Week 12 Handout-Flipped 3 - part 3 Flashcards
What is thromboelastography (TEG)?
A visual representation of clot formation, strength, and fibrinolysis in real-time.
What does TEG evaluate compared to standard tests?
TEG evaluates the interaction of all components including platelets, fibrinogen, and clot stability.
What is the clinical purpose of TEG?
To guide patient-specific treatment decisions and coagulation therapy.
How does TEG help in transfusion therapy?
Reduces unnecessary blood product transfusions.
What is the normal range for R TIME in TEG?
4 to 8 minutes.
What does K TIME measure in TEG?
Time until clot has achieved fixed strength.
What is the normal range for K TIME?
1 to 4 minutes.
What does A-ANGLE indicate in TEG?
Speed of fibrin accumulation.
What is the normal range for A-ANGLE?
53 to 72 degrees.
What does MAXIMUM AMPLITUDE (MA) measure?
Clot strength (platelet specific).
What is the normal range for MAXIMUM AMPLITUDE (MA)?
50-70 mm.
What does LYSIS AT 30 MINUTES (LY30) measure?
Percentage decrease in clot strength after 30 minutes.
What is the normal range for LYSIS AT 30 MINUTES (LY30)?
0 to 8%.
What are possible TEG findings in trauma patients?
- Prolonged R time * Prolonged K time * Low MA * Elevated LY30.
What management strategies might be used for prolonged R time?
FFP (fresh frozen plasma).
What is the focus of Phase 1 resuscitation in trauma?
Early and aggressive use of hemostatic products in combination with RBCs.
What does TEG help differentiate in cardiac surgery?
Bleeding resulting from surgical causes versus CPB induced coagulopathies.
What is a typical TEG finding in obstetrics?
Decrease in R and K values, increase in the α angle and MA, decrease in LY30.
What is a major risk associated with postpartum uterine atony?
It is the leading cause of maternal death worldwide.
What does TEG indicate in liver disease management?
It estimates bleeding risk more accurately than standard tests.
What are possible TEG findings in liver transplantation?
- Preanhepatic: Near normal results * Anhepatic: Increased fibrinolysis * Neohepatic: Severe fibrinolysis after reperfusion.
What are some risks and limitations of TEG?
- Device variability * Lack of specificity * Costly * Delay in treatment.
What is the normal range for Alpha Angle?
47-74 degrees.
What does a prolonged R time indicate?
Hypocoagulability (delayed clot formation).
What does a low MA indicate?
Hypocoagulability (platelet dysfunction or deficiency).
What does a LY30 above normal indicate?
Hyperfibrinolysis (excessive breakdown, risk of hemorrhage).
What is the title of the book authored by R. and Holt?
Clinical anesthesia (8th ed.)
Who are the authors of ‘Chestnut’s obstetric anesthesia: Principles and practice’?
Chesnut, D. H., Wong, C. A., Tsen, L. C., Ngan Kee, W. D., Beilin, Y., Mhyre, J. M., Bateman, B. T., & Nathan, N.
What edition of ‘Miller’s anesthesia’ was published in 2020?
9th ed., Vols. 1–2
What is the name of the hemostasis analyzer system mentioned?
TEG® 5000 hemostasis analyzer system
In what year was the user manual for TEG® 5000 published?
2007
What is the title of the book by Nagelhout, Elisha, & Heiner?
Nurse Anesthesia (7th ed.)
Fill in the blank: The user manual for TEG® 5000 was published by _______.
Haemoscope Corporation
True or False: ‘Chestnut’s obstetric anesthesia’ is in its 5th edition.
False
Who are the editors of ‘Miller’s anesthesia’?
Gropper, M. A., Eriksson, L. I., Fleisher, L. A., Wiener-Kronish, J. P., Cohen, N. H., & Leslie, K.
What is a 12 lead EKG?
A diagnostic tool that records electrical activity of the heart from 12 different perspectives.
What are the benefits of using a 12 lead EKG?
- Rapid
- Non-invasive
- Ease of use
In what situations is a 12 lead EKG used?
- Suspected heart disease
- Preoperative cardiac screening
- Electrolyte imbalance assessment
- Monitoring cardiac medication effects
- Identify arrhythmias
- Detect myocardial ischemia or infarction
- Assess conduction defects
- Evaluate electrolyte imbalances
What are common arrhythmias identified by a 12 lead EKG?
- A-fib
- V-tach
- Heart blocks
What are the limitations of EKG interpretation?
- Poor electrode placement
- Artifact from movement
- Non-MI cause of abnormal readings
What is the first step in EKG interpretation?
Determine the rate.
What should be assessed in the QRS complex during EKG interpretation?
Assess QRS duration.
What is the significance of chest leads V3-V5?
They are most sensitive for detecting ischemia.
What are the normal cardiac axis ranges?
Normal Axis: -30° to +90°
What is Left Axis Deviation (LAD)?
More negative than -30°.
What is Right Axis Deviation (RAD)?
More positive than +90°.
What characterizes a normal EKG?
- P waves before each QRS
- PR interval 0.12-0.20 sec
- QRS duration < 0.12 sec
- ST segment is isoelectric
What is a characteristic of ST elevation on an EKG?
Indicates STEMI.
What indicates NSTEMI on an EKG?
ST depression and/or T wave inversion.
What are the inferior leads in a 12 lead EKG?
II, III, aVF.
What are the lateral leads in a 12 lead EKG?
I, aVL, V5, V6.
What are the anterior leads in a 12 lead EKG?
V3, V4.
What are the septal leads in a 12 lead EKG?
V1, V2.
What is coronary steal?
A phenomenon where blood flow is diverted away from ischemic tissue.
Do volatile anesthetics have cardiac effects?
Yes, they can affect cardiac function.
What is the PR interval range in a normal EKG?
0.12-0.20 seconds.
Fill in the blank: The EKG leads V3-V5 are most sensitive for detecting _______.
ischemia
True or False: The EKG is predictive of perioperative major cardiac events.
False
