T Wait For The Usually Long Turnaround Time Of Conventional Lab

T wait for the usually long turnaround time of conventional lab tests. The management of PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/20140276 massive bleeding in trauma requires prompt availability of lab test results. POC is clearly faster. In particular when A10 (amplitude at 10 minutes) is used, Cyclohept-2-enone which has been shown useful to early estimate the entire clot firmness [18-20] if they are to be useful at all. Frequently, laboratories are unable to respond to this time demand and most critical decisions in massively bleeding trauma patients are taken without them. Since the use of TEGW is being pushed forward for use in early trauma resuscitation, it is likely that many institutions will prefer to use it as POC rather than a hospital laboratory test. In fact, many studies have used TEGW in trauma as a POC test [17,21-25]. However its proper use as POC raises some considerations as follows: TEGW requires daily calibration This system has been criticized for not undergoing the same evaluation process as conventional tests, and the lack of quality assessment program. In practice electronic quality assurance should be run daily or with each set of tests using commercial lyophilized PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/10714611 samples [17]. The manufacturer recommendation is to calibrate the equipment 2 to 3 times a day. So any consideration of having the TEGW equipment in the trauma room as POC requires a quality assurance program in place that includes multiple daily calibrations. TEGW as POC should not be done by untrained personnel It is imperative that some form of training and qualification, besides quality assurance methodology, must be put in place for anyone performing the test, as required by regulatory agencies such as American Association Blood Banks, Clinical Laboratory Improvement Amendments (CLIA) and Food and Drug Administration (FDA). TEGW as POC requires standard techniques A major limitation of TEGW is the many 54718-39-7 Technical Information,39065-95-7 NMR,2454396-80-4 Description,503614-91-3 Technical Information,1088994-18-6 chemscene,2168499-15-6 Data Sheet,2137792-51-7 Technical Information,52222-73-8 supplier,944401-77-8 custom synthesis,142266-62-4 Technical Information,55860-35-0 In Stock,10325-70-9 manufacturer,15450-69-8 site,73246-45-4 Order Online,945244-29-1 Technical Information,13323-45-0 Description,89003-95-2 Formula,784-71-4 Documentation,78775-11-8 custom synthesis,25563-04-6 Data Sheet,17145-91-4 supplier,1416013-62-1 Data Sheet,20955-94-6 Technical Information,57196-62-0 manufacturer,20357-21-5 Technical Information,10542-80-0 web,32305-98-9 custom synthesis,7209-11-2 Technical Information,90259-31-7 chemscene,56962-10-8 custom synthesis,100523-84-0 Order Online,574007-66-2 supplier,926922-40-9 site,57097-81-1 MS,124276-67-1 web,869970-25-2 Documentation,376584-63-3 Documentation,40235-68-5 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Description,174565-63-0 site,159858-21-6 supplier,63878-73-9 Building Blocks,30363-03-2 Technical Information,362670-06-2 Documentation,106719-44-2 Formula,771-97-1 Order Online,381247-99-0 Data Sheet,65868-63-5 supplier,63639-61-2 Description,885952-18-1 manufacturer,88824-09-3 Documentation,117519-07-0 Technical Information,365996-06-1 Purity ¡۹54%,25339-99-5 manufacturer,352535-84-3 manufacturer,124668-49-1 Documentation,16265-11-5 manufacturer,187344-92-9 Technical Information,5900-59-4 chemscene,1185295-39-9 Description,1343056-10-9 Order Online,14997-58-1 web,28562-61-0 chemscene,2150-93-8 custom synthesis,1296209-28-3 Data Sheet,165727-45-7 Technical Information,1220028-20-5 Technical Information,16097-60-2 web,84153-82-2 web,87014-28-6 web,1201643-59-5 Formula,123926-62-5 chemscene,32993-05-8 Data Sheet,860296-12-4 chemscene,400899-84-5 NMR,89976-27-2 Documentation,599183-33-2 Building Blocks,7781-10-4 HPLC,447-53-0 supplier,1735-89-3 site,1447963-75-8 manufacturer,4815-29-6 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Building Blocks,6665-97-0 Formula,192214-06-5 supplier,70416-53-4 site,99455-15-9 Documentation,60633-26-3 Description,2103-49-3 supplier,84964-24-9 supplier,1567892-21-0 Documentation,790184-33-7 Description,1030012-30-6 Description,25566-00-1 Description,6947-94-0 Documentation,91760-66-6 In Stock,696-40-2 Documentation,1410002-81-1 In Stock,345954-83-8 Data Sheet,32111-28-7 site,779-27-1 custom synthesis,4108-90-1 Data Sheet,877-90-7 web,95715-87-0 chemscene,1210419-26-3 chemscene,174603-38-4 Purity ¡۱049%,167479-13-2 Technical Information,55750-48-6 supplier,5154-01-8 Formula,66361-67-9 site,106984-09-2 web,306960-74-7 site,89466-16-0 Technical Information,1185297-53-3 web,2199-58-8 chemscene,1142400-61-0 Technical Information,62456-34-2 Documentation,5147-80-8 site,854107-53-2 site,3034-48-8 web,412947-54-7 In Stock,819058-34-9 custom synthesis,1049706-73-1 Description,697300-73-5 Formula,203787-91-1 manufacturer,337904-92-4 Documentation,2589531-74-6 In Stock,66207-23-6 Technical Information,501435-91-2 Documentation variations in how it is done, and the different results each technique generates [3]. TEGW was originally designed for fresh whole blood and no additional activator [17]. Subsequent modifications have included sample anticoagulation and use of an activator to standardize the initiation of the coagulation [17,26].da Luz et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:29 http://www.sjtrem.com/content/21/1/Page 4 ofIn native whole blood the test should be done within 4 minutes while for recalcified citrated whole blood the recommendation is to wait 30 to 40 minutes for maximum stability, before doing the test [3]. This recommendation is sometimes neglected in trauma. The results from citrated blood are not comparable to native blood, thus anticoagulated samples are surrogate to native blood in assessing coagulation [26]. Furthermore each activator has indications with Kaolin being best for overall assessment of the coagulation; ADP and arachdonic acid for platelet function and tissue factor for evaluation of the extrinsic pathway and rapid TEGW [21]. Other studies 4-Bromopicolinaldehyde showed that repeated sampling results in false hypercoagulable results [26] while gender, age and even alcohol also affect the TEGW results [3,12,27]. TEGW may not be faster than standard tests While meaningful information can be obtained in approximately 10 minutes of initiating the test, when maximum clot firmness is reached [9], the whole test takes 30 to 60 minutes [17]. This time may be increased by the recommended 30 to 40-minute wait for anticoagulated samples [17]. Rapid TEGW (rTEGW) was recently propos.