But the INR is 3.2! Markers of Coagulation Status in Cirrhotics

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But the INR is 3.2! Markers of Coagulation Status in Cirrhotics

In patients with cirrhosis and ongoing bleeding, it can be challenging to determine whether or not patients are hyper or hypocoagulable. Traditional markers of coagulation status like INR can be difficult to interpret in patients with abnormal synthetic function and potentially increase consumption of coagulation factors. Can TEG (thromboelastography) be a helpful too in these situations? In this journal club recap, Dr. Grisoli recaps a recent article by Rout et al that addresses this issue.

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Grand Rounds Recap 9.1.21

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Grand Rounds Recap 9.1.21

Another excellent week of Grand Rounds reflection and learning. Check out the recap here as Dr. Curry shares insights from his work with OH-TF1 on the Surfside Building Collapse, Drs. Kein and Stark provide evidence-based recommendations for management of NSTEMI patients, Dr. Hunt discusses a case of basilar stroke in a patient with SLE, Dr. Milligan challenges Dr. Benoit with a pediatric acute urinary retention case, and Drs. Goff, Ramsey, and Zalesky provide quick hit wisdom in the “There will be blood” edition of the R3 small groups.

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Grand Rounds Recap 8.11.21

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Grand Rounds Recap 8.11.21

Another awesome week of Grand Rounds! If you couldn’t catch it live check out the summary here! Dr. Haffner discusses mesenteric ischemia, Dr. Roblee addresses dealing with patient deaths, Dr. Thompson gives us insight into quality improvement, Dr. Goodman reviews product resuscitation in trauma patients, and Dr. Ketabchi, one of our esteemed PEM fellows, takes us through neonatal sepsis.

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Hypocalcemia in Trauma

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Hypocalcemia in Trauma

We are all familiar with the “lethal triad” of trauma – coagulopathy, hypothermia, and acidosis.  We have multiple methods wherein we attempt to prevent or reverse these physiologic derangements.  In particular, in recent years many teams have focused heavily on limited crystalloid infusions, increasing our early blood product transfusion (especially plasma), and early administration of tranexamic acid.

One of the main reasons we focus on these interventions is to address trauma-induced coagulopathy.  Trauma-induced coagulopathy has a multifactorial etiology and is contributed to by the other corners of the triad (hypothermia and acidosis).  However, one of the least appreciated contributing factors are electrolyte deficiencies, in particular calcium.

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

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Air Care Series: Ideal Resuscitation Pressure in Polytrauma with TBI

Damage Control Resuscitation, Permissive Hypotension, Fluid Restrictive Resuscitation… Regardless of name, with all the enthusiasm surrounding permissive hypotension in the actively bleeding trauma patient, what do we do when they have a TBI? Take a dive into the literature surrounding ideal perfusion pressures of patients suffering from TBIs and traumatic injury to find out if we know what pressure is really the best.

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Whole Blood - More than the Sum of Its Components?

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Whole Blood - More than the Sum of Its Components?

Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?  

A: If they've lost blood, give them blood.  

It's never quite that simple though right?  For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components.  Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients.  Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy.  If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?

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