Understand TEG - Thromboelastogram! Make it easy!

What is a TEG? A thromboelastogram? And when do we use it?

How can you use a thromboelastogram to help guide a trauma resuscitation or care for a sick, bleeding patient in the ICU?

How do you interpret a TEG?


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Thromboelastogram, TEG, is a test to examine the entire life span of a blood clot.

While PT, PTT, INR and Fibrinogen are single dimension lab values (still helpful in particular situations), TEG gives you information on the clotting factors, fibrinogen and the strength of clot, the number of platelets and platelet function as well as fibrinolysis and the breakdown of a clot.

With a TEG you can get an idea what blood product is most appropriate during the resuscitation or if you need to make a decision for a patient on the ECMO circuit or a patient with liver failure who needs a procedure and to be optimized.

In this video I'm going to take you through how a TEG works, the benefits of a TEG and then I'll go through the different aspects of a TEG and how to interpret the waveforms.

We'll look at what the R time, K time, alpha angle, maximum amplitude and LYT30 mean and how you can understand it instead of just memorize it!

I'll take you through some different clinical scenarios and we will have an example trauma case that will give us a clear picture of the TEG to begin and to end the video.

I'll also present a few papers I've found most helpful in understanding TEG as well as some links to relevant literature which demonstrates the value of TEG in various clinical applications.


Check out these AMAZING timestamps and fast forward if you need to:

Start 00:00
Clinical Case 01:35
Why use Thromboelastography? 03:15
How does a TEG works? 05:14
TEG is the Lifespan of a Clot 09:00
R time 10:26
K time 11:39
Alpha angle 12:24
Maximum amplitude & LY30 13:15
What does the literature show? 14:15
Example #1 - Increased R Time 16:00
Example #2 - Increase K Time, Decreased Alpha angle 16:34
Example #3 - Decreased Maximum Amplitude 17:37
Example #4 - Increased LY30 18:13
Example #5 - Hypercoagulable 19:12
Example #6 - Disseminated Intravascular Coagulation 20:20
Limitations of TEG 21:12
Clinical case and summary 22:40


REFERENCES
National Library of Medicine TEG Review https://citizensurgeon.co/TEGreview
EAST Podcast on TEG https://citizensurgeon.co/TEGpodcast
Goal Directed Hemostatic Resuscitation of Trauma Induced Coagulopathy https://citizensurgeon.co/TEGgoaldire...
TEG Guided Resuscitation is Superior to MTP https://citizensurgeon.co/TEGmtp


WHO AM I?
I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a weekly newsletter called the Saturday Six where I identify Six different discoveries of the week. You can get the weekly newsletter by signing up to the CITIZENSURGEON Community!

DISCLAIMER
While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these videos are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. If you have medical questions definitely consult a medical professional. Good luck and enjoy!

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