Thromboelastography

All right, what is up, y'all? This is John LaRance, and this is episode number 127, the use of TEG-6S in trauma resuscitation with Nathan Bowser.

This episode's coming out to you in the middle of September in 2026, and my guest today is Nathan Bowser, a third-year doctor of nursing practice resident at the University of Arizona's Nurse Anesthesia Program.

Nathan is the lead author on a paper that was published last month in the August 2026 edition of the AANA Journal titled Use of Thromboelastography 6S in Trauma, an Integrated Review for Anesthesia Providers.

Everyone thinks about DIC, disseminated intravascular coagulopathy.

This is kind of the trauma version of that, and it can lead into DIC as you move forward.

Not really getting into the weeds there, but So our article looked at kind of the culmination of literature surrounding the TEG6S device.

It's a little bit newer.

It came out in about 2019, I believe it was approved for use by the FDA in the United States for trauma.

But the important caveat here is that most of these studies and certainly the algorithms that are published are actually using fibrinogen concentrate to correct a known deficit in fibrinogen.

So what I mean by that is that there is laboratory evidence that the fibrinogen, the Klaus fibrinogen from the blood test is low, or using a viscoelastic test such as Rotem or Teg, the fibrinogen component is low.

So this is not blind empiric use.

This is targeted treatment for a known fibrinogen deficit.

And there is randomized data behind, like you said, Ian, the viscoelastic testing here.

Specifically, David Petrie and colleagues, they showed that the TEG-guided transfusion substantially reduced prophylactic blood product use before invasive procedures without increasing bleeding complications.

which is

nice.

And I'm like, you mean like a fucking Reverend Mother who has...

Direct experience older than any of these fucking people? What the fuck are you talking about? The idea that, like, Teg, legendary Bashar of the Bene Gesserit, or Duncan, ultimate human who's lived a hundred lifetimes, could benefit at all from fucking Liet Kynes is...

ridiculous

insane the justification for why we have to bring back the entire cast of hamilton makes no sense yeah and i think especially what's driving me nuts is like of all people duncan idaho should be most conflicted about this

that's the bare minimum that's the bare

minimum and yet you have Brian and Kevin with all of the resources they have literally the notes the you know anything that's like behind the scenes they have it and yet right so starting with something that kept pissing me off so much and that is tags abilities are apparently secret Don't tell anyone.

Teg can move quickly.

Do people actually know this? Yes, but don't tell anyone.

Okay, my favorite learners, today we're tackling a pretty crazy topic, advanced laboratory testing every SRNA needs to know for that NCE for board's purposes.

From ACT to TEG or TEG, using labs to make clinical decisions.

That is what we're discussing today.

Before you turn out my voice because you think this is going to be an hour of memorizing normal values, we're not doing that here.

So to be honest with you, if I had to do an analysis of a TAG or a Rotem for a patient tomorrow, I would have to re- learn all of this and kind of refresh my memory on it because I do not see these every day.

But we're talking about visoelastic testing.

So TEG, which is thromboelastography, and RODM, which is rotational thromboelastometry.

Traditional coagulation tests give us pieces of the coagulation picture, but visoelastic testing gives us a dynamic assessment of clot formation, clot strength, and clot breakdown over time.

Very individualized plan for the patient.

I started with only a small part and then expand, expand to cover all anesthesia, how to ma- manage any patient plan, ventilation, ROTEM, TEG, ECMO, TE.

The other point is very important to me that I didn't depend on generative AI.

I...

Everyone would go to the wake up show.

You would go to the wake up show with Sway and Teg

and

get busy.