Rotunda ROTEM

1
The following should be done in all cases of haemorrhage to support coagulation:

1. Give 1g of TXA

2. Start ACTIVE warming

3. Keep pH>7.2 and Ca⁺⁺ mmol/L
2
Check FIBTEM A5 result at 5 minutes (amplitude at 5 mins). This will determine if fibrinogen is required.* This field is required.
FIBTEM A5 ≥ 9 mm
FIBTEM A5 is 5-8 mm
FIBTEM A5 is ≤ 4 mm
3
Fibrinogen is likely to be normal and is not indicated (fibrinogen < 2g/L or FIBTEM A5 ≥ 9 mm is the threshold level for fibrinogen transfusion). Now check EXTEM CT
EXTEM CT ≥ 75 seconds
EXTEM CT < 75 seconds
4
Fibrinogen is likely to be low. Give 4 g fibrinogen. Now check EXTEM CT
EXTEM CT ≥ 130 seconds
EXTEM CT < 130 seconds
5
Fibrinogen is critically low. Give 6 g fibrinogen. Now check EXTEM CT
EXTEM CT ≥ 130 seconds
EXTEM CT < 130 seconds
6
EXTEM CT is prolonged (abnormal). Octaplas 10-15 mL/kg is indicated. This is usually 3-4 pools. Octaplas will provide higher level clotting factors to support coagulation. Now check EXTEM A5 to see if platelets are indicated.
EXTEM A5 ≥ 35 mm
EXTEM A5 < 35 mm
7
EXTEM CT result is normal, suggesting Octaplas is not indicated. Now check EXTEM A5 (platelet and fibrinogen function).
EXTEM A5 ≥ 35 mm
EXTEM A5 < 35 mm
8
EXTEM CT is prolonged (abnormal). Octaplas 10-15 mL/kg is indicated in addition to fibrinogen. This is usually 3-4 pools. Octaplas will provide higher level clotting factors to support coagulation. Now check EXTEM A5 result to see if platelets are indicated.
EXTEM A5 ≥ 25 mm
EXTEM A5 < 25 mm
9
EXTEM CT is normal. So far the ROTEM suggests fibrinogen replacement only. Now check EXTEM A5.
EXTEM A5 ≥ 25 mm
EXTEM A5 < 25 mm
10
EXTEM CT is prolonged (abnormal). Octaplas 10-15 mL/kg is indicated in addition to fibrinogen. This is usually 3-4 pools. Octaplas will provide higher level clotting factors to support coagulation. Now check EXTEM A5 to see if platelets are indicated.
EXTEM A5 ≥ 25 mm
EXTEM A5 < 25 mm
11
EXTEM CT is normal. So far the ROTEM suggests fibrinogen replacement only. Now check EXTEM A5 to see if platelets are indicated.
EXTEM A5 ≥ 25 mm
EXTEM A5 < 25 mm
12
Platelets are not indicated. To summarise your ROTEM result suggests administering:

1. Octaplas 10-15 mL/kg only.

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
13
Platelets indicated. To summarise your ROTEM result suggests administering:

1. Octaplas 10-15 mL/kg

2. One pool of platelets

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
14
Platelets not indicated. The ROTEM result is NORMAL and no coagulation products are indicated. Await the lab coag study and Clauss fibrinogen level.

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
15
Platelets indicated. To summarise your ROTEM result suggests administering:

1. One pool of platelets.

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
16
Platelets are not indicated. To summarise your ROTEM result suggests administering:

1. 4g of fibrinogen

2. 10-15 mL/kg of Octaplas

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
17
Platelets are indicated. To summarise your ROTEM result suggests administering:

1. 4g of fibrinogen

2. 10-15 mL/kg of Octaplas

3. One pool of platlets

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
18
Platelets are not indicated. To summarise your ROTEM result suggests administering:

4g of fibrinogen

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
19
Platelets are indicated. To summarise your ROTEM result suggests administering:

1. 4g of fibrinogen

2. One pool of platelets

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
20
Platelets are not indicated. To summarise your ROTEM result suggests administering:

1. 6g of fibrinogen

2. 10- 15 mL/kg of Octaplas

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
21
Platelets are indicated. To summarise your ROTEM result suggests administering:

1. 6g of fibrinogen

2. 10- 15 mL/kg of Octaplas

3. One pool of platelets

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
22
Platelets are not indicated. To summarise your ROTEM result suggests administering:

6g of fibrinogen

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
23
Platelets are indicated. To summarise your ROTEM result suggests administering:

1. 6g of fibrinogen

2. One pool of platelets

Repeat dose of TXA and repeat ROTEM if still bleeding after administration of blood products. Check laboratory values for clotting and treat if low and bleeding (Clauss Fibrinogen <2g.L, platelets < 75 x 10⁹/L or PT/aPTT > 1.5 x normal)
24
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Should be Empty: