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Managing Acid-Base Balance and Coagulopathy in Massive Hemorrhage

Learn to assess and maintain physiologic pH levels for optimal coagulation system function during massive hemorrhage. Utilize active tests like TEG or ROTEM and algorithm-based transfusion guidelines for effective management.

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Managing Acid-Base Balance and Coagulopathy in Massive Hemorrhage

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  1. W.A.R.: Assess Assess and maintain physiologic acid-base balance • The coagulation system is run by enzyme systems that do not • function optimally at nonphysiological pH • Nonphysiological pH creates/exacerbates coagulopathy • Make all efforts to maintain a pH of 7.4 during massive hemorrhage Assess the integrity of the coagulation system • Active tests such as the TEG or ROTEM likely provide the most effective assessments of the coagulation system • Multiple prospective randomized controlled trials have established the clinical utility of employing algorithm-based transfusion guidelines (INR, ACT & TEG) • Note that the various published algorithms were tested for microvascular bleeding and not specifically for massive hemorrhage • Frequent retesting is necessary to gauge impact

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