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Behind the Knife, the Surgery Podcast, where we take a behind the scenes intimate look at surgery from leaders in the field. Welcome back to the Big T trauma series on Behind the Knife. In this series

we cover clinically oriented material that focuses on how best to care for

dramatically injured and critically ill patients. My name is

Patrick Georgeoff, Trauma Surgery Fellow at the University of Texas Memorial Herman Red

Duke Trauma Institute in Houston Texas. And today I'm joined by Jason Brill, also a trauma surgery fellow at

the University of Texas and Houston, and a lieutenant commander in the United States

Navy. Today we are going to continue our discussion about trauma resuscitation strategies.

That's right. We are going to dive deep into Thrombie lastography and the reversal of common

anti-coagulance. As usual I need to start with a disclaimer that the information, content, and conclusions in this episode do not necessarily represent the official position of, nor should any official endorsement be inferred by, the United States Navy, the Department of Defense, nor the U.S. government.

All right, Jason, let's say that you have a patient who's involved in a motor vehicle crash.

They're hypotensive and they have a positive fast.

You've already given two units of pack cells

and two units of FFP through a large bore central line.

Whole blood is not available but a massive

transfusion pack has arrived and you start making your way to the operating room.

In the OR more blood is hung in one to one to one to one fashion. You open the

belly and it's full of blood. There's a

grade four liver injury that is actively bleeding. You pack the liver and you

...