The Bleeding Trauma Pt + TIC Flashcards
(24 cards)
Trauma induced coagulopathy
Acute traumatic coagulopathy + resuscitation coagulopathy
How are clotting factors effected in trauma
Dilution - massive transfusion and iv fluid replacement
Loss - bleeding or consumption of clotting factors
Dysfunction - hypothermia and acidosis
What percentage of trauma patients are cagulopathic on arrival to ed
24%
Clotting factors involved in intrinsic, extrinsic, and common pathways
Intrinsic - 12, 11, 9, 8
Extrinsic - 7
Common - 10, 2, 1, 13
Action of factor 10
Activates prothrombin (factor 2) to thrombin
Thrombin then activates fibrinogen (factor 1) to fibrin
What causes TIC
Trauma -> incr thrombin, decr fibrinogen, fibrinolysis -> ATC
Shock -> fibrinolysis, platelet dysfunction -> ATC
Trauma, shock -> incr activated protein C
Resuscitation -> haemodilution, acidaemia, hypothermia
ATC + Resuscitation related + protein C -> TIC
What factor has the greatest influence on increased fibrinogen breakdown rate
Acidosis
What lab tests is TIC defined based on
PT (>16/18s)
INR (>1.5)
PTT (>1.5xnormal/>60s)
Platelets (<100/80/50)
What device can be used to POC Prothrombin time
Coaguchek
ITACTIC
Implementing Treatment Algorithms for the Correction of Trauma Induced Coagulopathy
Viscoelastic haemostatic assay
What may be given to a patient with TIC
Fibrinogen - 4g equivalent (as cryoprecipitate or concentrate)
Platelets - 1 additional pool
Plasma - 4 additional units
TXA - additional 1g IV bolus
How does hyperfibrinolysis appear on viscoelastic assay
Horizontally squashed
CRASH 2
Effect of TXA in haemorrhage
Significantly reduced risk of death due to bleeding and all cause death with TXA
When should TXA be given
Within 60 mins
CRASH 3
Effect of TXA in acute TBI
No sig difference in head injury related death in 28 days or neuro recovery compared to placebo
TXA use for code red
1g prehospital bolus (within 1 hr of injury)
1g in hospital bolus
TXA use for TBI
Head injury GCS </=12 / ICH on CT / HEMS intubated head injury
2g bolus
What did COMBAT show
No benefit of prehospital plasma
What did CRYOSTAT 2 investigate
Effect of early cryoprecipitate administration on mortality in major trauma haemorrhage
No difference
FINTIC
Fibrinogen in TIC
CHIPS
CHIlled Platelet Study
Disadvantages of whole blood
Coagulation factor loss (V and VIII)
Cold platelets
Effects of bleeding in first mins to hours
Hypocoagulation
Bleeding
ATC/TIC
Effects of haemorrhage hours-days after injury
Hypercoagulation
Fibrin deposition
Immunosuppression
Cardiac dysfunction
MODS
