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Wed Apr 15 13:59:47 BST 2009

This is very interesting.  Should we go back to filter paper and
bleeding times?  

Or would point-of-care tests (we use I-STAT) be more informative than
blood sent to the lab?

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Timothy
Hardcastle
Sent: Wednesday, April 15, 2009 2:01 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Trauma Coagulopathy - what values?

Cat

This is a difficult one: There is a clinical coagulopathy unrelated to
specific numbers that is seen to occur with severe trauma. When the
initial bloods are drawn and the results come back the INR is >1,5, the
TEG is prolonged / abnormal - (often the first sign) and the platelets
progressively drop.

The problem is that the lab does the tests at 37'C, so any effect of
hypotermia is negated, thus giving values that may actually be more
normal
than they truly are. The most important thing is a clinical ooze fromt
he
patient's wounds.

Hope this helps

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa
> Dear Traumalist
>
> What are the values for the current defintion of traumatic
coagulopathy?
>
> At what values do you consider your trauma-patient coagulopathic, what
> INR, what platelet, what fibrinogen, what pH?
>
> Thanks, Cat
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Trauma Coagulopathy - what values?