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    ROTEM Interpretation

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    distopicmag
    The document provides guidance on interpreting ROTEM test results to guide transfusion of blood products for major bleeding. It outlines 4 steps to analyze EXTEM and FIBTEM test parameters to identify fibrinogen deficiency, thrombocytopenia, low clotting factors or anticoagulation. Threshold values and treatment dosages are provided.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    ROTEM Interpretation

    Uploaded by

    distopicmag
    64 views1 page
    The document provides guidance on interpreting ROTEM test results to guide transfusion of blood products for major bleeding. It outlines 4 steps to analyze EXTEM and FIBTEM test parameters to identify fibrinogen deficiency, thrombocytopenia, low clotting factors or anticoagulation. Threshold values and treatment dosages are provided.

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    ROTEM-interpretation

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    The document provides guidance on interpreting ROTEM test results to guide transfusion of blood products for major bleeding. It outlines 4 steps to analyze EXTEM and FIBTEM test parameters to identify fibrinogen deficiency, thrombocytopenia, low clotting factors or anticoagulation. Threshold values and treatment dosages are provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    64 views1 page

    ROTEM Interpretation

    Uploaded by

    distopicmag
    The document provides guidance on interpreting ROTEM test results to guide transfusion of blood products for major bleeding. It outlines 4 steps to analyze EXTEM and FIBTEM test parameters to identify fibrinogen deficiency, thrombocytopenia, low clotting factors or anticoagulation. Threshold values and treatment dosages are provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ROTEM Interpretation

    Implemented
    October 2021

    Introduction
    ROTEM gives a more accurate idea of clot formation and which products are required to maintain normal clotting in major bleeding, it
    does not guide on Hb levels or volume resuscitation
    It provides a graphical display of the ‘firmness’ of a clot over time
    • FIBTEM A5: the amplitude (firmness) of the clot at 5 minutes due to
    fibrinogen, in mm
    • EXTEM A5 : the amplitude (firmness) of the clot at 5 minutes due to
    extrinsic pathway, in mm
    • EXTEM CT: the clotting time due to extrinsic pathway, in seconds

    ROTEM results should be tracked in live time on ROTEMLive shortcut


    on Resus computer, password is located under keyboard Example EXTEM and FIBTEM

    Fibrinogen Deficiency
    Step
    1 FIBTEM A5 < 10 mm • Correct as below ‘Dosages’ if
    not already doing so
    • Proceed to next ‘Step’
    ≥ 10 mm

    Step
    2
    EXTEM CT ≥ 85 s FIBTEM A5 < 10 mm

    < 85 s
    ≥ 10 mm
    Thrombocytopaenia
    • If FIBTEM A5 ≥ 10 then
    patient is thrombocytopaenic
    and requires platelets only
    •
    Step
    3
    EXTEM A5 < 35 mm
    If FIBTEM A5 < 10 then
    correct low fibrinogen and
    consider also giving platelets
    if EXTEM A5 < 25
    ≥ 35 mm • Go to ‘Step 4’

    Step
    4
    EXTEM CT ≥ 85 s FIBTEM A5 < 10 mm

    ≥ 10 mm Low Clotting Factors or


    < 85 s
    anticoagulated – give FFP or
    reverse anticoagulation

    If EXTEM CT < 85s, EXTEM A5 ≥ 35 and FIBTEM ≥ 10, no further products are required, repeat the ROTEM
    after transfusion, check the ROTEM for signs of hyperfibrinolysis

    Dosages Hyperfibrinolysis
    Low fibrinogen:
    • FIBTEM A5 5 – 9: 3 bags of CRYO or 4g of riastap EXTEM amplitude decreases
    • FIBTEM A5 < 5: 4 bags of CRYO or 6g of riastap over time, treatment is
    Platelets: 1 pool tranexamic acid, graph
    FFP: 20 ml/kg appears like the following
    Tranexamic acid: up to 2g IV as 1g bolus and 1g over 8 hours with decreasing amplitude

    Lead: J Chan, D Bootland, R Kong Prompt card by: J Castle Version 6.0 For review: Oct 2023

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