Disclosure(s): No financial relationships to disclose
Disclosure(s):
Andrew Philips, FAAEM: No financial relationships to disclose
When you have given 2 MTPs but the bleeding won't stop, and you can't keep up with the blood pressure, often the cause is as much "medical" bleeding as "surgical." It's iatrogenic coagulopathy.
1:1:1 and cryoprecipitate here and there isn't good enough in the setting of modern laboratory methods for assessing coagulopathy. Whether the patient has liver disease, is a trauma status post 2 MTPs, a GIB status post 1 MTP, or any other need for massive blood resuscitation, we will cover the tools you have to improve your resuscitation.
We will discuss how to take PT, PTT, DDimer, and Fibrinogen findings en bloc to determine what product is needed most urgently. We will also discuss TEG (which your hospital probably has hidden away in the OR but can serve you well!) and its role in urgently guiding active resuscitation.
After this course you will no longer be blindly adding product but rather directing specific blood products for specific needs to resolve iatrogenic coagulopathy.
Learning Objectives:
Explain and apply the different parameters measured by PT, PTT, fibrinogen, and Ddimer to target specific causes of coagulopathy in the setting of massive blood transfusion resuscitation.
Understand thromboelastography (TEG) and use cases to demonstrate ability to apply its understanding to resolving iatrogenic coagulopathy.
