 7.5-15 minutes
- If prolonged (>15 min)- deficiency in coag factors, effect of endogenous heparin release during trauma, and/or hemodilution
- TXMT- FFP
-
If shortened (less than 3 mintes)
- state of hypercoagulability
- treatment with anticoag of choice may be beneficial
- state of hypercoagulability
What is the K value?
Normal?
Interventions?
fibrin kinetics or speed of clot formation
- Normal= 3-6 minutes
- low vlaue= fibrinogen administration needed
- High value= hypercoagulability
What is the maximum amplitude?
Normal?
Treatment?
Width of tracing representing clot strength
- Normal 50-60mm
- Low value= hypofibrinogenemia, decreased PLT function or quality
- TXMT- PLT transfusion
- High value (>75)= prothrombotic state, need anticoagulant)
What values to you expect to see on TEG when hemodiluation is present?
Treatment?
- R value= high
- K and alpha= normal
- MA= normal
- Treatment= no treatment necessary
What do you expect to see on TEG when you have factor deficiency? Treatment?
- R value= high
- K and alpha= low or normal
- MA= low or normal
- Treatment= FFP
What do you expect to see on TEG with fibrinogen deficiency?
- R time= normal
- K and alpha= low
- MA= low or normal
- Treatment= cryoprecipitate
What do you expect to see on TEG when PLT low or dysfunctional?
Treatment?
- R time= normal
- K and alpha= normal
- MA= low
- Treatment= platelets
What do you expect to see on TEG with primary fibrinolysis?
- R value= normal
- K and alpha= normal
- MA= low
- Treatment= antifibrinolytics, TXA, Aproptinin
What do you expect to see on TEG in DIC stage 1 and 2?
DIC stage 1= hypercoagulability with fibrinolysis
- R time= low
- K and alpha= high
- MA= high
- treatment= Treat DIC
DIC Stage 2= hypocoaguability after consumption
- R time= high
- k and alpha= low
- MA= low
- treatment- treat DIC
Why isnt’ PT/INR sufficent?
Only covers factor VII and III (extrinsic pathway) only accounts for 3% of clot strength
doesn’t account for platelets role in clot strength
What does a aPTT assay assess?
- Intrinsic pathway
- factors XII, XI, IX, VII
- 3 natural anticoagulant proteins C, S, Z
- 10% of overall clot strength
