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Credits: 1.0 CME / 1.0 CNE | Expired
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Bleeding among patients undergoing elective or emergent surgical procedures, experiencing trauma, or receiving anticoagulant therapy can result in acquired coagulopathy and poor outcomes. The challenges in managing and preventing coagulopathy include clinical decisions about patients currently taking warfarin who may require urgent reversal to undergo emergency surgery or who experience uncontrolled bleeding while on anticoagulant therapy, or those patients being treated for trauma. For this learning activity, the Blood CME Center has brought together a diverse group of experts representing anesthesiology, blood banking and hematology, emergency medicine, pathology, and surgery to address issues relevant to the support teams who manage surgical and trauma patients on a daily basis. As part of this learning activity, registered participants will have the opportunity to hear expert faculty present clinical data, discuss representative cases from their professional experience, and interact with the audience via polling questions conducted in real time.
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Credits: 0.5 CME | Expired
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This vodcast activity explores the role of fibrinogen in clot formation and its importance in the correction of hemostatic impairment during cardiac surgery, when excessive bleeding is not an uncommon occurrence. As part of his presentation, anesthesiologist Mark Ereth addresses the function of fibrinogen in the coagulation cascade, its impact on surgically acquired coagulopathy, and forms of fibrinogen replacement.
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Credits: 0.5 CME | Expired
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Is fibrinogen deficiency a fundamental risk factor for cardiac surgery? In an interview with Blood CME Center staff, Aryeh Shander, MD, FCCM, FCCP, offers his expert opinion on the role of fibrinogen in surgical hemostasis. As part of his discussion, Dr. Shander reflects on recent data correlating fibrinogen levels with the risk of bleeding, particularly in the cardiac surgery population, as well as current and emerging strategies for achieving and maintaining optimal hemostasis.
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Credits: 1.0 CME | Expired
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Listen to Ian J. Welsby, MD, MBBS, FRCA, and Peter K. Smith, MD, both on the faculty at Duke University Medical Center in Durham, North Carolina, discuss the essential aspects of hemostasis, as well as current and emerging therapeutic options for restoring hemostasis in cardiac surgery patients. This presentation includes a comprehensive overview of hemostasis, available treatments for coagulopathy, frequently encountered complications in cardiac surgery, and strategies for managing perioperative bleeding.
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Credits: 0.5 CME / 0.5 CNE | Expired
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This learning activity addresses the issue of coagulopathy in trauma care, noting specifically the role of shock as an inducer of acute traumatic coagulopathy and providing a breakdown of contributing physiologic events. Implementation of a trauma exsanguination protocol has been shown to improve patient survival, minimize costly delays, and reduce blood product consumption. Trauma surgeon Bryan A. Cotton presents the components of such a protocol, as well as current recommendations for optimal blood product ratios. Additional commentary from trauma care specialists Martin A. Schreiber, MD, FACS, and Richard P. Dutton, MD, MBA, sheds light on the off-label use of recombinant factor VIIa to treat trauma patients and emerging strategies for the treatment of the coagulopathy of trauma.
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Credits: 0.5 CME | Expired
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Listen to Aryeh Shander, MD, FCCM, FCCP, and William C. Chapman, MD, address questions on the benefits and risks of available topical thrombin preparations. As part of their discussion, these blood management experts draw on their clinical experiences to reflect on the controversies surrounding bovine thrombin exposure, as well as the role topical hemostatic agents can play in achieving surgical hemostasis.
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Credits: 0.25 CME | Expired
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In this premier vodcast activity of the Blood CME Center, Martin A. Schreiber, MD, FACS, discusses the mechanisms that contribute to the acute coagulopathy of trauma. In examining the physiology of trauma-shock, Dr. Schreiber specifically notes the role of protein C, thrombomodulin, hypothermia, and dilution and their effects on the coagulation system following trauma. Drs. Bryan A. Cotton and Richard P. Dutton contribute to the activity with commentary on evolving resuscitation strategies for managing the coagulopathy of trauma and the direction of research in this clinical area.
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Credits: 0.5 CME | Expired
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Listen to Lawrence T. Goodnough, MD, discuss the risks of perioperative anemia, options for minimizing transfusions, and management strategies to control anemia. Perioperative anemia carries many risks for a variety of patients in the elective surgery setting and managing it preoperatively can minimize the number of blood transfusions administered to this patient population.
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Credits: 0.75 CME | Expired
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Listen to Aryeh Shander, MD, FCCM, FCCP, outline ways to manage perioperative anemia and discuss why this condition should be a concern for clinicians. Anemia is a neglected diagnosis, with multiple causes. Thought to be a condition primarily affecting underdeveloped populations, anemia is also prevalent in Western countries. Perioperative anemia is associated with increased morbidity and mortality, and elderly patients are among those at greatest risk.
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Credits: 0.5 CME | Expired
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Trauma anesthesiologist Richard P. Dutton, MD, MBA, addresses a series of questions on the mechanistic theory of coagulopathy, evolving resuscitation techniques, and recent changes in the way clinicians regard the early coagulopathy of trauma. Hemorrhage is a major contributor to the dilemma of traumatic injury and its subsequent care, and patients with massive traumatic hemorrhage inevitably develop coagulopathy. More than 80% of the trauma deaths that occur in the OR do so as a result of hemorrhage. The acquired coagulopathy of trauma is an important clinical issue that continues to be studied and debated.
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Credits: 0.5 CME | Expired
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Listen to vascular surgeon Jeffrey H. Lawson, MD, PhD, discuss the issues surrounding today’s therapeutic options for controlling intraoperative bleeding, as well as current protocols designed to achieve and maintain optimal surgical hemostasis. As part of his discussion, Dr. Lawson differentiates the available topical hemostatic agents and addresses the benefits and risks of recombinant technology in managing surgical hemostasis.
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Credits: 0.5 CME / 0.6 CNE | Expired
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Aryeh Shander, MD, FCCM, FCCP, addresses questions about acquired inhibitors to factor VIII and the clinical challenges presented by this coagulation disorder, particularly as it concerns elderly patients in the perioperative setting. Spontaneously acquired inhibitors to factor VIII occur rarely, with no known etiology in approximately half of all diagnosed cases. However, the majority of cases occur in older adults. In this Q&A podcast, Dr. Shander discusses the difficulties inherent in diagnosing acquired coagulopathies and treatment strategies specifically for managing acquired inhibitors to factor VIII. A case study complements this learning activity and reinforces key points raised in the Q&A.
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Credits: 1.75 CME / 1.7 CNE | Expired
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Trauma surgeon Bryan A. Cotton, MD, FACS; hematologist B. Gail Macik, MD; and colorectal surgeon Ronald A. White, MD, JD, discuss the diagnostic and treatment strategies for congenital and acquired hemophilia as they meet the challenges presented by two fictitious cases that comprise one nightmare weekend in the ED and the OR of a small community hospital. In sharing professional insights about two relatively rare bleeding disorders, these experts address the difficulties inherent in performing diagnostic workups with limited laboratory resources; making appropriate treatment choices; and preparing patients for elective or emergent surgery.
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Credits: 0.5 CME / 0.6 CNE | Expired
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Listen to Michael J. Paidas, MD, an expert in blood disorders, discuss the identification and clinical management of postpartum acquired hemophilia. Although the development of inhibitors in the postpartum period is a rare occurrence, it can be a potentially life-threatening complication. As part of his discussion, Dr. Paidas addresses the association between prompt diagnosis and successful outcome in postpartum acquired hemophilia and outlines treatment strategies to achieve hemostasis and eradicate inhibitors.
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Credits: Up to 2.25 CME | Expired
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Choose your path! Learn expert approaches for managing patients with acquired coagulopathy from the perspective of an anesthesiologist, a pathologist/transfusion specialist, and a surgeon. Two tracks, consisting of 4 modules each, cover such subjects as the physiology and evolving models of hemostasis and the ways in which acquired coagulopathy is managed and treated. You can earn up to 2.25 CME credits in the anesthesiology track and up to 2.0 CME credits in the surgery track.
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Credits: 0.5 CME | Expired
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Listen to John B. Holcomb, MD, FACS, a Trauma Consultant for the Surgeon General, discuss the potential consequences of traumatic combat injury and the measures taken to prevent these consequences. As part of his discussion, Dr. Holcomb describes the differences between current and past patterns of combat injury, the signs and symptoms of hemorrhagic shock, and the effects of various types of transfusion and other treatments.
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Credits: 0.5 CME | Expired
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Listen to Deborah M. Stein, MD, MPH, FACS, discuss aspects of traumatic brain injury, including epidemiology, etiology, and treatment options for coagulopathy. Trauma is the third leading cause of death overall and the leading cause of death among those aged 1 to 44 years in the United States. Trauma care is continually evolving to enhance outcomes. This CEnow™ explores traumatic brain injury with acquired coagulopathy as a significant clinical challenge with far-reaching implications.
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Credits: 1.5 CME | Expired
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Two experts in blood management, Jeffrey H. Lawson, MD, PhD, and Jerrold H. Levy, MD, FAHA, exchange their thoughts in this forum and moderated roundtable discussion on some of the hemostatic challenges currently facing the anesthesiology/surgical team in the OR and throughout recovery. The subjects addressed in this learning activity include stratification of patients’ preoperative risk for bleeding, the prognosis for patients with acquired coagulopathy from surgery, and pharmacologic interventions that can be employed to achieve optimal hemostasis.
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Credits: 0.5 CME | Expired
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Listen to Jerrold H. Levy, MD, FAHA, a cardiothoracic anesthesiologist, share his insights on the prevention and management of surgical coagulopathy. Coagulopathy can prevent normal hemostatic mechanisms from functioning, thereby placing certain surgical patients at risk. It becomes incumbent on healthcare professionals who look after such patients to have appropriate measures in place by which to identify and treat acquired coagulation disorders both perioperatively and postoperatively.
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