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Thromboelastography
Aka: Thromboelastography, Viscoelastic Assay, Rotational Thromboelastography, ROTEM, TEG, Viscoelastic Substances, Thromboelastography Panel
- Indications
- Massive Hemorrhage related transfusions
- May assist in determining ratio of Red Blood Cell Transfusions to Fresh Frozen Plasma and Platelet Transfusion
- Mechanism
- Whole blood assay of a blood's ability to clot based on viscoelastic blood properties
- As blood clot forms, analyzer detects resistance over time
- Analyzer plots measurized resistance over time in form of a graph
- Typically graph is plotted over a 20-30 minute period until maximal clot firmness
- Interpretation
- Abnormal Clotting Time
- In early trauma Coagulopathy, often related to plasma related deficiencies
- In later trauma Coagulopathy, Fibrinogen deficiency may be treated with Cryoprecipitate or Fibrinogen
- Poor maximal clot firmness (poor maximal amplitude)
- Consider Platelet Transfusion
- Hyperfibrinolysis
- Typically assumed as a part of early trauma Coagulopathy, and Tranexamic Acid is given empirically
- May appear as abnormal clot breakdown over time (typically subtle in graph)
- Labs: Bedside Viscoelastic Assay
- Thromboelastography (TEG)
- Rotational Thromboelastography (ROTEM)
- Resources
- Shaydakov, Sigmon, Blebea (2019) Stat Pearls
- https://www.ncbi.nlm.nih.gov/books/NBK537061/
- References
- Swaminathan and Hicks in Herbert (2020) EM:Rap 20(7): 1-2