Acute Coagulopathy of Trauma

OVERVIEW

  • new terms that are in vogue are trauma-induced coagulopathy (TIC) and acute traumatic coagulopathy (ATC)
  • not simply a ‘dilutional coagulopathy’ or ‘consumptive coagulopathy’!

PATHOPHYSIOLOGY

  • TIC was conventionally construed simply as depletion, dysfunction or dilution of procoagulant factors
  • actually an imbalance of the dynamic equilibrium between procoagulant factors, anticoagulant factors, platelets, endothelium and fibrinolysis
  • characterized by isolated factor V inhibition, dysfibrinogenemia, systemic anticoagulation, impaired platelet function and hyperfibrinolysis
  • exacerbated by hypothermia, acidosis (together with coagulopathy they form ‘the lethal triad’) and resuscitation with hypocoagulable fluids

MANAGEMENT

  • early detection (ROTEM /TEG holds promise for this)
  • early activation of massive transfusion protocols
  • aggressive proactive blood product administration (PRBCs, FFP, platelets, cryoprecipitate)
  • prevent and treat hypothermia and acidosis
  • early use of tranexamic acid
  • give calcium if hypocalcaemic
  • consider Factor VII if non-surgical bleeding and all the other parameters have been corrected

References and Links

  • Frith D, Brohi K. The pathophysiology of trauma-induced coagulopathy. Curr Opin Crit Care. 2012 Dec;18(6):631-6. PMID: 23010636.
  • Frith D, Davenport R, Brohi K. Acute traumatic coagulopathy. Curr Opin Anaesthesiol. 2012 Apr;25(2):229-34. PMID: 22270921.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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