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Thromboelastography TEG is coming to an emergency department near you. For those who rotated at Shock, TEG is utilized to guide administration of blood products during massive transfusion protocol in a bleeding patient. INR and aPTT only measure the enzymatic clotting time, which means they only measure clotting cascade up until fibrin.

Utilizing these tests, it is impossible to know the causes s of coagulopathy in intracranial hemorrhage or GI bl er the last https://booksarchive.ru/pro/kombayn-beper-90470a-90470b-90470v.html the took their meds.

TEG is a whole blood test and assays AVAST Business Pro Plus - managed 24 months (цена за 1 лиц.

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при покупке 200 лиц.) formation, mechanical strength and stability across time. This allows AVAST Business Pro Plus - managed 24 months (цена за 1 лиц. при покупке 200 лиц.) of the curve to determine the cause of coagulopathy.

Old TEG machines AVAST Business Pro Plus - managed 24 months (цена за 1 лиц. при покупке 200 лиц.) the mechanical elasticity and strength of the clot by physically interacting with whole blood.

The TEG output across time is measured in maximum amplitude, which is a function of dynes of force generated by the elastic clot. This an example of what a TEG curve looks like Trepani, et al. Reaction Time R is the time to activation, ending in thrombin. Theoretically any deficiency can cause prolonged R time eg thrombophiliabut in the setting of trauma, it is most commonly associated with thrombin deficiency.

R will also be long with anticoagulation. Clot Kinetics K is dependent on fibrinogen AVAST Business Pro Plus - managed 24 months (цена за 1 лиц.

при покупке 200 лиц.) and fibrin cross linking. Maximum amplitude MA in mm or G dynes represents clot strength at its peak. The lower the amplitude, the lower the platelet function.

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Here is a diagram with each of the variables as they relate to the coagulation cascade. Abnormalities in these values suggest the possible cause of their coagulopathy:.

Previous machines analyzed the thromboelastic properties of the clot across time using physical forces.

This new generation of machine sends sound waves through 4 channels and measures motion of the sample optically across the clotting time. All 4 tests occur simultaneously in the microfluidic test cartridges.

A 5th channel assays platelet читать больше, which we may or may not use.

Kaolin TEG: kaolin is used as an initiation of coagulation cascade. This is channel gives you the classic TEG graph.

R will be dramatically shortened because the coagulation cascade is activated faster in this channel. Functional Fibrinogen : AVAST Business Pro Plus - managed 24 months (цена за 1 лиц.

при покупке 200 лиц.) specific assay determines whether fibrinogen should be repleted. The 4 channel readout will come off the machine as below. We do not have to take a super deep dive into the physics.

Rather, as Emergency Medicine providers, we should focus on pattern recognition. Theoretically, in early DIC or other hypercoagulable states, the tracing will show that the clot does not lyse. Therefore, heparin may be indicated. Dosing of heparin can be titrated to normalization of the TEG curve, but this is case report level at the moment and the literature is sparse.

We have more than a few patients in DIC progressing https://booksarchive.ru/pro/videokarta-his-radeon-x700-pro-425mhz-agp-256mb-860mhz-128-bit-dvi-tv-yprpb.html hypercoagulable to hypocoagulable as all of their factors and platelets are consumed.

Imagine a patient on dual anti-platelet and anti-factor-Xa agent who presents with a GI bleed but did not take his or her medicine in 2 days.

In this particular patient reversal of antiplatelet, transfusion, of 4-factor PCC administration may make them dangerously hypercoagualable. Finally, TEG is only an in vitro assay and it does not take into account host factors such as anatomic адрес, endothelial damage, etc.

No test is perfect, but hopefully this will be a tool to better guide interventions we make on bleeding or clotting patients.

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Anzoletti, M. Plos One, 10 8e Gill, M. The Journal of Extra-Corporeal Technology, 49 126— Stammers, A. Coagulation monitoring during extracorporeal membrane oxygenation: the role of thrombelastography.

J Extra Corpor Technol, 27 3— Trapani, L.

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