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Assess and maintain physiologic acid-base balance

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 N onphysiological pH creates/exacerbates coagulopathy

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Assess and maintain physiologic acid-base balance

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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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