Your SlideShare is downloading. ×
0
ACUTE TRAUMATIC COAGULOPATHY
Centre for Trauma Sciences
Queen Mary University of London
www.c4ts.qmul.ac.uk
Royal London M...
0%
20%
40%
60%
0 - 3 4 - 7 8 - 11 12 - 15 16 - 19 20 - 23 24 - 27 28 - 31
Mortality(%)
PRBCs in 24 Hours
Acute Traumatic Coagulopathy
ATC
HAEMOSTATIC Resuscitation
1. Early haemorrhage control (DCS)
2. Permissive hypotension
3. Limit fluid infusions (dilution)...
Hallmarks of ATC
-100
-80
-60
-40
-20
0
20
40
60
80
100
0 10 20 30 40 50 60
Firmness[mm]
Time [min]
exTEM PTr Comparison
EXTEM PTR<1.2
EXTE...
ATC:
CA5 < 36mm
CRYOSTAT
CRYOSTAT Mortality
a
Standard: Y 7/22 : 32%
Early CRYO: 3/21 : 14%
6% hyperfibrinolysis
100% mortality
-100
-80
-60
-40
-20
0
20
40
60
80
100
0 10 20 30 40 50 60
Firmness[mm]
Time [min]
exTEM PTr Comparison
EXTEM PTR<1.2
EXTE...
0%
20%
40%
60%
80%
100%
≤15 16 - 50 >50
%ofPatients
% Maximum Lysis
Occult Fibrinolysis
Normal %ML + PAP 1500-7000ng/ml
Severe Occult Fibrinolysis
Normal %ML + PAP >7000ng/ml
Overt Fibrinoly...
0%
20%
40%
60%
Normal Occult Severe Occult Overt
%ofPatients
Hyperfibrinolysis
Mechanism of ATC
Systemic Activation of Protein C
ActivatedProteinC(ng/ml)
VIIa IXa Xa
+++
+
XIIa XIa
TM TM TM TM
Thrombin Fibrin
+
platelet
Thrombin-TM
Fibrinogen
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-
Thrombin Fibrin
+
platelet
TM TM TM TM
Fibrinogen
hyperfibrinolysis
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-
Thrombin Fibrin
+
platelet
TM TM TM TM
Fibrinogen
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-
FDPs
Plasmin
tPA
+
Thrombin Fibrin
+
platelet
+
Fibrinogen
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-
FDPs
Plasmin
tPA
+
Thrombin Fibrin
+
platelet
+
Fibrinogen
-
VIIa IXa Xa
+
XIIa XIa
aPC
PC
-
Thrombin-TM
-
FDPs
Plasmin
tPAPAI-1
+
-
-
Thrombin Fibrin
+
platelet
+
Fibrinogen
-
ACUTE TRAUMATIC COAGULOPATHY
Fibrinolysis
Fibrinogen loss
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Not all bleeding stops: acute coagulopathy of trauma by Brohi
Upcoming SlideShare
Loading in...5
×

Not all bleeding stops: acute coagulopathy of trauma by Brohi

1,975

Published on

Karim Brohi highlights the pitfalls of fluid resuscutation and the deadly spiral of coagulopathy in severe trauma.

Published in: Health & Medicine
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,975
On Slideshare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
58
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Transcript of "Not all bleeding stops: acute coagulopathy of trauma by Brohi"

  1. 1. ACUTE TRAUMATIC COAGULOPATHY Centre for Trauma Sciences Queen Mary University of London www.c4ts.qmul.ac.uk Royal London Major Trauma Centre Barts Health NHS Trust KARIM BROHI, FRCS FRCA Professor of Trauma Sciences, QMUL
  2. 2. 0% 20% 40% 60% 0 - 3 4 - 7 8 - 11 12 - 15 16 - 19 20 - 23 24 - 27 28 - 31 Mortality(%) PRBCs in 24 Hours
  3. 3. Acute Traumatic Coagulopathy ATC
  4. 4. HAEMOSTATIC Resuscitation 1. Early haemorrhage control (DCS) 2. Permissive hypotension 3. Limit fluid infusions (dilution) 4. Target coagulopathy
  5. 5. Hallmarks of ATC
  6. 6. -100 -80 -60 -40 -20 0 20 40 60 80 100 0 10 20 30 40 50 60 Firmness[mm] Time [min] exTEM PTr Comparison EXTEM PTR<1.2 EXTEM PTR>1.2
  7. 7. ATC: CA5 < 36mm
  8. 8. CRYOSTAT
  9. 9. CRYOSTAT Mortality a Standard: Y 7/22 : 32% Early CRYO: 3/21 : 14%
  10. 10. 6% hyperfibrinolysis 100% mortality
  11. 11. -100 -80 -60 -40 -20 0 20 40 60 80 100 0 10 20 30 40 50 60 Firmness[mm] Time [min] exTEM PTr Comparison EXTEM PTR<1.2 EXTEM PTR>1.2
  12. 12. 0% 20% 40% 60% 80% 100% ≤15 16 - 50 >50 %ofPatients % Maximum Lysis
  13. 13. Occult Fibrinolysis Normal %ML + PAP 1500-7000ng/ml Severe Occult Fibrinolysis Normal %ML + PAP >7000ng/ml Overt Fibrinolysis %ML >15%
  14. 14. 0% 20% 40% 60% Normal Occult Severe Occult Overt %ofPatients Hyperfibrinolysis
  15. 15. Mechanism of ATC
  16. 16. Systemic Activation of Protein C
  17. 17. ActivatedProteinC(ng/ml)
  18. 18. VIIa IXa Xa +++ + XIIa XIa TM TM TM TM Thrombin Fibrin + platelet Thrombin-TM Fibrinogen
  19. 19. VIIa IXa Xa + XIIa XIa aPC PC - Thrombin-TM - Thrombin Fibrin + platelet TM TM TM TM Fibrinogen
  20. 20. hyperfibrinolysis
  21. 21. VIIa IXa Xa + XIIa XIa aPC PC - Thrombin-TM - Thrombin Fibrin + platelet TM TM TM TM Fibrinogen
  22. 22. VIIa IXa Xa + XIIa XIa aPC PC - Thrombin-TM - FDPs Plasmin tPA + Thrombin Fibrin + platelet + Fibrinogen
  23. 23. VIIa IXa Xa + XIIa XIa aPC PC - Thrombin-TM - FDPs Plasmin tPA + Thrombin Fibrin + platelet + Fibrinogen -
  24. 24. VIIa IXa Xa + XIIa XIa aPC PC - Thrombin-TM - FDPs Plasmin tPAPAI-1 + - - Thrombin Fibrin + platelet + Fibrinogen -
  25. 25. ACUTE TRAUMATIC COAGULOPATHY Fibrinolysis Fibrinogen loss
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×