What does a TEG do? A 🧵
Several blood tests are used to assess clinical diagnosis of coagulopathies: PT, INR, APTT, platelet count, activated clotting time, bleeding time. Specific clotting factors can also be measured: Factor V, protein C and S, anti-thrombin III, anticardiolipin antibodies.
These tests are all very specific and useful in certain clinical scenarios (anticoagulation monitoring, investigation of unprovoked PE, for example), but they usually have a long turnaround time and rarely measure platelet function and the activity of the clotting cascade.
Thromboelastography (TEG) was developed and first described by Dr. Hellmut Hartert in 1948, in Germany. #chestcritcare @accpchest

TEG measures the ability of whole blood to form a clot, by detecting and quantifying dynamic changes of its viscoelastic properties under low shear stress.
#chestcritcare @accpchest
Reaction time (R) is the time to the 1st detectable clot formation, depends on the concentration and function of the coagulation factors;
#chestcritcare @accpchest
Kinetics (K) time from the beginning of clot formation to a clot w/ a certain level of strength, depends on the concentration of fibrinogen and its activation; alpha angle is the imaginary line from the time of clotting initiation to the max clot formation speed.
The alfa angle depends on fibrinogen concentration and to a lesser extend on platelets. Maximum amplitude (MA) is the maximal amplitude of the curve and reflects the maximal strength of the clot, depends on plt number, clotting factors interactions and fibrin cross-linking
Lysis at 30 minutes (LY30) is the percentage of the amplitude reduction 30 min after reaching max amplitude, depends on the presence of plasmin, plasminogen and its activation.
#chestcritcare @accpchest
So when should a TEG be used? There is enough evidence for its use in cardiac surgery, improving patients' outcomes by decreasing blood product transfusion and the need for re-exploration #chestcritcare @accpchest
There is conflicting evidence for its use in bleeding from trauma. There is not enough data to favor the use of TEG over PT/INR in the diagnosis of traume-induced coagulopathy. @accpchest #chestcritcare
In major trauma, TEG is better in predicting the need for transfusion of FFP, RBCs, and platelets compared to conventional coagulation tests of PT, aPTT, INR, platelet count, and fibrinogen
@accpchest #chestcritcare
In ECMO patients, a small RCT showed that TEG was better at guiding anticoagulation compared to APTT, reducing the dose of heparin used.
@accpchest #chestcritcare
TEG has been found to be helpful in detecting intraoperative coagulopathy in liver transplant.
#chestcritcare @accpchest
The use of TEG to guide blood products transfusion in critically ill patients outside of major trauma, cardiac surgery and liver Tx population still lacks evidence.
@accpchest #chestcritcare

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with CHEST Critical Care NetWork

CHEST Critical Care NetWork Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @CHESTCritCare

21 Oct 20
Get your popcorn ready because this is going to be quite the learning contest. #CHEST2020

The webinar is LIVE in T - 5mins, speakers are checking their 🎤🎤

We are only a tiny bit biased towards our co-chair @GallodeMoraesMD!
Dr. Mathews: Starts with sharing what drives ventilation-induced lung injury. This is "leak" is likely more pronounced in #COVID19

Dr. Mathews: ARMA supported LTVV in ARDS with significantly improved mortality. LTVV has been since found to be beneficial in non ARDS situations. #CHEST2020
Read 26 tweets
21 Oct 20
Join us now to learn about Sepsis Antibiotics and Fluids!

Moderated by our co-chair @virenkaul

Up first is Dr. Angel Coz

Decrease in expected mortality with introduction of sepsis protocol.

Why broad spectrum antibiotics?? This means:

- not the same for every patient
- based on patient history and source
- based on institutional resistances

Read 30 tweets
21 Oct 20
Coagulopathy on COVID-19 is about to start! @accpchest #CHEST2020 #CHESTCritCare
Comparison of VTE in other diseases in the ICU #CHEST2020 #CHESTCritCare
And comparison of COVID-19 VTE and historical ICU co-horts. Thrombosis in COVID higher in well matched ARDS patients and also higher than in patients with flu. @accpchest #CHEST2020 #CHESTCritCare
Read 11 tweets
20 Oct 20
@GallodeMoraesMD will be live tweeting the #PICS talk @accp #CHESTCritCare
@crit_caring_MD @GioraNetzer @itsradu @ICU_Recovery are talking about #PICS now!
At 12 months only 44% of ICU survivors are PICS-free, being cognitive a significative part of the post-ICU impairment. With more ICU survivors, we will likely be seeing more PICS. #CHEST2020 #CHESTCritCare
The lack of visitors in the COVID-19 era, will likely contribute to higher number of survivors with PICS #CHEST2020 #CHESTCritCare
Read 11 tweets
19 Oct 20
Starting soon, Sepsis: Most Recent Advances

#CHESTCritCare is going to be Tweeting hightlights live by @crit_caring_MD

Up first, Dr. Matthew Churpek discussing machine learning and big data.

Trade off between high sensitivity and high specificity depending on if you use SIRS vs. qSOFA.

NEWS and MEWS much more acute tools for predicting mortality.

Read 21 tweets
19 Oct 20
First up: Props to #CHEST2020 learning partners for that amazing wait music. Ne'er been a fan of wait music. But this is ... well .. peppy. Am in the mood to learn about #AirwayManagement!

Speakers: @Chaeface @J_Mendelson_MD @KDoerschug

Coverage: @virenkaul

.@J_Mendelson_MD: HFNC and proning in severe hypoxic resp failure:

- Can reduce dead space ventilation, assist with WOB, improved resp mechanics
- Pre-COVID data: Can be successful in potentially preventing invasive ventilation vs NIV and low flow O2

#CHEST2020 #CHESTCritCare Image
.@Chaeface: Pre-oxygenation modifications to reduce aerosolization

Use V-E technique vs C-E technique for rescue BMV. Improved efficacy for ventilation and better seal. (Lower picture): bit.ly/2H5aY7a

#CHEST2020 #COVID19 Image
Read 9 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!