TEG

Access TEG Viewer here: prdlabteg.mc.uky.edu

Login and password are per usual.

Purpose:   There are two systems in the blood which interact to allow the blood to coagulate and maintain hemostasis: the enzymatic proteins (clotting factors) and platelets (non nucleated cells).  PT and aPTT measure the time it takes to form fibrin clot via the extrinsic and intrinsic pathways while the platelet count indicates platelet mass (though says nothing about how well platelets function) (1). When patients experience traumatic injury, infection, or inflammation these systems are activated, affecting hemostasis (1).

In trauma, coagulation disturbance is caused by consumption of clotting factors and dilution from the massive infusion of crystalloids and RBCs (2). But even before substantial amounts of fluid resuscitation and RBC transfusion, one-quarter of trauma patients already have abnormal coagulation parameters, highlighting the importance of  inflammation and fibrinolysis in the coagulopathy of trauma (3) (1).

To treat the coagulation disturbances appropriately, an expanded view of coagulation is needed, measuring both clotting factors and platelet aggregation together. Thromboelastography (TEG) provides this expanded view of coagulation, measuring clot formation via the tensile strength of the fibrin-polymer-platelet complex. (1)

In severely injured trauma patients, Thromboelastography (TEG) will be drawn to guide the administration of blood products with the goal of improving patient mortality, reducing the amount of blood required for transfusion, and preventing unnecessary transfusions (1).

Indications:                                                                                                                 

1.       Trauma Alert Red 

2.       MTP

References:

1.Kroll, M, MD Clinical Laboratory News: Thromboelastography: Theory and Practice of Measuring Hemostatis , AACC.Org 2012 Dec 32(12)

2.Jeannie L. Callum¹,² and Sandro Rizoli, Assessment and management of massive bleeding: coagulation assessment, pharmacologic strategies, and transfusion management, American Society of Hematology , 2012 pp 522-528

3.Victor Jeger, Heinz Zimmermann, and Aristomenis K. Exadaktylos ,  The Role of Thrombelastography inMultiple Trauma   doi: Hindawi Publishing Corporation

Emergency Medicine International Volume 2011, Article ID 895674, 4 pages

4.Cushing, M;Shaz,B/.H. Blood Transfusions in trauma patients: unresolved questions. Mineva Anestesiologica, March 77(3): 349-359

5. Holcomb, John B.; Minei, Kristin M.: et al; Admission rapid thrombelastography can replace conventional coagulation test in the emergency room department: Experience with 1974 consecutive trauma patients .Annals of Surgery, September 256(3): 256(3):476-486

For more TEG training:

1. Go to https://tegtraining.haemonetics.com
2. Enter your account details when prompted
1. Account Name: UKY
2. Account Password: teg351
3. Select desired training module or assessment; YOU’LL TAKE THE TEG 6s TRAUMA TRAINING AND TEG MANAGER VIEWER TRAINING
4. Enter your first and last name and Submit to begin the module
5. Courses take approximately ½ hour, progress is tracked, allowing you to come back to complete.
6. A certificate can be printed and/or saved upon

successful assessment completion