TEG Nonsense Flashcards
What does the TEG-ACT rapid measure, and what is the normal range?
Activated clotting time to initial fibrin formation. 80 - 140 sec
What does R-time measure? Range?
Reaction time to initial fibrin formation. 5 - 10 min
What does K-time measure? Range?
Kinetic time for fibrin cross linkages to reach 20 mm clot strength (simple version, measures clot strength and fibrinogen/number of platelets). 1 - 3 min
What does alpha angle measure? Range?
Angle from baseline to slope of tracing that represent clot formation (gives insight to fibrinogen and number of platelets). 53 to 72 degrees
What does MA measure? Range?
Maximum amplitude of tracing which indicates platelet number/function, 50 - 70 mm
What does G value measure? Range?
Calculated value of clot strength (gives insight to the entire coagulation cascade) 5.3 - 12.4 dynes/cm2
What does LY30 measure? Range?
Clot lysis at 30 minutes following MA (measure of fibrinolysis), 0 - 3%
What is the treatment for a high TEG-ACT? Include the lab value
Greater than 140, give FFP
What is the treatment for a high R time? Include the lab value
Greater than 10, give FFP (most common choice) or give a PCC (pro-thrombin complex)
What is the treatment for a high K time? Include the lab value
Greater than 3, give Cryo
What is the treatment for a low alpha angle? Include the lab value
Less than 53 degrees, Cryo and platelets
What is the treatment for a low MA? Include the lab value
Less than 50, give platelets
Identify the TEG tracing
Normal
Identify the TEG tracing
Heparin or warfarin
Identify the TEG tracing
Qualitative or quantitative platelet dysfunction (looks similar to DIC with platelet coagulation/factor depletion, take note that the R time is NOT exaggerated here whereas in that stage of DIC it is elongated)
Identify the TEG tracing
Hyperfibrinolysis
Identify the TEG tracing
Hypercoagulable state
Identify the TEG tracing
DIC with intravascular thrombosis with secondary hyperfibrinolysis
Identify the TEG tracing
DIC with platelet coagulation and factor depletion
What is the dose of DDAVP?
0.3 mcg/kg in 50 mL given over 15-20 minutes. Maximal effect in 30 minutes, lasts 6-8 hours. Tachyphylaxis is a concern.
What must be done after administration of DDAVP?
Water restriction; very easy for patient to become hyponatremic and progress to seizure/coma/death
What would you give to a vWF deficient patient not responding to DDAVP? What would you give if your hospital is rich?
Cryo with normal hospitals. Factor VIII concentrate if your hospital can also afford gold toilet seats
If MA is low, what would you give if FF (functional fibrinogen) is low? FF is normal?
FF low = Cryo
FF normal = give platelets
