Collection
Built automatically
From across the library
Not curated by a person
Hemorrhagic Shock
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Massive transfusion protocols should deliver blood products in 1:1:1 ratio, and this is part of American College of Surgeons Committee on Trauma verification standards for trauma centers. — Vogel, Coagulopathy and Analgesia · 19:07
Coagulopathy and Analgesia
Listen →
This podcast is an interactive discussion about the management of coagulopathy, analgesia, sedation, and delirium in critically ill pediatric patients between Dr. Adam Vogel and Dr. Alexander Gibbons. Intro and outro tracks are adapted from
podcast45:33 · Dec 2020
Trauma II: Solid Organ Injury
Listen →
This podcast is an interactive discussion about solid organ injury between Dr. Todd Ponsky, Dr. Mark McCollum, and Dr. David Notrica.Dr. David Notrica is the trauma medical director at Phoenix Children's Hospital and is associate professor
podcast37:47 · Dec 2020
ATLS 2021 Pediatric Surgery Update
Listen →
In this episode, we hear important 2021 ATLS updates for the care of pediatric trauma patients from Dr. Rich Falcone, Director of Trauma Services at Cincinnati Children's Hospital Medical Center. Hosted by Rod Gerardo, Ellen Encisco, and To
podcast16:05 · Oct 2021
ATLS 2021 Pediatric Surgery Update
Watch →
video16:06 · Jun 2026
Expert statements from the recordings in this collection.
Coagulopathy and Analgesia
Dr. Vogel completed fellowships in both pediatric surgery and surgical critical care, with research interests in viscoelastic monitoring, goal-directed hemostatic resuscitation, massive transfusion, and optimizing anticoagulation/ventilation during ECLS.
In coagulopathic trauma patients, trending coagulation values over time is more clinically useful than a single point measurement.
Vogel1:53
Initial assessment of coagulopathy should include review of crystalloid volume, blood product volumes, and transfusion ratios (red cells to plasma to platelets) received during resuscitation.
Vogel1:53
Goal-directed hemostatic therapy requires INR, PTT, hemoglobin, platelet count, and ideally viscoelastic monitoring (TEG or ROTEM) to assess functional coagulation.
Vogel1:53
Viscoelastic monitoring (TEG/ROTEM) provides global assessment of the entire coagulation system including hemostasis and fibrinolysis by transducing mechanical changes in clotting blood into electrical signals.
Vogel7:10
Viscoelastic tests measure four phases: time to clot formation (factor function), amplification rate (fibrinogen function), clot strength (platelet function), and fibrinolysis.
Vogel7:10
Prolonged clot formation time on viscoelastic monitoring indicates factor deficiency and should be treated with plasma.
Vogel7:10
Abnormal amplification phase (alpha angle) on viscoelastic monitoring indicates fibrinogen dysfunction and should be treated with cryoprecipitate or fibrinogen concentrate.
Vogel7:10
Reduced clot strength (maximal amplitude on TEG) indicates platelet dysfunction and can be treated with platelet transfusion or DDAVP in specific populations like end-stage renal disease patients.
Vogel7:10
Rapid drop-off in clot strength on viscoelastic monitoring indicates hyperfibrinolysis and may warrant antifibrinolytic therapy with tranexamic acid or aminocaproic acid.
Vogel7:10
Tranexamic acid has been widely used in adults for trauma-associated hyperfibrinolysis and is being used increasingly in children.
Vogel7:10
Viscoelastic monitoring results are available within 5-15 minutes, compared to 30-45 minutes for conventional coagulation tests (PT/INR/PTT).
Vogel11:42
Severely injured children exhibit two fibrinolytic phenotypes: hyperfibrinolysis (rapid fibrinolysis contributing to coagulopathy) and fibrinolytic shutdown (smaller percentage).
Vogel14:38
Tranexamic acid may be beneficial in hyperfibrinolytic patients but potentially detrimental in fibrinolytic shutdown patients by increasing hypercoagulability.
Vogel14:38
In adults, balanced resuscitation with 1:1:1 ratio of red cells to plasma to platelets improves mortality based on prospective observational studies and randomized trials.
Vogel16:16
Balanced resuscitation in adults improves multiple ICU outcomes including kidney injury, ventilator duration, ICU length of stay, and infection rates.
Vogel16:16
Balanced resuscitation achieves coagulopathy control more efficiently with less overall blood product volume despite appearing to use more products.
Vogel16:16
In pediatric trauma, retrospective studies using National Trauma Databank and TQIP show that 1:1 ratio of red cells to plasma provides improved outcomes.
Vogel16:16
The ATOMIC Group published a study of over 100 severely injured pediatric trauma patients showing best outcomes and survival with resuscitation closer to 1:1:1 balanced ratio.
Vogel16:16
Standard of care for hemostatic resuscitation in 2019 is balanced resuscitation with 1:1:1 ratio of red cells, plasma, and platelets.
Massive transfusion protocols should deliver blood products in 1:1:1 ratio, and this is part of American College of Surgeons Committee on Trauma verification standards for trauma centers.
Multimodal approach to postoperative analgesia has substantial benefits and should include narcotics, non-narcotics, regional techniques, and non-pharmacologic interventions.
Vogel19:56
Partnering with anesthesia pain service teams and pharmacists is valuable for managing complex postoperative pain in pediatric patients.
Non-steroidal anti-inflammatory medications (IV Toradol or oral NSAIDs) help minimize narcotic use and can decrease postoperative complications like ileus.
Vogel19:56
Regional analgesia techniques including epidural catheters and ultrasound-guided nerve blocks are effective for managing incisional pain and reducing intraoperative and postoperative opioid use.
Vogel19:56
Indwelling analgesic catheters that deliver slow-release local anesthetics into surgical wounds have been shown to be helpful for large incisions.
Vogel19:56
Gabapentinoids (pregabalin and gabapentin) are useful components of multimodal pain management.
Vogel19:56
Non-pharmacologic therapies for pain and distress include creating child-friendly environments, supporting families, pet therapy, and augmented virtual reality devices for procedures like dressing changes in burn patients.
Vogel19:56
When children are less stressed, their pain tends to be more manageable.
Vogel19:56
Most intubated postoperative patients receive combination sedative therapy with benzodiazepines (midazolam or lorazepam) plus low-dose narcotic infusions (fentanyl, morphine, or dilaudid).
Vogel25:56