Workup and Initial Therapy for Coagulopathy PDF
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This document describes a workup and initial therapy for coagulopathy, focusing on different types of bleeding, surgical hemostasis, hypothermia, and immediate tests. It details how to manage decreased platelets or suspicions of thrombocytopathy, as well as cases with increased prothrombin time (PT), partial thromboplastin time (PTT), and fibrinogen levels. The document also includes a figure (Fig. 49.11) illustrating the algorithm for evaluation and initial therapy in suspected perioperative coagulopathy, highlighting clinical scenarios and their effects on the evaluation.
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# Workup and Initial Therapy for Coagulopathy - **Type of bleeding:** - Diffuse from wound or intravenous sites, or both, and from mucous membranes vs local petechiae, ecchymoses, or both - **Rule out lack of surgical hemostasis** - **Correct hypothermia** - **Immediate PT, PTT, fibrinogen, pla...
# Workup and Initial Therapy for Coagulopathy - **Type of bleeding:** - Diffuse from wound or intravenous sites, or both, and from mucous membranes vs local petechiae, ecchymoses, or both - **Rule out lack of surgical hemostasis** - **Correct hypothermia** - **Immediate PT, PTT, fibrinogen, platelet count** - **Decreased platelets or suspicion of thrombocytopathy** - Transfuse 5-10 units of platelets, consider DDAVP - **Increased PT, PTT Normal platelet counts Normal or increased fibrinogen levels** - Fresh frozen plasma - **Increased PT, PTT Low platelets Decreased fibrinogen** - Fibrin split products + cryoprecipitate + platelets - Workup for disseminated intravascular coagulopathy fibrinolysis # Fig. 49.11 Algorithm for the evaluation and initial therapy of a patient with suspected perioperative coagulopathy. The evaluation is based on the clinical scenario and is affected by the type and location of injury, the amount of fluid administered, and the age and body temperature of the patient. DDAVP, 1-Deamino-8-D-arginine vasopressin, a vasopressin analogue also known as desmopressin acetate; PT, prothrombin time; PTT, partial thromboplastin time. (Modified from Habibi S, Corrsin DB, McDermott JC, et al. Trauma and massive hemorrhage. In: Muravchick S, Miller RD, eds. Atlas of Anesthesia: Subspecialty Care New York: Churchill Livingstone; 1998)
