false
Catalog
Current Concepts in Adult Critical Care
Case Presentation and Audience Participation - 2
Case Presentation and Audience Participation - 2
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
All right, so Dr. Mattiara did a great job of outlining the answer to this one. Hyperthermia is not a component of the lethal diamond of trauma. And I'd expand this out to lethal diamond of hemorrhage in general, so not just trauma-related. The TAG curve, I'll take a minute here just to talk a little bit about this. We use TAG quite a bit where I'm at. And so we really appreciate the ability to target our therapies using TAG. There are four components to this that I'd like to highlight. The first is that straight line at the beginning on the far left. That in this patient is prolonged. And that's called the R time or the reaction time. In order to make that faster, we give the patient platelets because the first step of the clotting cascade is factors, clotting factors. So providing those will actually shorten your R time and allow clots to begin forming. Then as that line diverges around 17 minutes, the velocity with which that clot starts to form can be affected by cryoprecipitate. And then the strength of the clot or the maximum width of those lines, probably around minute 35, 40, that is affected by platelets and platelet function. And then the strength of that clot or how quickly those lines come back together is affected by tranexamic acid, which can help to stabilize your clot. So in this case, the answer is going to be FFP. And finally, because it's a closed space, you can't really have hemorrhagic shock from hemorrhage into the cranium. So as our patient is resuscitated and his blood pressure starts to normalize, his mental status slowly starts to improve. He undergoes surgical fixation of his pelvis. However, on hospital day two, the ICU team starts to notice that he's been more diaphoretic, tremulous, hypertensive, and less purposeful with his movements. Shortly after ICU rounds, he has a generalized tonic-clonic seizure that lasts more than two minutes. And he's given six milligrams of lorazepam with resolution of the seizure. So question for this section. What syndrome is the patient most likely experiencing? Can we go back one? Hyponatremia, PCP intoxication, alcohol withdrawal, or neuroleptic malignant syndrome. Give your screen a refresh if the question does not come up, but it does come up now. All right. So perhaps a little tangentially related to this patient's presentation.
Video Summary
Dr. Mattiara explained that hyperthermia is not part of the lethal diamond of trauma or hemorrhage. The TAG curve is used to target therapies, with R time being prolonged in this patient, improved by platelets, cryoprecipitate affecting clot formation velocity, platelets affecting clot strength, and tranexamic acid stabilizing clots. The correct therapy for this patient is FFP. Due to being a closed space, hemorrhagic shock cannot occur from cranial hemorrhage. After surgical fixation, the patient experiences symptoms like diaphoresis, tremors, and seizures, indicating likely hyponatremia, PCP intoxication, alcohol withdrawal, or neuroleptic malignant syndrome.
Keywords
hyperthermia
TAG curve
hemorrhagic shock
FFP
clot formation
Society of Critical Care Medicine
500 Midway Drive
Mount Prospect,
IL 60056 USA
Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email:
support@sccm.org
Contact Us
About SCCM
Newsroom
Advertising & Sponsorship
DONATE
MySCCM
LearnICU
Patients & Families
Surviving Sepsis Campaign
Critical Care Societies Collaborative
GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. |
Privacy Statement
|
Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.
×
Please select your language
1
English