Condition in which the blood’s ability to coagulate (form clots) is impaired
POPULARITY
3 episodes with Coagulopathy
4 episodes with Coagulopathy
4 episodes with Coagulopathy
3 episodes with Coagulopathy
3 episodes with Coagulopathy
2 episodes with Coagulopathy
2 episodes with Coagulopathy
2 episodes with Coagulopathy
2 episodes with Coagulopathy
In this episode of The One Thing Podcast, hosted by Dr. Adam Rinde, the focus is on integrative and naturopathic medicine, specifically addressing complex chronic illnesses and cancer care. Dr. Rinde introduces the guest, Dr. Paul Anderson, a leading voice in the field with over 30 years of clinical experience. The episode aims to explore the topic of coagulopathy in chronic disease, discussing its mechanisms, implications, and potential treatments. Guest Highlights • Dr. Paul Anderson: o Leading voice in integrative and naturopathic medicine. o Specializes in complex chronic illness and cancer care. o Over 30 years of clinical experience. o Led the interventional arm of a US NIH-funded human research trial on IV and integrative therapies for cancer patients. o Founder of Advanced Medical Therapies in Seattle, Washington. o Collaborates with clinics and hospitals worldwide. o Academic contributions include serving as a professor of pharmacology and clinical medicine and as the chief of IV Services for Baer's Oncology Research Center. o Published works include "Outside the Box Cancer Therapies" and "Cancer, the Journey for Diagnosis to Empowerment." o Notable work on intravenous nutrient therapy featured in a scientific reference textbook. Main Topics Covered 1. Mechanisms of Coagulation: o Discussion on the intrinsic and extrinsic pathways of coagulation. o Role of immune chemicals in triggering clotting. o Impact of chronic illnesses and infections like COVID-19 on coagulation. 2. Coagulopathy in Chronic Disease: o Excessive coagulation in chronic disease states. o Specific conditions discussed include COVID-19, fibromyalgia, chronic fatigue syndrome, and POTS (postural orthostatic tachycardia syndrome). o How coagulopathies may hinder patient recovery and the importance of assessing and addressing these issues. 3. Genetic and Environmental Factors: o Influence of genetics on susceptibility to hypercoagulability. o Role of diet, hydration, and lifestyle in managing coagulation issues. o Importance of testing and early detection for prevention and treatment. 4. Treatment Approaches: o Use of supplements like vitamin E, omega oils, and fibrinolytic enzymes (e.g., nattokinase, lumbrokinase). o Potential use of baby aspirin for managing clotting issues. o Importance of a stepwise approach to treatment, starting with lifestyle modifications and progressing to more intensive interventions if necessary. 5. Biofilm and Chronic Infections: o Connection between biofilm formation and chronic infections. o How pathogens use fibrin to form protective biofilms, complicating treatment. o Strategies for breaking down biofilms to improve patient outcomes. 6. Hope and Recovery: o Emphasis on the possibility of recovery from chronic illnesses and coagulopathies. o Importance of finding a supportive healthcare team and utilizing available resources for treatment and management Related Links 1. Dr. Paul Anderson's Books: o "Outside the Box Cancer Therapies" by Dr. Paul Anderson and Dr. Mark Stengler o "Cancer, the Journey from Diagnosis to Empowerment" by Dr. Paul Anderson 2. Research on Coagulation and COVID-19: o Studies on interleukin-6 and its role in COVID-19 o Research on microclots in COVID-19 patients 3. Supplements Mentioned: o Nattokinase o Lumbrokinase o Baby aspirin o Vitamin E o Omega oils 4. Organizations and Labs: o Fry Laboratories (historical reference) 5. Conditions Discussed: o COVID-19 and Long COVID Socials Mentioned: • Social Media Handles: o Twitter: @DrAConsult o LinkedIn: Dr. Paul Anderson • Website: ConsultDrAnderson.com --- Support this podcast: https://podcasters.spotify.com/pod/show/onethingpod/support
Got a young patient who just won't stop bleeding from their microchip site, vaccine site, or gingiva after deciduous tooth loss? There's a good chance they have a coagulopathy. We see two types of coagulopathy in practice - congenital and acquired - and it's those congenital ones we're discussing today. It's important we pick up on these as soon as possible in the patient's life, to prevent severe haemorrhage at the time of neutering or during other procedures. Identifying congenital coagulopathies starts with understanding what they are, and how they impact our patients - which is exactly what you'll be able to do after this episode. ---
Moderator: BobbieJean Sweitzer, M.D. Participants: Karim Brohi, M.D. and Richard P. Dutton, M.D., M.B.A. Articles Discussed: Correction of Trauma-induced Coagulopathy by Goal-directed Therapy: A Secondary Analysis of the ITACTIC Trial Tactics versus Strategy in Trauma Resuscitation Transcript
Today we're diving deep into a critical and often deadly complication in septic patients: Sepsis-Induced Coagulopathy or SIC. We'll be discussing the pathophysiology, clinical presentation, diagnosis, and management strategies based on a comprehensive narrative review by Drs. Brittney Williams, Lin Zou, Jean-Francois Pittet, and Wei Chao. Here's some of what we discuss in this episode: The pathophysiology of SIC is a complex interplay between the immune and coagulation systems. We'll discuss the diagnostic criteria and tools in detail. Early and accurate diagnosis is essential for initiating appropriate management strategies and improving patient outcomes. Management of SIC involves both supportive care and targeted therapies. Ongoing research is essential to develop more effective diagnostic tools and treatment strategies. Visit us online and get show resources here: https://beyondthemaskpodcast.com/ Get the CE Certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf Help us grow by leaving a review: https://podcasts.apple.com/us/podcast/beyond-the-mask-innovation-opportunities-for-crnas/id1440309246
You receive a page from labour ward. A woman at 35/40 weeks gestation has just arrived in the hospital very distressed in a lot of pain. A quick bedside ultrasound by the obstetric team has unfortunately demonstrated a large abruption and fetal death in utero. She is contracting strongly and beside herself in pain, the team would like you to come down and place an epidural for analgesia. The team are hoping she will deliver vaginally in the next few hours. What is your approach in this situation? Join Graeme and I as we discuss this complex and challenging clinical condition and the coagulopathy that can occasionally occur. Here is a link to cases we have had in the past here at KEMH in the ROTEM Real Cases Discussed section: Case 6 - Abruption and fetal death in utero Case 11 - Abruption and severe coagulopathy References Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy 2015 Liverpool Womens Hospital - this is not open access but available through the ANZCA library or your hospital library. It contains 4 very interesting case reports Fibrinolytic and thrombotic DIC an explanation 2023 - This paper explains how there are two types of DIC one predominantly causing microvascular thrombosis and eventually factor depletion. The second which is possibly the mechanism seen in some abruptions is massive activation of fibrinolysis and fibrinogenolysis. WARNING this paper is highly technical!
More clinical pearls from ACP #IM2024, including emerging infectious diseases in the US (malaria, dengue, super gonorrhea, and a resurgence of syphilis), new C. diff treatments, coagulopathy and cirrhosis, fatty liver disease, HFpEF, peripheral arterial disease, Lp(a) and ApoB, CAR T-cells for autoimmune disease, SGLT2i for gout, and hematology updates. Paul and Watto are joined by Drs. Nora Taranto, Beth Garbitelli, and of course Chris “The Chiu Man” Chiu. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Tropical Diseases: Resurgence of Malaria and Dengue Fever 03:44 Infectious Diseases: Syphilis Rates and New Treatments for C. diff 08:28 Coagulopathy and Cirrhosis: Managing Hemostasis and Portal Vein Thrombosis 11:34 Fatty Liver Disease: Risk Stratification and Treatment 14:59 Cardiology Updates: Cardiovascular Kidney Metabolic Syndrome 31:03 New Medications for Hypertension 32:54 Renal Denervation and Hypertension 33:51 Lp(a) Drugs and Their Potential 36:01 Peripheral Arterial Disease and Claudication 38:10 SGLT2 Inhibitors and Gout 41:50 APO-B and LDL Cholesterol 42:45 Secondary Hypogonadism and Head and Neck Radiation 45:30 VEXAS: A Genetic Autoimmune Condition 49:08 Obesity-Induced Leukocytosis 52:49 CAR T-Cell Therapy in Rheumatologic Diseases Credits Producers/Writers/Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD, Chris Chiu MD, Beth Garbitelli MD CME, Cover Art: Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Reviewer: Nora Taranto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Sponsor: Litter Robot Go to stopscooping.com/CURB and enter promocode CURB to save an EXTRA $50 on any Litter-Robot bundle. Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Beginly Visit beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice
Shelby Mills on behalf of the UTH Medical Genetics Team, invites you to consider three mystery cases serving to hi-light some common, and some less common, presenting features for a treatable inherited metabolic disease. Arginase deficiency masked by cerebral palsy and coagulopathy—Three varied presentations of Latin American origin Shelby L. Mills, et al https://doi.org/10.1002/jmd2.12397
In this week's episode, we'll review a detailed safety profile of acalabrutinib versus ibrutinib in patients with previously treated chronic lymphocytic leukemia, discuss a report that leukocyte inflammation contributes to trauma-induced coagulopathy by oxidation and degradation of fibrinogen, and finally, discuss a pharmacokinetic-pharmacodynamic analysis that shows higher abatacept exposure decreases occurrence of acute graft versus host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) from an unrelated donor.
How does Military Medicine learn lessons and overcome barriers in trauma resuscitation? How have transfusion practices on the battlefield evolved? Tune in and find out! Intro: WarDocs had the pleasure of discussing the evolution of transfusion medicine on the battlefield with LTC(R) Philip C. Spinella, MD, a Professor in the Departments of Surgery and Critical Care Medicine and Co-director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. We delved into the history of blood transfusion practices during the Vietnam War, the shift from using whole blood to a mixture of red cells and crystalloids, and the lessons learned from Iraq and Afghanistan. We also explored the concept of damage control resuscitation, the transition from component therapy to whole blood therapy, and the barriers faced in developing high-level evidence through randomized controlled trials. Additionally, we touched on life-threatening hemorrhage in pediatric patients, the differences between adult and pediatric populations, and the future of therapy for life-threatening hemorrhage. Don't miss this fascinating episode highlighting the importance of having various tools in the "toolbox" to ensure the best care for patients experiencing life-threatening hemorrhage. Chapters: (0:00:00) - Transfusion Medicine on Battlefield (0:09:12) - The Evolution of Hemostatic Resuscitation (0:18:24) - Damage Control Resuscitation (0:28:10) - Trauma Care (0:37:08) - Precision Transfusion Medicine Chapter Summaries: (0:00:00) - Transfusion Medicine on Battlefield (9 Minutes) In this episode, we explore the evolution of transfusion medicine on the battlefield with LTC(R) Philip C. Spinella, MD, a Professor in the Departments of Surgery and Critical Care Medicine and Co-director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. We discuss how strategies for hemostatic resuscitation have moved from component therapy to whole blood transfusion. Dr. Spinella shares his experiences deploying to Baghdad in 2004 and working with the 31st Combat Support Hospital. (0:09:12) - The Evolution of Hemostatic Resuscitation (9 Minutes) We dive into the history of blood transfusion practices during the Vietnam War and the shift from using whole blood to a mixture of red cells and crystalloids. The conversation highlights the lessons learned from Iraq and Afghanistan and the importance of keeping this knowledge alive for future conflicts. The discussion also covers the role of transfusion ratios in improving outcomes, the origin of the one-to-one-to-one ratio, and the use of recombinant activated factor VIIa in trauma resuscitation. Dr. Philip C Spinella shares the fascinating story behind these developments and the importance of considering a bundle of care for optimal patient outcomes. (0:18:24) - Damage Control Resuscitation (10 Minutes) We discuss the concept of damage control resuscitation and the transition from component therapy to whole blood therapy with the various barriers that needed to be overcome. Focusing on the importance of safety in transfusion medicine, we explore the challenges in developing high-level evidence through randomized controlled trials and the alternative approach of focused empiricism. We also examine the three main barriers to whole blood use in hemostatic resuscitation: ABO specificity, leukocyte reduction, and cold storage platelets. (0:28:10) - Trauma Care (9 Minutes) In this conversation, we examine life-threatening hemorrhages in pediatric patients and the differences between adult and pediatric populations. We discuss an NIH-sponsored prospective observational study that found a higher mortality rate in children with massive bleeding compared to adults. We also explore the types of whole blood, their nuances, and how they differ from component therapy. Additionally, we touch on the role of freeze-dried plasma in transfusion options and the current state of synthetic blood products. Ultimately, we emphasize the importance of having various tools in the "toolbox" to ensure the best care for patients experiencing life-threatening hemorrhage. (0:37:08) - Precision Transfusion Medicine (9 Minutes) We delve into the development of a dry artificial whole-blood product and its potential applications for various types of bleeding. This project, funded by DARPA, aims to create custom-made whole blood-like products specific to a patient's coagulopathy. We also discuss the challenges and barriers in conducting clinical trials in transfusion medicine, emphasizing the importance of funding, access to blood products, and the need for precision transfusion medicine. The conversation also touches on the future of therapy for life-threatening hemorrhage, focusing on metabolism-reducing agents to salvage patients in shock. Episode Keywords: Transfusion Medicine, Battlefield, Hemostatic Resuscitation, Whole Blood Therapy, Component Therapy, Damage Control Resuscitation, Vietnam War, Iraq and Afghanistan, Trauma Care, Life-Threatening Hemorrhage, Pediatric Patients, Blood Transfusion Practices, ABO Specificity, Leukocyte Reduction, Cold Storage Platelets, Freeze-Dried Plasma, Synthetic Blood Products, Precision Transfusion Medicine, Coagulopathy, Metabolism-Reducing Agents #wardocs #military #medicine #podcast #TransfusionMedicine #BattlefieldMedicine #HemostaticResuscitation #WholeBloodTherapy #DamageControlResuscitation #PediatricHemorrhage #TransfusionResearch #MilitaryMedicine #BloodTransfusionEvolution #LifeSavingMedicine Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission is to improve military and civilian healthcare and foster patriotism by honoring the legacy, preserving the oral history, and showcasing military medicine career opportunities, experiences, and achievements. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/episodes Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in military medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast
Calcium administration to trauma patients has become a hot topic with the rise of the “Lethal Diamond." While evidence exists regarding the association between hypocalcemia and mortality, it remains unclear whether hypocalcemia is the problem or simply a finding secondary to critical injury. In this podcast, Dr. Lauria reviews the evidence behind calcium administration in trauma and identifies which patients, given the available evidence, might benefit from calcium administration. Don't miss another FlightBridgeED Podcast feature episode of the MDCast! So much good stuff! Please like, subscribe, and leave any questions or comments. References for the use of Calcium in Severe Trauma Chanthima P, Yuwapattanawong K, Thamjamrassri T, et al. Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma. Anesth Analg. Jun 1 2021;132(6):1684-1691. doi:10.1213/ANE.0000000000005431 D B. Prehospital administration of calcium in trauma J Paramed Prac. 2022; DeBot M, Sauaia A, Schaid T, Moore EE. Trauma-induced hypocalcemia. Transfusion. Aug 2022;62 Suppl 1:S274-S280. doi:10.1111/trf.16959 Ditzel RM, Jr., Anderson JL, Eisenhart WJ, et al. A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. Mar 2020;88(3):434-439. doi:10.1097/TA.0000000000002570 Giancarelli A, Birrer KL, Alban RF, Hobbs BP, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. May 1 2016;202(1):182-7. doi:10.1016/j.jss.2015.12.036 Kronstedt S, Roberts N, Ditzel R, et al. Hypocalcemia as a predictor of mortality and transfusion. A scoping review of hypocalcemia in trauma and hemostatic resuscitation. Transfusion. Aug 2022;62 Suppl 1(Suppl 1):S158-S166. doi:10.1111/trf.16965 Leech C, Clarke E. Pre-hospital blood products and calcium replacement protocols in UK critical care services: A survey of current practice. Resusc Plus. Sep 2022;11:100282. doi:10.1016/j.resplu.2022.100282 Messias Hirano Padrao E, Bustos B, Mahesh A, et al. Calcium use during cardiac arrest: A systematic review. Resusc Plus. Dec 2022;12:100315. doi:10.1016/j.resplu.2022.100315 Moore HB, Tessmer MT, Moore EE, et al. Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock. J Trauma Acute Care Surg. May 2020;88(5):588-596. doi:10.1097/TA.0000000000002614 Savioli G, Ceresa IF, Caneva L, Gerosa S, Ricevuti G. Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes. Medicines (Basel). Mar 24 2021;8(4)doi:10.3390/medicines8040016 Steele T, Kolamunnage-Dona R, Downey C, Toh CH, Welters I. Assessment and clinical course of hypocalcemia in critical illness. Crit Care. Jun 4 2013;17(3):R106. doi:10.1186/cc12756 Stueven H, Thompson BM, Aprahamian C, Darin JC. Use of calcium in prehospital cardiac arrest. Ann Emerg Med. Mar 1983;12(3):136-9. doi:10.1016/s0196-0644(83)80551-4 Vallentin MF, Granfeldt A, Meilandt C, et al. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. Dec 14 2021;326(22):2268-2276. doi:10.1001/jama.2021.20929 Vallentin MF, Povlsen AL, Granfeldt A, Terkelsen CJ, Andersen LW. Effect of calcium in patients with pulseless electrical activity and electrocardiographic characteristics potentially associated with hyperkalemia and ischemia-sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. Dec 2022;181:150-157. doi:10.1016/j.resuscitation.2022.11.006 Vasudeva M, Mathew JK, Groombridge C, et al. Hypocalcemia in trauma patients: A systematic review. J Trauma Acute Care Surg. Feb 1 2021;90(2):396-402. doi:10.1097/TA.0000000000003027 Vettorello M, Altomare M, Spota A, et al. Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion. J Pers Med. Dec 28 2022;13(1)doi:10.3390/jpm13010063 Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. Mar 2021;41:104-109. doi:10.1016/j.ajem.2020.12.065 Zhang Z, Xu X, Ni H, Deng H. Predictive value of ionized calcium in critically ill patients: an analysis of a large clinical database MIMIC II. PLoS One. 2014;9(4):e95204. doi:10.1371/journal.pone.0095204 See omnystudio.com/listener for privacy information.
Coagulopathy is a severe and frequent complication in critically ill patients, for which the pathogenesis and presentation may be variable depending on the underlying disease. Therefore, a review has been conducted to differentiate between hemorrhagic coagulopathies, characterised by a hypercoagulable and hyperfibrinolysis state, and thrombotic coagulopathies with a systemic prothrombotic and antifibrinolytic phenotype, based on the dominant clinical phenotype. Dr Julie Helms, our podcast guest, will explain more about the review and discuss the differences in pathogenesis and treatment of the common coagulopathies. Original paper: How to manage coagulopathies in critically ill patients SpeakersJulie HELMS. Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg (FR). Ahmed ZAHER. Oxford University Hospitals (UK). NEXT Committee member, ESICM.
The BBANYS Podcast Lecture series presents short lectures on core topics in blood banking, transfusion medicine or cellular therapy for both trainees and seasoned professionals. In this episode, Dr. Gael Uy discusses a patient with intractable coagulopathy after liver transplant.
MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: December 28, 2017 In this week's clinical case, Dr. John Baird (Stanford) shares the story of a patient he's been following who's experienced a neurologic complication of her hematologic illness. Check it out. Produced by James E Siegler. Music by Chris Zabriskie, Ian Southerland, Julie Maxwell, Jason Shaw, and Rafael Archangel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision-making. REFERENCES Bakshi R, Shaikh ZA, Bates VE, Kinkel PR. Thrombotic thrombocytopenic purpura: brain CT and MRI findings in 12 patients. Neurology 1999;52(6):1285-8. PMID 10214762 George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med 2006;354(18):1927-35. PMID 16672704 George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med 2014;371(7):654-66. PMID 25119611 Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AA. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood 2015;125(9):1470-6. PMID 25588677 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode801. In this episode, I’ll discuss the 6th edition of the European guideline on management of major bleeding and coagulopathy following trauma. The post 801: 7 Pharmacotherapy-Related Recommendations from the 6th European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma appeared first on Pharmacy Joe.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode801. In this episode, I’ll discuss the 6th edition of the European guideline on management of major bleeding and coagulopathy following trauma. The post 801: 7 Pharmacotherapy-Related Recommendations from the 6th European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma appeared first on Pharmacy Joe.
Managing bleeding in a patient with severe trauma is a complex process, with multiple interventions occurring in parallel. Derek Kleinveld is an anesthesiology resident at the Erasmus MC in Rotterdam, The Netherlands, and a post-doc researcher with an interest in Trauma Induced Coagulopathy. He joins Todd to discuss haemostatic resuscitation in trauma.See omnystudio.com/listener for privacy information.
Today's guests are Lynn Miller, DO, FACOS, director of education, and Kelly Burns, CCS, education analyst, both at Accuity in Mt. Laurel, New Jersey. Today's show is co-hosted by Sharme Brodie, RN, CCDS, CCDS-O, CDI education specialist at HCPro and ACDIS in Middleton, Massachusetts. Featured solution: Today's featured ACDIS solution is Imagine: 2022 ACDIS Conference. Imagine the possibilities and join your CDI peers in Orlando May 2–5, 2022, at the Gaylord Palms Resort & Convention Center! As we reconnect after the COVID-19 pandemic, we all need a little magic in our lives, and we all need to Imagine what might be in store for us professionally. The ACDIS annual conference provides countless opportunities to engage personally and professionally with like-minded individuals across the healthcare spectrum. The educational offerings are unparalleled. The networking opportunities are extensive. Our exhibitors are waiting to share their national knowledge. The only necessary ingredient remaining is you. This year we are offering dedicated outpatient CDI content, a masterclass track to improve your interpersonal skills so critical to CDI success, a location with shuttle busses running to the major Disney theme parks, and more! Learn more or register by clicking here. (http://ow.ly/rG5Y30s7Pzt) In the News: 2021 ACDIS CDI Salary Survey report (http://ow.ly/TngM30saOjn) ACDIS update: Send ideas for the “Talking CDI: No punches pulled” panel discussion at the 2022 ACDIS conference to bmurphy@acdis.org
In Part Two of this podcast series (straight from the 2020 Midyear Clinical Meeting), Dr. Igneri describes the clinical manifestations of COVID-19 associated coagulopathy, shares best practices on interpreting the available literature and given a patient scenario, design a treatment plan to manage COVID-19 associated coaguopathy. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode651. In this episode, I’ll discuss the Sepsis-Induced Coagulopathy (SIC) Score. The post 651: What is the Sepsis-Induced Coagulopathy (SIC) Score? appeared first on Pharmacy Joe.
The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
Show notes at pharmacyjoe.com/episode651. In this episode, I’ll discuss the Sepsis-Induced Coagulopathy (SIC) Score. The post 651: What is the Sepsis-Induced Coagulopathy (SIC) Score? appeared first on Pharmacy Joe.
Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat and I'm Rahul Damania. We are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode of 17-year old with h/o of SLE and now acute liver failure. Here's the case presented by Rahul: A 17-year old teenage female year old presents to the PICU with acute liver failure. Important past h/o includes a diagnosis of SLE on therapy with prednisone, mycophenolate (cellcept), and plaquenil. 4 days prior to this admission, patient presented to an OSH with RUQ pain, vomiting (non bloody & no bilious), fever & malaise. Initially due to concern for "lupus Flare" patient was given steroids at the OSH. At the OSH notable initial labs included a mild transaminitis and an INR of 1.5. She suddenly at the OSH developed fluid refractory hypotension and was started on a pressor. Due to continued worsening of her transaminitis well as a rising INR on her repeat labs she was referred to our tertiary PICU for further management. Pertinent history also includes a negative urine pregnancy test. No recreational drug use, and only as needed use of Tylenol. She now is in the PICU. She generally appears tired and ill. She is tachypneic on 4 LPM of nasal canulla and her oxygen saturation is 98%. She has a non-focal lung exam. Her cardiac exam is notable for tachycardia, and pertinently no gallop, rub or murmur. Her abdominal exam is non-focal except for mild discomfort on palpation of the RUQ with a palpable liver edge. Her extremities are cool with 3-4 capillary refill time. She is able to answer questions but intermittently doses off. No rash is noted. To summarize key elements from this case, this patient has: H/o of lupus and is on immunosuppressive medications New onset fever/malaise This sounds like a LUPUS flare as she has a clinical picture of generalized inflammation. Rahul: Lets pause right here and take a look at key history and physical exam components in a patient who has a chronic auto-immune condition: Fever, malaise and feeling tired all signs of constitutional symptoms. She has abdominal pain and vomiting that could again be related to systemic inflammation but also an intra-hepatic lesion. Are there some red-flag symptoms or physical exam components which you could highlight? This patient has signs of shock! Tachycardia with delayed cap refill and cool extremities Tachypnea & hepatomegaly which could indicate increased central venous pressures. Initially her outside presentation of fluid refractory shock is of utmost concern! Fluid refractory shock with multi organ presentation involving liver, kidney and the blood/coagulation systems All of these elements bring up a concern for some acute life threatening process such as sepsis, or even immune dys-regulation due to her h/o of Lupus To continue with our case, the patients labs were consistent with:Acute liver dysfunction (Elevated AST and ALT in the thousands, Total bilirubin 1.6, GGT 56) although the total bilirubin is not elevated to a degree I would expect. AKI (creatinine 2.18) An uptrending Coagulopathy with elevated PT and INR: PT 120 and a peak INR of 16 Thrombocytopenia: Platelets < 50K She had a peak lactate 9.2 and concurrent Metabolic acidemia: serum HCO3 7, and pH 7.18. A Pertinent negative: Normal serum ammonia
Hemorrhage, Coagulopathy, and Transfusion Medicine with John Kowalcz
EMplify - September 2021 Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net ! Abnormal Uterine Bleeding in the Emergency Department Authors: Tazeen Abbas, MD Abbas Husain, MD, FACEP Physiology review Terminology Differentiating Causes: PALM-COEIN Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise Age Based Differential 12-18 Immaturity of the hypothalamic-pituitary- ovarian axis Sexually transmitted infections Coagulopathies, and bleeding disorders (von Willibrand disease) 19-39 polyps fibroids malignancy PCOS Age 40 and older endometrial atrophy malignancy History Physical Exam Diagnostic Studies Treatment Unstable Stable Special Cases DOACs Prepubescent girls genital injuries
EMplify - September 2021 Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net ! Abnormal Uterine Bleeding in the Emergency Department Authors: Tazeen Abbas, MD Abbas Husain, MD, FACEP Physiology review Terminology Differentiating Causes: PALM-COEIN Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise Age Based Differential 12-18 Immaturity of the hypothalamic-pituitary- ovarian axis Sexually transmitted infections Coagulopathies, and bleeding disorders (von Willibrand disease) 19-39 polyps fibroids malignancy PCOS Age 40 and older endometrial atrophy malignancy History Physical Exam Diagnostic Studies Treatment Unstable Stable Special Cases DOACs Prepubescent girls genital injuries
Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat and I'm Rahul Damania. We are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode of 17-year old with h/o of SLE and now acute liver failure. Here's the case presented by Rahul: A 17-year old teenage female year old presents to the PICU with acute liver failure. Important past h/o includes a diagnosis of SLE on therapy with prednisone, mycophenolate (cellcept), and plaquenil. 4 days prior to this admission, patient presented to an OSH with RUQ pain, vomiting (non bloody & no bilious), fever & malaise. Initially due to concern for "lupus Flare" patient was given steroids at the OSH. At the OSH notable initial labs included a mild transaminitis and an INR of 1.5. She suddenly at the OSH developed fluid refractory hypotension and was started on a pressor. Due to continued worsening of her transaminitis well as a rising INR on her repeat labs she was referred to our tertiary PICU for further management. Pertinent history also includes a negative urine pregnancy test. No recreational drug use, and only as needed use of Tylenol. She now is in the PICU. She generally appears tired and ill. She is tachypneic on 4 LPM of nasal canulla and her oxygen saturation is 98%. She has a non-focal lung exam. Her cardiac exam is notable for tachycardia, and pertinently no gallop, rub or murmur. Her abdominal exam is non-focal except for mild discomfort on palpation of the RUQ with a palpable liver edge. Her extremities are cool with 3-4 capillary refill time. She is able to answer questions but intermittently doses off. No rash is noted. To summarize key elements from this case, this patient has: H/o of lupus and is on immunosuppressive medications New onset fever/malaise This sounds like a LUPUS flare as she has a clinical picture of generalized inflammation. Rahul: Lets pause right here and take a look at key history and physical exam components in a patient who has a chronic auto-immune condition: Fever, malaise and feeling tired all signs of constitutional symptoms. She has abdominal pain and vomiting that could again be related to systemic inflammation but also an intro-hepatic lesion. Are there some red-flag symptoms or physical exam components which you could highlight? This patient has signs of shock! Tachycardia with delayed cap refill and cool extremities Tachypnea & hepatomegaly which could indicate increased central venous pressures. Initially her outside presentation of fluid refractory shock is of utmost concern! Fluid refractory shock with multi organ presentation involving liver, kidney and the blood/coagulation systems All of these elements bring up a concern for some acute life threatening process such as sepsis, or even immune dys-regulation due to her h/o of Lupu To continue with our case, the patients labs were consistent with: Acute liver dysfunction (Elevated AST and ALT in the thousands, Total bilirubin 1.6, GGT 56) although the total bilirubin is not elevated to a degree I would expect. AKI (creatinine 2.18) An uptrending Coagulopathy with elevated PT and INR: PT 120 and a peak INR of 16 Thrombocytopenia: Platelets < 50K She had a peak lactate 9.2 and concurrent Metabolic acidemia: serum HCO3 7, and pH 7.18. A Pertinent negative: Normal serum ammonia
In this episode of the Award-winning PRS Journal Club Podcast, 2021 Resident Ambassadors to the PRS Editorial Board – Saïd Azoury, Lindsay Janes, and Ara Salibian- and special guest Hani Sbitany, MD, discuss the following articles from the July 2021 issue: “The Impact of Coagulopathy on Clinical Outcomes following Microsurgical Breast Reconstruction” by Liu, Miller, Wan, and Momeni. Read the article for FREE: https://bit.ly/BreastReconCoagulopathy Special Guest Hani Sbitany, MD, is an Associate Professor of Plastic and Reconstructive Surgery at Mount Sinai in New York City. READ the articles discussed in this podcast as well as free related content from the archives: http://bit.ly/PRSJCJuly21Collection
Explore the intersection of hematology and women's health as we discuss heavy menstrual bleeding (HMB), gynecologic risks of therapeutic anticoagulation, and prescribing contraception in the setting of venous thromboembolic disease. Wondering how to expand your women's health knowledge as an internist? Listen as our insightful guest Dr. Bethany Samuelson Bannow @bsamuelson_md (Oregon Health & Science University) helps us navigate the intersections between non-malignant hematology and menstrual health. This episode will empower you to tackle the stigma and overcome knowledge gaps with regard to abnormal menstrual bleeding, as well as learn treatment, and management pearls. We also explore the intersection between therapeutic anticoagulation, heavy menstrual bleeding, and thromboembolic disease of different contraceptive options. Finally, we face the themes of overcoming sexism, and even misogyny, in women's health head-on throughout this episode. After all, half the population has a uterus. Claim Free CE credit for this episode through VCU Health CE at http://curbsiders.vcuhealth.org/ Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and Produced by: Avital O'Glasser MD, FACP, FHM Infographic: Avital O'Glasser MD, FACP, FHM Cover Art : Kate Grant MBChB MRCGP DipGUMed Show Notes: Kate Grant MBChB MRCGP DipGUMed, Maddie Morgan, and Avital O'Glasser MD, FACP, FHM Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Avital O'Glasser MD, FACP, FHM Reviewer: Carolyn Chan, MD Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Bethany Samuelson Bannow, MD Sponsor: Birch by Helix birchliving.com/curb Sponsor: Green Chef GreenChef.com/curb100 CME Partner: VCU Health CEThe Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit. Show Segments Intro, disclaimer, guest bio Guest one-liner Case 1 from Kashlak Definitions related to menstrual health Quantifying/defining heavy menstrual bleeding Overcoming stigma of asking about menstrual history/health Clinical evaluation/management of the patient with heavy menstrual bleeding Case 2 from Kashlak Risk of heavy menstrual bleeding (HMB) in the setting of therapeutic anticoagulation Hormonal and nonhormonal therapy options for HMB while anticoagulated Contraception options for someone who develops VTE Case 3 from Kashlak Counseling about VTE risk of different contraception options Take Home Points; Outro; Bonus clip
Moderator: BobbieJean Sweitzer, M.D. Participants: Jerrold Levy, M.D., and Jean M. Connors, M.D.
It's the JournalFeed Podcast for the week of Jun 7-11, 2021. We cover overuse of antibiotics for ED sepsis alerts, HEART or EDACS with hs-cTn 0-1 hour rule outs, ED-AWARENESS - paralysis awareness after RSI, thoracentesis or chest tubes in coagulopathic patients, and a review on managing the difficult airway.
Colorectal cancer screening update, COVID-19 vaccine update, and abnormal uterine bleeding basics.Today is May 24, 2021.Colorectal cancer screening update Written by Hector Arreaza, MD. Participation: Ikenna Nwosu, MD, and Daniela Viamontes, MD.Today is May 24, 2021.On august 29, 2020, we were in the midst of a pandemic and we woke up with the sad news about the death of Chadwick Aaron Boseman (also known as Black Panther). An interesting fact: The tweet in which his family announced his death on Twitter became the most-liked tweet in history. But why are we talking about Chadwick’s death? Because he died of colon cancer. I do not know if this recommendation came because of Chadwick, but it’s a good way to open this episode: remembering Black Panther.We heard the rumors, but now it’s official. On May 18, 2021, the USPSTF released their final recommendation statement about colorectal cancer screening. The age to start screening has been changed from 50 to 45 years old. This is a grade B recommendation. Grade B means that this recommendation has moderate to substantial net benefit, so offer this service to your patients. Screening adults between 76 and 85 years old who have been previously screened has a small net benefit (grade C recommendation). So, select patients may be screened for colorectal cancer in this age group (76-85), especially those who have never been screened.Do you remember this recommendation from medical school for high risk patients? Start screening at age 40 or 10 years before a patient’s direct-relative was diagnosed with colon cancer. This was a recommendation given by the US Multi-Society Task Force (which includes the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy). This same organization already recommended in 2017 to start screening at age 45 in African American patients, and the American Cancer Society recommended screening all patients at age 45 in 2018. The ACS does not have a guideline to screen high risk patients for colon cancer. Most organizations agreed on not screening after age 85.Strategies for screening:High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every yearDani: Stool DNA-FIT every 1 to 3 years (Cologuard®) CT colonography every 5 years Flexible sigmoidoscopy every 5 years OR Flexible sigmoidoscopy every 10 years + annual FIT Colonoscopy screening every 10 yearsDiscuss different options with your patients, choose your favorite and do it! Introduction: Update on COVID 19 vaccines By Hector Arreaza, MD, and Lillian Petersen, RN. COVID-19 vaccines now can be co-administered with other vaccines according to the ACIP. COVID-19 vaccines and other vaccines may now be administered without regard to timing. They can be given on the same day or within the 14 days previously recommended between vaccines. It is not known if reactogenicity of COVID-19 vaccine is increased with co-administration with other reactogenic vaccines (such as vaccines with live attenuated viruses). How do you decide if you want to co-administer a vaccine? 1. Consider whether the patient is behind or at risk of becoming behind on recommended vaccines.2. Consider their risk of vaccine-preventable disease.3. Consider the reactogenicity profile of the vaccines. If multiple vaccines are administered at a single visit, administer each injection in a different injection site, at least one inch apart or in different limbs. Current or previous SARS-CoV-2 infection: Everyone should be offered COVID-19 vaccination regardless of their history of COVID-19 infection. Viral testing or serologic test is not recommended for the purposes of vaccine decision-making. People with current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness (if the person had symptoms) and they have met criteria to discontinue isolation. This applies to patients who got the disease before receiving any vaccine or after receiving the first dose. A minimum interval between infection and vaccination has not been established, but evidence suggests that the risk of reinfection is low in the months after initial infection but may increase with time due to waning immunity. People with a history of multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A):It is unclear if people with a history of MIS-C or MIS-A are at risk of recurrence of the same dysregulated immune response following reinfection with SARS-CoV-2 or in response to vaccination. People with a history of MIS-C or MIS-A may choose to be vaccinated but they should consider delaying vaccination until they have recovered from their illness and for 90 days after the date of diagnosis. Find more information at the CDC.gov website. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Abnormal Uterine Bleeding. By Sherika Adams, MS3, P. Eresha Perera, MS3, and Hector Arreaza, MD. Definition. AUB is a symptom, not a diagnosis. It is equivalent to say: “This patient’s periods are abnormal.” Anything that falls out of what is considered “normal periods” is classified as abnormal uterine bleeding.These 4 elements are assessed when determining if a patient has AUB: Regularity, frequency, duration, and volume. What is considered normal? Frequency = Every 24-38 days, regularity +/- 2-20 days over 12 months, duration = 4.5 to 8 days, volume = 5-80 mL. 10-30% of women of reproductive age may have AUB. According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is characterized by bleeding or spotting following sexual intercourse or menopause, between menstrual cycles, menstrual cycles lasting more than 38 days or shorter than 24 days, heavy bleeding during menstruation, and “irregular” menstrual cycles that have 7-9 days of variation.Terms no longer used: menorrhagia, metrorrhagia, and dysfunctional uterine bleeding (DUB). Not all symptoms reported as “vaginal bleeding” are coming from the vagina. For example, bleeding from anus, urethra, bladder, and perineum should be ruled out before establishing the diagnosis of AUB. Classification of Abnormal Uterine Bleeding (AUB). Abnormal uterine bleeding (AUB) in nonpregnant premenopausal women can be classified by the acronym PALM-COEIN, which was established by the International Federation of Gynecology and Obstetrics (FIGO) in 2011. PALM-COEIN: Palm: Structural etiologies, Coein: Non-structural etiologies P is for polyps: Polyps are epithelial tumors in the endometrium or cervix and can be identified by hysterosonography or hysteroscopic imaging. A is for adenomyosis: Adenomyosis is endometrial stroma and glands in the myometrium and can be identified by histopathology, and now MRI and transvaginal ultrasound. L is for leiomyomas: Leiomyomas also known as uterine fibroids are benign smooth muscle tumors that are diagnosed by pelvic examination and pelvic imaging such as ultrasound with contrast or MRI. M is for malignancy and hyperplasia: Malignancy and hyperplasia are often abnormal epithelial tissue that is benign or cancerous that can be seen with transcervical endometrial sampling. C is for coagulopathy: Coagulopathy is bleeding disorders such as Von Willebrand disease is identified by laboratory testing. O is ovulatory dysfunctions: Ovulatory dysfunction occurs when there is a variation of more than seven days of the menstrual cycle in the past 12 months and ovulation is dysfunctional. In a woman without ovulation, there is no corpus luteum, and there is no progesterone, so estrogen goes unopposed, causing a buildup of endometrium and irregular bleeding. E is endometrial causes: Endometrial causes can occur when there is normal ovulation, no other identifiable cause of AUB, and there is heavy menstrual bleeding, which includes intermenstrual bleeding. Primary disorders of endometrial hemostasis are likely due to vasoconstriction disorders, inflammation, or infection. Endometrial dysfunction is poorly understood; there are no reliable diagnostic methods, and it should be considered only after other causes are excluded. I is for iatrogenic cause: Iatrogenic causes include gonadal steroids (estrogen, androgens), anticoagulants, intrauterine devices, antipsychotics, antidepressants, and anti-hypertensives. N is for not otherwise classified: Example of an etiology under not otherwise classified might be AV malformations. This classification does not include pregnancy. Postmenopausal bleeding: Abnormal uterine bleeding can also occur in post-menopausal women and is an indication of potentially lethal endometrial cancer. Post-menopausal women should be worked up for cancer when they present with bleeding. However, most common cause of bleeding in this population is atrophy of the vaginal mucosa or endometrium. If younger than 45 patients but history of unopposed estrogen exposure (PCOS, obesity, estrogen therapy) should also undergo endometrial biopsy to rule out possibility of endometrial cancer. Management of AUB. Management of the AUB can be initiated only after the etiology of the bleeding has been established. Firs of all, rule out pregnancy related bleeding by performing a pregnancy test. Also, rule out other sources of bleeding. The first question to answer would be: Does this patient need an emergent treatment for her AUB or can she be treated as outpatient? Determine that by checking the history, vitals, orthostatic vitals, physical exam, and labs. If patient requires admission, the options for treatment include: uterine tamponade, intravenous estrogen, dilation and curettage, and uterine artery embolization. In case of severe bleeding without hemodynamic instability, patients can be treated initially with oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, or intravenous tranexamic acid.For chronic AUB, once etiology has been established, the goal is to treat the underlying condition. The goal of treatment is to control the bleeding since AUB can persists until menopause. Initial outpatient treatment is usually pharmacological. For those not wanting to conceive soon, consider IUD placement. “Among medical therapies, the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is most effective for decreasing heavy menstrual bleeding (71% to 95% reduction in blood loss) and performs similarly to hysterectomy when quality-adjusted life years are considered.”[8] Other long-term medical treatment options include estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, NSAIDs (nonsteroidal anti-inflammatory drugs), and depot medroxyprogesterone. Surgical treatment is often considered for patients on long term medical therapy with no response, or for severe cases of bleeding with recurrent need for emergent treatment. Some surgical options are endometrial ablation, which performs as well as the levonorgestrel-releasing intrauterine system. Some structural lesions can be resected via hysteroscopy (polyps). Myomectomy and uterine artery embolization are options for patients with severe AUB who want to preserve fertility. Uterine leiomyomas or adenomyosis can be medically managed with OCPs but can also be treated with surgery as well, depending on the physician-patient discussion of options. Hysterectomy is the definitive treatment of severe AUB. Remember, PALM COEIN stands for: Polyps, Adenomyosis, Leiomyomas, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic cause, Not otherwise classified. ____________________________Conclusion. Written by Hector Arreaza, MDNow we conclude our episode number 53 “Abnormal Uterine Bleeding”. Eresha and Sherika did a great job explaining the Palm-Coein classification, and gave us a good overview of the management of AUB. Remember to start screening for colorectal cancer at age 45 now, what strategy for screening will you use? And for those patients who were hesitant about getting the COVID-19 vaccine with other vaccines, well, the ACIP said we can co-administer it with other vaccines. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Daniela Viamontes, Ikenna Nwosu, Lillian Petersen, Sherika Adams, and P. Eresha Perera. Audio edition: Suraj Amrutia. See you next week! _____________________References:U.S. National Library of Medicine, Clinical Trials.Gov, https://clinicaltrials.gov/ct2/show/study/NCT02026869. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, Centers for Disease Control and Prevention, https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Coadministration, accessed on May 20, 2021. Colorectal Cancer: Screening, Final Recommendation Statement, U.S. Preventive Services Task Force, May 18, 2021, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Abnormal Uterine Bleeding FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding, accessed on May 17, 2021. Fraser, Ian, et al. Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification, Up to Date, last updated: Dec 16, 2019. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-reproductive-age-women-terminology-and-palm-coein-etiology-classification?search=palm%20coein&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Goodman Annekathryn, et al, Postmenopausal uterine bleeding, Up to Date, last updated: Feb 02, 2021. https://www.uptodate.com/contents/postmenopausal-uterine-bleeding?search=abnormal%20uterine%20bleeding%20postmenopausal&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Kaunitz, Andre M, Abnormal uterine bleeding: Management in premenopausal patients, Up to Date, last updated: Aug 25, 2020. https://www.uptodate.com/contents/abnormal-uterine-bleeding-management-in-premenopausal-patients?search=abnormal%20uterine%20bleeding%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019 Apr 1;99(7):435-443. PMID: 30932448. https://pubmed.ncbi.nlm.nih.gov/30932448/
Referências1.Sista AK, Kuo WT, Schiebler M, Madoff DC. Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary Embolism. Radiology. 2017;284(1):5-24.2.Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.3.Essien EO, Rali P, Mathai SC. Pulmonary Embolism. Med Clin North Am. 2019;103(3):549-64.4.Albrecht MH, Bickford MW, Nance JW, Jr., Zhang L, De Cecco CN, Wichmann JL, et al. State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol. 2017;208(3):495-504.5.Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-43.6.Kline JA. Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res. 2018;163:207-20.7.Raju S, Ghosh S, Mehta AC. Chest CT Signs in Pulmonary Disease: A Pictorial Review. Chest. 2017;151(6):1356-74.8.Lyhne MD, Schultz JG, MacMahon PJ, Haddad F, Kalra M, Tso DM, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol. 2019;26(6):623-30.9.Beenen LFM, Bossuyt PMM, Stoker J, Middeldorp S. Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism. Eur Respir J. 2018;52(1).10.Doherty S. Pulmonary embolism An update. Aust Fam Physician. 2017;46(11):816-20.11.Peiman S, Abbasi M, Allameh SF, Asadi Gharabaghi M, Abtahi H, Safavi E. Subsegmental pulmonary embolism: A narrative review. Thromb Res. 2016;138:55-60.12.Im DJ, Hur J, Han KH, Lee HJ, Kim YJ, Kwon W, et al. Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured With Dual-Energy CT. AJR Am J Roentgenol. 2017;209(5):1015-22.13.Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, et al. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology. 2018;289(2):546-53.14.Celtikci P, Hekimoglu K, Kahraman G, Bozbas S, Gultekin B, Akay HT. Diagnostic Impact of Quantitative Dual-Energy Computed Tomography Perfusion Imaging for the Assessment of Subsegmental Pulmonary Embolism. J Comput Assist Tomogr. 2021;45(1):151-6.15.O'Shea A, Parakh A, Hedgire S, Lee SI. Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19). AJR Am J Roentgenol. 2021;216(4):1088-98.16.Patelli G, Paganoni S, Besana F, Codazzi F, Ronzoni M, Manini S, et al. Preliminary detection of lung hypoperfusion in discharged Covid-19 patients during recovery. Eur J Radiol. 2020;129:109121.17.Poyiadji N, Cormier P, Patel PY, Hadied MO, Bhargava P, Khanna K, et al. Acute Pulmonary Embolism and COVID-19. Radiology. 2020;297(3):E335-E8.18.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021:204522.19.Hammer MM, Raptis CA. COVID-19 and Pulmonary Thromboembolism. Radiology. 2021;299(2):E252.20.Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-E80.21.Woodard PK. Pulmonary Thromboembolism in COVID-19. Radiology. 2021;298(2):E107-E8.22.Valle C, Bonaffini PA, Dal Corso M, Mercanzin E, Franco PN, Sonzogni A, et al. Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak. Eur J Radiol. 2021;137:109613.23.Ooi MWX, Rajai A, Patel R, Gerova N, Godhamgaonkar V, Liong SY. Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography - Prevalence, pattern of disease and relationship to D-dimer. Eur J Radiol. 2020;132:109336.
Referências1.Sista AK, Kuo WT, Schiebler M, Madoff DC. Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary Embolism. Radiology. 2017;284(1):5-24.2.Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.3.Essien EO, Rali P, Mathai SC. Pulmonary Embolism. Med Clin North Am. 2019;103(3):549-64.4.Albrecht MH, Bickford MW, Nance JW, Jr., Zhang L, De Cecco CN, Wichmann JL, et al. State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol. 2017;208(3):495-504.5.Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-43.6.Kline JA. Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res. 2018;163:207-20.7.Raju S, Ghosh S, Mehta AC. Chest CT Signs in Pulmonary Disease: A Pictorial Review. Chest. 2017;151(6):1356-74.8.Lyhne MD, Schultz JG, MacMahon PJ, Haddad F, Kalra M, Tso DM, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol. 2019;26(6):623-30.9.Beenen LFM, Bossuyt PMM, Stoker J, Middeldorp S. Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism. Eur Respir J. 2018;52(1).10.Doherty S. Pulmonary embolism An update. Aust Fam Physician. 2017;46(11):816-20.11.Peiman S, Abbasi M, Allameh SF, Asadi Gharabaghi M, Abtahi H, Safavi E. Subsegmental pulmonary embolism: A narrative review. Thromb Res. 2016;138:55-60.12.Im DJ, Hur J, Han KH, Lee HJ, Kim YJ, Kwon W, et al. Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured With Dual-Energy CT. AJR Am J Roentgenol. 2017;209(5):1015-22.13.Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, et al. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology. 2018;289(2):546-53.14.Celtikci P, Hekimoglu K, Kahraman G, Bozbas S, Gultekin B, Akay HT. Diagnostic Impact of Quantitative Dual-Energy Computed Tomography Perfusion Imaging for the Assessment of Subsegmental Pulmonary Embolism. J Comput Assist Tomogr. 2021;45(1):151-6.15.O'Shea A, Parakh A, Hedgire S, Lee SI. Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19). AJR Am J Roentgenol. 2021;216(4):1088-98.16.Patelli G, Paganoni S, Besana F, Codazzi F, Ronzoni M, Manini S, et al. Preliminary detection of lung hypoperfusion in discharged Covid-19 patients during recovery. Eur J Radiol. 2020;129:109121.17.Poyiadji N, Cormier P, Patel PY, Hadied MO, Bhargava P, Khanna K, et al. Acute Pulmonary Embolism and COVID-19. Radiology. 2020;297(3):E335-E8.18.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021:204522.19.Hammer MM, Raptis CA. COVID-19 and Pulmonary Thromboembolism. Radiology. 2021;299(2):E252.20.Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-E80.21.Woodard PK. Pulmonary Thromboembolism in COVID-19. Radiology. 2021;298(2):E107-E8.22.Valle C, Bonaffini PA, Dal Corso M, Mercanzin E, Franco PN, Sonzogni A, et al. Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak. Eur J Radiol. 2021;137:109613.23.Ooi MWX, Rajai A, Patel R, Gerova N, Godhamgaonkar V, Liong SY. Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography - Prevalence, pattern of disease and relationship to D-dimer. Eur J Radiol. 2020;132:109336.
Referências1.Sista AK, Kuo WT, Schiebler M, Madoff DC. Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary Embolism. Radiology. 2017;284(1):5-24.2.Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.3.Essien EO, Rali P, Mathai SC. Pulmonary Embolism. Med Clin North Am. 2019;103(3):549-64.4.Albrecht MH, Bickford MW, Nance JW, Jr., Zhang L, De Cecco CN, Wichmann JL, et al. State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol. 2017;208(3):495-504.5.Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-43.6.Kline JA. Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res. 2018;163:207-20.7.Raju S, Ghosh S, Mehta AC. Chest CT Signs in Pulmonary Disease: A Pictorial Review. Chest. 2017;151(6):1356-74.8.Lyhne MD, Schultz JG, MacMahon PJ, Haddad F, Kalra M, Tso DM, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol. 2019;26(6):623-30.9.Beenen LFM, Bossuyt PMM, Stoker J, Middeldorp S. Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism. Eur Respir J. 2018;52(1).10.Doherty S. Pulmonary embolism An update. Aust Fam Physician. 2017;46(11):816-20.11.Peiman S, Abbasi M, Allameh SF, Asadi Gharabaghi M, Abtahi H, Safavi E. Subsegmental pulmonary embolism: A narrative review. Thromb Res. 2016;138:55-60.12.Im DJ, Hur J, Han KH, Lee HJ, Kim YJ, Kwon W, et al. Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured With Dual-Energy CT. AJR Am J Roentgenol. 2017;209(5):1015-22.13.Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, et al. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology. 2018;289(2):546-53.14.Celtikci P, Hekimoglu K, Kahraman G, Bozbas S, Gultekin B, Akay HT. Diagnostic Impact of Quantitative Dual-Energy Computed Tomography Perfusion Imaging for the Assessment of Subsegmental Pulmonary Embolism. J Comput Assist Tomogr. 2021;45(1):151-6.15.O'Shea A, Parakh A, Hedgire S, Lee SI. Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19). AJR Am J Roentgenol. 2021;216(4):1088-98.16.Patelli G, Paganoni S, Besana F, Codazzi F, Ronzoni M, Manini S, et al. Preliminary detection of lung hypoperfusion in discharged Covid-19 patients during recovery. Eur J Radiol. 2020;129:109121.17.Poyiadji N, Cormier P, Patel PY, Hadied MO, Bhargava P, Khanna K, et al. Acute Pulmonary Embolism and COVID-19. Radiology. 2020;297(3):E335-E8.18.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021:204522.19.Hammer MM, Raptis CA. COVID-19 and Pulmonary Thromboembolism. Radiology. 2021;299(2):E252.20.Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-E80.21.Woodard PK. Pulmonary Thromboembolism in COVID-19. Radiology. 2021;298(2):E107-E8.22.Valle C, Bonaffini PA, Dal Corso M, Mercanzin E, Franco PN, Sonzogni A, et al. Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak. Eur J Radiol. 2021;137:109613.23.Ooi MWX, Rajai A, Patel R, Gerova N, Godhamgaonkar V, Liong SY. Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography - Prevalence, pattern of disease and relationship to D-dimer. Eur J Radiol. 2020;132:109336.
Referências1.Sista AK, Kuo WT, Schiebler M, Madoff DC. Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary Embolism. Radiology. 2017;284(1):5-24.2.Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543-603.3.Essien EO, Rali P, Mathai SC. Pulmonary Embolism. Med Clin North Am. 2019;103(3):549-64.4.Albrecht MH, Bickford MW, Nance JW, Jr., Zhang L, De Cecco CN, Wichmann JL, et al. State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol. 2017;208(3):495-504.5.Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther. 2018;8(3):225-43.6.Kline JA. Diagnosis and Exclusion of Pulmonary Embolism. Thromb Res. 2018;163:207-20.7.Raju S, Ghosh S, Mehta AC. Chest CT Signs in Pulmonary Disease: A Pictorial Review. Chest. 2017;151(6):1356-74.8.Lyhne MD, Schultz JG, MacMahon PJ, Haddad F, Kalra M, Tso DM, et al. Septal bowing and pulmonary artery diameter on computed tomography pulmonary angiography are associated with short-term outcomes in patients with acute pulmonary embolism. Emerg Radiol. 2019;26(6):623-30.9.Beenen LFM, Bossuyt PMM, Stoker J, Middeldorp S. Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism. Eur Respir J. 2018;52(1).10.Doherty S. Pulmonary embolism An update. Aust Fam Physician. 2017;46(11):816-20.11.Peiman S, Abbasi M, Allameh SF, Asadi Gharabaghi M, Abtahi H, Safavi E. Subsegmental pulmonary embolism: A narrative review. Thromb Res. 2016;138:55-60.12.Im DJ, Hur J, Han KH, Lee HJ, Kim YJ, Kwon W, et al. Acute Pulmonary Embolism: Retrospective Cohort Study of the Predictive Value of Perfusion Defect Volume Measured With Dual-Energy CT. AJR Am J Roentgenol. 2017;209(5):1015-22.13.Weidman EK, Plodkowski AJ, Halpenny DF, Hayes SA, Perez-Johnston R, Zheng J, et al. Dual-Energy CT Angiography for Detection of Pulmonary Emboli: Incremental Benefit of Iodine Maps. Radiology. 2018;289(2):546-53.14.Celtikci P, Hekimoglu K, Kahraman G, Bozbas S, Gultekin B, Akay HT. Diagnostic Impact of Quantitative Dual-Energy Computed Tomography Perfusion Imaging for the Assessment of Subsegmental Pulmonary Embolism. J Comput Assist Tomogr. 2021;45(1):151-6.15.O'Shea A, Parakh A, Hedgire S, Lee SI. Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19). AJR Am J Roentgenol. 2021;216(4):1088-98.16.Patelli G, Paganoni S, Besana F, Codazzi F, Ronzoni M, Manini S, et al. Preliminary detection of lung hypoperfusion in discharged Covid-19 patients during recovery. Eur J Radiol. 2020;129:109121.17.Poyiadji N, Cormier P, Patel PY, Hadied MO, Bhargava P, Khanna K, et al. Acute Pulmonary Embolism and COVID-19. Radiology. 2020;297(3):E335-E8.18.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021:204522.19.Hammer MM, Raptis CA. COVID-19 and Pulmonary Thromboembolism. Radiology. 2021;299(2):E252.20.Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-E80.21.Woodard PK. Pulmonary Thromboembolism in COVID-19. Radiology. 2021;298(2):E107-E8.22.Valle C, Bonaffini PA, Dal Corso M, Mercanzin E, Franco PN, Sonzogni A, et al. Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak. Eur J Radiol. 2021;137:109613.23.Ooi MWX, Rajai A, Patel R, Gerova N, Godhamgaonkar V, Liong SY. Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography - Prevalence, pattern of disease and relationship to D-dimer. Eur J Radiol. 2020;132:109336.
In Part Two of this podcast, straight from the 2020 Midyear Clinical Meeting, Dr. Igneri describes the clinical manifestations of COVID-19 associated coagulopathy, shares best practices on interpreting the available literature and given a patient scenario, design a treatment plan to manage COVID-19 associated coagulopathy. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.
Visit http://journalclubpodcasts.com/cvd to view the activity and CME/CE information, download the transcript, and complete the posttest and evaluation to earn CME/CE credit. In this Journal Club Podcast our faculty look at venous thrombosis appearing to be a complicated feature of Covid-19 and discuss treatments, including the role of direct oral anticoagulants in the pandemic of Covid-19.
80 mmHg","type":"unordered-list-item","depth":0,"inlineStyleRanges":[{"offset":0,"length":36,"style":"ITALIC"}],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"56arn","text":"Both recommendations received a Grade 1C recommendation, meaning it was a recommended practice. However, this was a recommended practice for each respective clinical presentation, not with both etiologies present at the same time (Spahn, et al., 2019). What the literature has suggested from numerous pre-hospital and in-hospital studies is that reduced or restricted fluid administration in trauma was shown to be less harmful overall than large volume resuscitation (Carrick, et al., 2016). For patients presenting with both insults, it is necessary to accommodate both management strategies.","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"8omnf","text":"","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"ddm55","text":"TBI insult and subsequent management should take priority over the hypotensive approach for hemorrhage as any single episode of hypotension increases the mortality to nearly 50%. ","type":"unstyled","depth":0,"inlineStyleRanges":[{"offset":0,"length":178,"style":"ITALIC"}],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"76a2f","text":"","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"6f7l3","text":"To accommodate both, the MAP should be kept near 80 mmHg with limited fluid resuscitation to achieve that status. Secondarily, patients with TBI and hemorrhagic shock were also found to have worsening coagulopathy compared to those with TBI and hemorrhagic shock alone (Galvagno, et al., 2017). Furthering the premise that maintaining a fluid restriction resuscitation along with a MAP at or just above 80 mmHg in a patient with both insults is theoretically the best way to manage these patients. This is a field of medicine that does require future studies for best practice advice. ","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{"dynamicStyles":{"line-height":"1.5","padding-top":"0","padding-bottom":"0"}}},{"key":"fqgup","text":"","type":"unstyled","depth":0,"inlineStyleRanges":[],"entityRanges":[],"data":{}},{"key":"4qjjn","text":"In this podcast, I sit down with Tyler & Sam to discuss TBI + Multisystem trauma management. ","type":"unstyled","depth":0,"inlineStyleRanges":[{"offset":0,"length":93,"style":"{"FG":"#000000"}"},{"offset":0,"length":93,"style":"BOLD"}],"entityRanges":[],"data":{}}],"entityMap":{}}"> It was a quiet afternoon in Bentonville, Arkansas. 8 pm and you hear dispatch crackle over the radio and summon your station to respond for a motor vehicle accident at SW Regional and SW I street. Multiple reports of persons ejected”. As you arrive on the scene, you note two teenage patients ejected 50-75 feet from where the accident occurred. It appears they were traveling at a high rate of speed through a red light and were struck by another vehicle. You approach a motionless patient lying prone on the pavement, you note obvious head trauma, and presume multi-system trauma given the mechanism of injury. Your first blood pressure reveals a MAP of 55 and the pelvis is unstable. While we know aiming for a normal blood pressure in the presence of non-compressible hemorrhage is likely not ideal, a primary concern for this patient is that permissive hypotension may compromise cerebral perfusion pressure (CPP) and put the patient at further risk of a secondary brain injury. A single episode of hypotension in the TBI patient nearly doubled their mortality (Spahn, et al., 2019). The clinical conundrum most emergency medical providers face is having to manage both injuries and the repercussions of both management strategies. The European Guidelines on Management of Major Bleeding and Coagulopathy following Trauma: Fifth Edition published the following recommendations: For hemorrhagic shock: Hypotensive fluid resuscitation with a goal of a systolic blood pressure between 80-90 mmHg (MAP of 50-60 mmHg) without evidence of brain injury For TBI: Maintain a MAP of > 80 mmHg Both recommendations received a Grade 1C recommendation, meaning it was a recommended practice. However, this was a recommended practice for each respective clinical presentation, not with both etiologies present at the same time (Spahn, et al., 2019). What the literature has suggested from numerous pre-hospital and in-hospital studies is that reduced or restricted fluid administration in trauma was shown to be less harmful overall than large volume resuscitation (Carrick, et al., 2016). For patients presenting with both insults, it is necessary to accommodate both management strategies. TBI insult and subsequent management should take priority over the hypotensive approach for hemorrhage as any single episode of hypotension increases the mortality to nearly 50%. To accommodate both, the MAP should be kept near 80 mmHg with limited fluid resuscitation to achieve that status. Secondarily, patients with TBI and hemorrhagic shock were also found to have worsening coagulopathy compared to those with TBI and hemorrhagic shock alone (Galvagno, et al., 2017). Furthering the premise that maintaining a fluid restriction resuscitation along with a MAP at or just above 80 mmHg in a patient with both insults is theoretically the best way to manage these patients. This is a field of medicine that does require future studies for best practice advice. In this podcast, I sit down with Tyler & Sam to discuss TBI + Multisystem trauma management.
Dr. Jim Tisdale discusses the treatment options for venous thromboembolism in patients with COVID-19 with authors Dr. Paul Dobesh and Dr. Jim Tisdale. Be sure to listen to part I to first hear about the pathophysiology and prophylaxis. Manuscript available at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2465
Dr. Jim Tisdale discusses the pathophysiology and prophylaxis of thrombotic events in patients with COVID-19 with authors Dr. Paul Dobesh and Dr. Jim Tisdale. Be sure to listen to part II to hear about treatment. Manuscript available at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2465
Nahla Heikal, M.D., a clinical pathologist in Mayo Clinic's Department of Laboratory Medicine and Pathology who specializes in coagulation testing, joins the "Answers From the Lab" podcast to discuss the role of coagulopathies in COVID-19, including conditions such as thrombosis and disseminated intravascular coagulation.
In this VETgirl online veterinary continuing education podcast, we review canine anaphylaxis. What do the signs of severe canine anaphylaxis look like, and what is the mortality? Is the prognosis good? In this study, 85.1% of dogs survived. Coagulopathy, gallbladder wall edema, and abdominal effusions are a relatively common occurrence in canine anaphylaxis. Serum phosphorus levels greater than 12 mg/dL, refractory hypoglycemia, and PT prolongation greater than 50% are correlated with a decreased chance of survival.
In this VETgirl online veterinary continuing education podcast, we review canine anaphylaxis. What do the signs of severe canine anaphylaxis look like, and what is the mortality? Is the prognosis good? In this study, 85.1% of dogs survived. Coagulopathy, gallbladder wall edema, and abdominal effusions are a relatively common occurrence in canine anaphylaxis. Serum phosphorus levels greater than 12 mg/dL, refractory hypoglycemia, and PT prolongation greater than 50% are correlated with a decreased chance of survival.
COVID-19 is associated with a high prevalence of coagulopathy and venous thromboembolism.
COVID-19 is associated with a high prevalence of coagulopathy and venous thromboembolism.
The ABMP Podcast | Speaking With the Massage & Bodywork Profession
Send your future questions to podcast@abmp.com. The podcast sponsored by: Anatomy Trains Guests: Eric Stephenson is a 20-year massage veteran and Chief Wellness Officer for Elements Massage. Eric is also Co-Founder of imassage, Inc., an education and consulting company dedicated to extending the careers of massage therapists and spa practitioners through customized continuing education focusing on preventing injury and workers’ compensation claims. In 2014, Eric joined the Board of Directors of the International Spa Association. Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist’s Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Laura Embleton is Director of Government Relations for ABMP. Debbie Higdon is Risk Management/Special Services for ABMP. Les Sweeney is President of ABMP. Links: Werner’s books are available at Books of Discovery Ruth Werner Elements Massage
Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.09.08.272328v1?rss=1 Authors: Holcomb, D., Alexaki, A., Hernandez, N., Laurie, K., Kames, J., Hamasaki-Katagiri, N., Komar, A. A., DiCuccio, M., Kimchi-Sarfaty, C. Abstract: Thrombosis has been one of the complications of the Coronavirus disease of 2019 (COVID-19), often associated with poor prognosis. There is a well-recognized link between coagulation and inflammation, however, the extent of thrombotic events associated with COVID-19 warrants further investigation. Poly(A) Binding Protein Cytoplasmic 4 (PABPC4), Serine/Cysteine Proteinase Inhibitor Clade G Member 1 (SERPING1) and Vitamin K epOxide Reductase Complex subunit 1 (VKORC1), which are all proteins linked to coagulation, have been shown to interact with SARS proteins. We computationally examined the interaction of these with SARS-CoV-2 proteins and, in the case of VKORC1, we describe its binding to ORF7a in detail. We examined the occurrence of variants of each of these proteins across populations and interrogated their potential contribution to COVID-19 severity. Potential mechanisms by which some of these variants may contribute to disease are proposed. Some of these variants are prevalent in minority groups that are disproportionally affected by severe COVID-19. Therefore, we are proposing that further investigation around these variants may lead to better understanding of disease pathogenesis in minority groups and more informed therapeutic approaches. Copy rights belong to original authors. Visit the link for more info
In this podcast, Dr. Patrick Lawler and Dr. Lucas Godoy discuss the evidence around endothelial injury related to SARS-CoV-2 cellular invasion. In some cases, thrombosis is a prominent clinical feature of COVID-19 that may lead to organ failure, multi system injury or death. Dr. Lawler is a cardiologist at the Peter Munk Cardiac Centre in Toronto and a clinician-scientist at the Toronto General Hospital Research Institute. Dr. Godoy is a cardiologist and research fellow at the Peter Munk Cardiac Centre in Toronto. The review article they authored is published in CMAJ: www.cmaj.ca/lookup/doi/10.1503/cmaj.201240 ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite aggregator. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.
Dr. Eric Simms joins us on Rounds to share with us his foolproof and fun way of remembering the dreaded coagulation cascade. Supplementing this podcast is a vidcast (https://www.traumaicurounds.ca/vidcasts) that provides us with a helpful visual explanation for understanding the key factors, steps, and intricacies of the coagulation cascade.
The last episode of our series with John Bishara DO. In this discussion we try and cover the most current developments in COVID and address some of the social media challenges in a public health crisis. It will probably run a little long but hey, you get what you pay for and in the case of Rotations you get a lot more than you pay for sometimes. And as always… Wear a mask in close and indoor public spaces. Period. Full stop. Coagulopathy and COVID https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225095/ Management of Pregnancy with COVID-19 https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019 This seems like a perfectly good place to have Armando Hasudungan talk to us about cells… https://www.youtube.com/watch?v=HjlWm3LudJs How about Nucleus Medical Media as well? https://www.youtube.com/watch?v=URUJD5NEXC8 And while we are at it lets review Drew Berry’s TED talk… https://www.youtube.com/watch?v=WFCvkkDSfIU WVU Medicine Charleston Area Medical Center https://en.wikipedia.org/wiki/Charleston_Area_Medical_Center Rotationspodcast@gmail.com But honestly, we seldom check it. Use the Social Media links… Catch us on twitter at @RotationsPcast Todd @MedicalCinema. Brian @Profplow and Nisarg @NisargBakshi You can also send comments to Todd at TR Fredricks on Facebook. Look for more Rotations Content at mediainmedicine.com/Rotations and on Soundcloud and iTunes at Rotations Podcast. Intro and Outro Music: Born Again by Michael Shynes Courtesy of Artlist.io Produced by: Todd Fredricks DO and Brian Plow MFA Edited by: Todd Fredricks DO Cohost: None, I did this after hours and you know work rules for students Disclaimers: Sarah Adkins PharmD, The Phlegmatic Pharmacologist (It’s truly worth listening to her outro…you’re welcome) Cut Clip: None Rotations is produced using (and we always accept donations from any gear folks): Rode Podcaster Pro Rode NT1-A mics Zoom H4N Rode Lavalier Go mics Countryman Lavalier mics Polsen Studio Headphones Kopul XLR cables SanDisk media Final Cut Pro X MacBook Pro Tama mic stands Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted. Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.
In part 2 we cover secondary coagulopathy, including the coagulation cascade. Bruce gives us the most simple and memorable explanation of that Y-shaped beast that you'll ever hear, and we learn how and when to use the tests of secondary coagulation: Activated clotting time, APTT and APT. We get deep into the weeds of the most commonly seen causes that will disrupt the coagulation cascade, and Bruce also clarifies some of the ‘unusual suspects' - the congenital factor abnormalities. This episode is brought to you by Heska; THE most exciting new player in in-house diagnostics in Australia. Heska aims to change the way you think about and run your in-house diagnostics to save you both time and money while increasing your standards of care. Best of all, you don't pay a cent for the analysers - you only pay for the test you perform. It's that simple! Pay less, get more, no tricks. Go to heska.com.au/vetvault to claim your Vet Vault listener exclusive offer of $5000 with of consumables. --- Send in a voice message: https://anchor.fm/vet-vault/message
In our two-part series on coagulation, we talk to Prof. Bruce Parry, a former clinical pathologist from the University of Melbourne. In part 1 we cover primary coagulation. We talk everything platelets: how to accurately pick cases of thrombocytopaenia, pro-tips to make sure you get to the right answers, and common pitfalls. We also look at the buccal mucosal bleeding time test: how to do it, and what information it will provide. We're also excited to introduce you to our first-ever sponsor: our guest expert is brought to you by Heska, the most exciting new player in in-house diagnostics in Australia. Heska aims to change the way you think about and run your in-house diagnostics to save you both time and money while increasing your standards of care. Best of all, you don't pay a cent for the analysers; you only pay for the tests you perform. It's that simple. Pay less, get more, no tricks. Go to Heska.com.au/vetvault to get access to a special offer that they've created exclusively for Vet Vault listeners, which gives you $5000 worth of free consumables. --- Send in a voice message: https://anchor.fm/vet-vault/message
This episode is shared from Lab Medicine Rounds and was recorded May 1, 2020.To claim credit visit: https://ce.mayo.edu/covid19podcastGuest: Ariela L. Marshall, M.D. (@AMarshallMD)Host: Justin D. Kreuter, M.D. (@KreuterMD)What is COVID-Associated coagulopathy? Why is it so important to recognize early on? How does it differ from the typical disseminated intravascular coagulation (DIC) picture? Dr. Ariela Marshall details the lab patterns, implications for our patients, and what testing should be evaluated on patients being treated for COVID-19 and when.Time Stamps:00:00 Podcast Intro00:40 What is COVID-associated coagulopathy and why is it important to recognize this?02:45 How is this coagulopathy similar to or different from other coagulopathies that we commonly see in clinical practice?04:30 Is there recommended testing for COVID-associated coagulopathy?06:30 Can you explain what the soluble fibrin monomer test is?08:09 How is COVID-associated coagulopathy managed in terms of prophylactic anticoagulation, therapeutic anticoagulation, and prophylactic transfusion?14:23 What are a few lessons that you have learned during this pandemic so far?Resources: F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer, et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19,Thrombosis Research (2020) https://doi.org/10.1016/j.thromres.2020.04.013 Thachil J, Tang N, Gando S, Falanga A, Cattaneo M...Iba T, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID‐19 https://doi.org/10.1111/jth.14810AskMayoExpert COVID-19 Resources: https://askmayoexpert.mayoclinic.org/navigator/COVID-19ISTH COVID-19 ResourcesSubscribe to Lab Medicine Rounds here: https://news.mayocliniclabs.com/podcast/lab-medicine-rounds/Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Interview with Ariela Marshall, M.D. In this bonus episode of Lab Medicine Rounds, Dr. Ariela Marshall, Associate Professor of Medicine in the Division of Hematology at Mayo Clinic, discusses COVID-associated coagulopathy. Dr. Marshall will discuss this condition and why it’s important to recognize.
Welcome back Rounds Table Listeners! This week we interviewed Dr. Michelle Sholzberg to discuss coagulopathy associated with COVID-19. Dr. Sholzberg is a clinical hematologist with a focus on bleeding and is the Medical Director of the Coagulation Laboratory at St. Michael's Hospital in Toronto, Ontario, Canada. She is also the Co-Director of the Hematology-Oncology Clinical ... The post Episode 10 – Interview with Dr. Sholzberg on COVID coagulopathy appeared first on Healthy Debate.
Welcome back Rounds Table Listeners! This week we interviewed Dr. Michelle Sholzberg to discuss coagulopathy associated with COVID-19. Dr. Sholzberg is a clinical hematologist with a focus on bleeding and is the Medical Director of the Coagulation Laboratory at St. Michael's Hospital in Toronto, Ontario, Canada. She is also the Co-Director of the Hematology-Oncology Clinical ...The post Episode 10 – Interview with Dr. Sholzberg on COVID coagulopathy appeared first on Healthy Debate.
Welcome to the COVID-ZONE--------------------------- Journalspotting is here to bring you important clinical updates on coronavirus. Get in touch: journalspotting@gmail.com Twitter @JournalSpotting ----------------------------In today's episode:#Transmision models: out with the old and in with the new- Turbulent gas clouds- Barney's Jigglypuff work shelf- Presymptomatic transmission- Jogging with COVID-19#Treatment update: Remdesivir, convalescent plasma, RECOVERY trial- Remdesevir: NEJM paper, orphan status, STAT news#Cover your face(mask)- BMJ analysis - How good are cotton masks?#Coagulopathy & COVID-19- Cui et al + D-Dimer pooled analysis- ISTH Interim guidance- The dutch anticoagulateCovid rants- Donald Trump cuts WHO funding - 5G conspiracy + app ideasCovert Covid Distractions- Explicit lyric warning!!
ROTEM for Management of Coagulopathy in Pregnancy with Shubhangi Singh
In this podcast, Dr. Mark Young, a stroke Neurologist with Abbott Northwestern Hospital, discusses current guidelines for ischemic stroke management and care. Enjoy the podcast! Objectives: Upon completion of this podcast, participants should be able to: Summarize the latest guidelines and management for acute ischemic stroke. Describe current interventional management for large vessel occlusion with thrombectomy. Identify modified Rankin scores and the impacts on stroke patients. Demonstrate an understanding of new timelines to guide therapy such as Diffuse-3 and DAWN trials. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks. You may contact the accredited provider with questions regarding this program at rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Stroke Updates: Guidelines and Management for 2018-2019" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.” FACULTY DISCLOSURE ANNOUNCEMENT It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: CHAPTER 1: One large impact on stroke care 2018 is the thrombectomy window expansion time for large vessel occlusion out to 24-hours. https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.023310 Current perfusion imaging available is able to identify core infarct- establish the quantity and mismatch ration of available brain that is salvageable. Futile reperfusion is something that should not be undertaken due to high risk of reperfusion hemorrhage which can ultimately worsen outcomes. Last known well time means exactly that. When was the patient last seen well. So if they go to bed and then come in with a wake up stroke then LKW is when they went to bed. Some studies on wake up strokes showed that the majority developed symptoms 2-3 hours prior to waking up. LKW and wake up stroke are different but can often help us guide therapy. For instances pt goes to bed is LKW time and then wakes up with stroke like symptoms. Perfusion imaging is instrumental in the decision process for these patients often guiding us with further management. The NINDS trials came out in '95-'96. However the bottom line showed - in patients, with ischemic stroke within 3 hours, tPA administration significantly improved HIHSS scores but did not confer survival benefit. https://www.nejm.org/doi/full/10.1056/NEJM199512143332401 Stroke neurologist typically want a call early in clinical course. Don't wait for CT prior to calling. Then when was the last known well time. Blood glucose, blood pressure, PMH and deficits (ie NIHSS), 'what are you observing'. Don't wait on labs - consideration is warfarin. There are trials following the NINDS trial that show evidence that patient with low HIHSS with potentially disabling deficits and rapidly improving stroke improve with TPA treatment and that the hemorrhage rates are lower. Definitely consider treating rapidly improving stroke sxs. With stutter stroke sxs, the clock resets when the patient returns back to baseline. CHAPTER 2: Most stroke centers uses -0-4.5 hours time frame for IV thrombolytics. Absolute and relative contraindications for thrombolytics include: greater than 2/3 MCA territory don't treat as there is little benefit. Patient on warfarin with INR greater than 1.7. Recent stroke or ICH. Endocarditis. Coagulopathy. People on DOACs. Significant thrombocytopenia. There are many more but these are the highlights. American Stroke Association says patient must be off DOAC's for 48-hours before lytic treatment as relative contraindication. Dr. Young's standard conversation with pt who are experiencing a stroke when discussing TPA. First, it is the standard of care, next the chance of hemorrhage is around 6-7%, but Abbott has a much lower rate of around 2.5%. We know that even with that risk patients do much better overall. At 90 days, the chance that the patient will be living independently are much better. 90-day Modified Rankin Scores are standards that we use to measure stroke outcomes. Modified Rankin Scale score of 0 is no deficit, no residual. MR of 1 can do everything you use to do although may still have mild symptoms that patient may notice. MR of 2 - you have some limitations but can live independently and do all ADLs MR of 3 - is dependent with ADLs although can walk with or without a device. MR or 4. Can't walk. MR of 5 - bed bound. MR of 6. DEAD. Some criteria for TPA with lower HIHSS with compelling deficits are #1, what's disabling #2. Others include limb ataxia, aphasia, paresis, dominant hand problem, dysphagia, dysarthria. Controversy Hemianopsia. Greater than or equal to NIHSS of 6 is generally recommended to get a CTA to evaluate for LVO stroke. Imaging generally requires CT/CTA of the head and neck. Always include imaging of the neck. Rapid perfusion imaging for LVO used in Diffuse 3 - (6-16 hours) for the window vs DAWN out to 24-hours. CHAPTER 3: So the order of imaging includes noncom CT head, CTA, CT perfusion. When evaluating the imaging studies we want the core infarct to be less than 70ccs and the ratio of the core infarct to at risk brain penumbra to be greater than 1.8. The use of rapid sequencing MRI has utility for post circulate symptoms, ie vertigo with/out nystagmus, abrupt onset. Generally diffusion weighted gradient echo/T2 flair images looking for blood. Other indications maybe for subacute findings/duration. LVO's that can be intervened on include: anterior communicating, distal carotid or carotid terminus, MCA M1, M2, basilar, distal verts, maybe PCA/P1. Important point if a patient has a LVO lesion and is within the 4.5 hour window at a small rural setting with lytic capabilities and the patient is going to a large tertiary stroke center does the patient still need to receive IV lytic therapy - knowing that the patient will require thrombectomy and answer is YES. No increased risk when using lytic with thrombectomy. A little controversial but we maybe seeing the bypass of non-stroke hospitals specifically with LVO to tertiary stroke centers with a new scoring system that EMS can do called RACE (Rapid Arterial oCclusion Evaluation) https://neuronewsinternational.com/racecat-trial-update/ CHAPTER 4: After care by the PMD what can we expect from these patients follow a LVO? 90-day Rankin 50% with modified Rankin 2 less to live independently following LVO. 50% of LVO have a 90 mortality. 70-80% will not live independently. Discharge meds for these patients will include DOACs or Warfarin, antiplatelet agents - such as Plavix. Occasionally patient will end up on dual antiplatelet therapy depending on disease state. Stoke mimics that have been given thrombolytics have less than 1/2% chance of hemorrhage.
Recap extravaganza 2019 featuring top pearls from our staff’s favorite episodes of 2019 and voicemails from Kashlak faculty, Dr. Avital O’Glasser (@aoglasser), Dr. Kimberly Manning (@gradydoctor), Dr. Renee Dversdal (@DrSonosRD) and The Curbsiders team. Topics include: HFpEF, the PARAGON-HF trial, Buprenorphine, Opioid Use Disorder, Cirrhosis, Coagulopathy, SBP, Hyperkalemia treatment, Multimorbidity, and how to think about NNT. Plus, the team shares a bunch of other favorite moments and random pearls! Upcoming shows: The next two weeks will feature REBOOT episodes with fresh intros from The Curbsiders team. Season 9 starts January 20, 2020 with a Lipid Update from Cardiologist Dr. Erin Michos (@ErinMichos) Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Produced by: Sarah Phoebe Roberts MPH and Chris Chiu MD, FACP, FAAP Writer: Sarah Phoebe Roberts MPH Infographic: Sarah Phoebe Roberts MPH Cover Art: Kate Grant MBChB DipGUMed Hosts: Chris Chiu MD, FACP, FAAP; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Chris Chiu MD, FACP, FAAP (audio), Matthew Watto MD, FACP (show notes) Time Stamps 00:00 Intro and disclaimer 04:25 Picks of the year*: The Expanse (TV show) -Chiu Man’s pick; Midsommar (film) -Paul’s pick; Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick; Sleep!!! -Stuart pick 08:37 Hyperkalemia Master Class Joel Topf MD 14:53 Multimorbidity Games with Josh Uy MD 21:54 Buprenorphine Master Master Class with Michael Fingerhood MD 27:50 Cirrhosis TIPS for Acute Complications with Scott Matherly MD 31:55 HFpEF with Clyde Yancy MD 39:50 Chronic pain, sickle cell disease, opioid tapers 43:13 Teaching in the Hospital 46:00 A quote from Paul Williams 47:35 Celebrity voicemails from Avital O’Glasser MD, Kimberly Manning MD, and Renee Dversdal MD 51:55 Voicemails and favorite pearls from our Curbsiders team! 62:23 Outro Goal Listeners will recall some of the top pearls from Curbsiders episodes on cirrhosis, buprenorphine, HFpEF, multimorbidity and hyperkalemia. Links* The Expanse (TV show) -Chiu Man’s pick Midsommar (film) -Paul’s pick Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick Sleep!!! -Stuart pick *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures The Curbsiders report no relevant financial disclosures. Citation Roberts SP, Chiu CJ, Williams PN, Brigham SK, Watto MF. “#190 Recap Extravaganza 2019”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 30, 2019.
Michael A. Mazzeffi, MD, Associate Professor of Anesthesiology presents on " ECMO Coagulopathy: Potential Mechanisms and Early Insights "
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. 00:00:00:00 Introduction 00:01:22:01 Case Scenario: 12-year-old male in helmeted MVC vs. bicycle accident 00:02:36:10 See Where You Are 00:05:22:17 Initial Therapy 00:06:26:04 General Management 00:07:00:04 Viscoelastic Monitoring 00:08:05:01 Phases of Viscoelastic Monitoring 00:10:47:02 Targeted Therapy 00:11:42:25 Real Time Monitoring 00:14:38:13 Management of Fibrinolysis 00:16:06:18 Balanced Resuscitation 00:17:26:16 Efficiency 00:18:12:29 Pediatric Evidence 00:19:07:08 Massive Transfusion and Balanced Resuscitation 00:19:42:28 Case Scenario: Pain Control After Laparotomy 00:21:02:12 Narcotics 00:22:08:19 Regional Analgesia 00:23:29:12 Anxiety 00:25:43:24 Case Scenario: Sedation 00:27:51:13 Validated Pain Scores 00:29:53:14 Validated Sedation Scores 00:31:23:23 Sedation Holidays and ABCDEF Bundles 00:32:09:08 A: Assessing Pain 00:32:20:29 B: Breathing and Awakening Trials 00:33:30:15 C: Choice of Analgesia and Sedation 00:34:24:15 D: Delirium 00:34:31:25 E: Early Mobility and Exercise 00:34:37:24 F: Family Engagement 00:35:47:28 Case Scenario: Post-Operative/ICU Delirium 00:36:38:04 Risk Factors for Delirium 00:37:21:15 Delirium Assessment Tools 00:39:23:20 Evaluating for Causes of Altered Mental Status 00:40:36:16 Multimodal Treatment for Delirium 00:42:51:23 Preventing Delirium 00:43:58:22 Conclusion 00:44:21:22 Outro/Teaser Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626
Associate Professor Samuel Galvagno: My bloody head: Diagnosis and management of coagulopathy and traumatic brain injury. From CICM ASM PROGRAM 2019.
Welcome to OBGYN Audiophile! A couple of free audio files will be uploaded as podcasts over the next few weeks. They contain practice questions and answers for those studying hard for their OBGYN oral examination. Good luck to all of you. Hope you find these files helpful to practice your oral exam skills while exercising, commuting or even doing your dishes! Happy multitasking. For more files like this one, please visit our website www.obgynaudiophile.com where files can be purchased for a small fee. Again, Good Luck! This episode contains questions and answers regarding DIC in Obstetrics. It is both a great popquiz for those of us on the labor units regularly and a perfect refresher for those in GYN only fellowships. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
May 28, 2019 edition of the weekly JAMA Editors' Summary
Join us as we interview Andrew Fisher on the multiplicity of managing civilian trauma patients. Although the complexity of trauma management is often understated, the basics are often not managed appropriately, and can have an appreciable affect on trauma outcomes. We discuss TEG, blood product administration, acute traumatic coagulopathy, the MARCH algorithm, and when it comes to permissive hypotension, just how low can you go?
Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean. Take our pretest on cirrhosis! Full show notes available at http://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Matthew Watto MD Pretest by: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Images and infographics: Hannah Abrams MS3 Edited by: Matthew Watto MD Guest: Scott Matherly MD Sponsor Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness teaser 00:50 Sponsor - Become an ACP Member today! 01:25 Intro, guest bio 03:45 Guest one-liner, keto diet 07:40 Picks of the week from Paul, Matt and Scott 11:50 Sponsor - Become an ACP Member today! 13:26 Clinical case of bleeding and altered mental status in cirrhosis 16:10 Interpretation of our patient’s labs and physical exam 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure) 24:48 Initial workup, resuscitation and stabilization in variceal bleeding 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis 33:10 Proton pump inhibitors and ulcers from variceal banding 34:00 Mechanism of action for octreotide and terlipressin 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers 40:40 Scores for prognostication in the acute setting 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used 48:38 Elevated INR and procedures 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE 87:58 Rifaximin 89:10 Take home points 91:02 Outro
In this special episode of Traumacast, we present the audio portion of our recent EAST Master Class Webinar. We had a pro con debate of the utility of clotting factor concentrates in resuscitation and reversal of anticoagulation, with Matt Martin and Bellal Joseph arguing in favor of factor concentrates and Macky Neal and Babak Sarani in favor of plasma-based resuscitation. Click here to watch the webinar held on February 13, 2019. This Traumacast and Webinar was sponsored by a grant from CSL Behring, makers of K-Centra.
Acute alcohol withdrawal and alcoholic hepatitis are common scenarios presenting to the Emergency Department (ED) and the ward. Recognition, investigation and management principles are imperative to prevent serious complications. Alcoholic hepatitis accounts for 3.3 million deaths worldwide and reports show an average mortality of 6.7% with acute alcoholic hepatitis, rising significantly with increased severity. It is characterised by acute inflammation of the liver due to excessive recent alcohol intake concomitant with COAGULOPATHY and JAUNDICE. Dr Liz Sweeney is a specialist hepatology registrar at the Royal Liverpool Hospital. In this episode, she talks to us about acute alcohol withdrawal and alcoholic hepatitis with key advice to junior doctors working in hospitals. Speak soon, Ollie Wright GET IN TOUCH! Either through the comments section or email foamdation@gmail.com if there are any comments or corrections or if you want to be involved with future topics. RATE US on iTunes to help others find the resource more easily! SHARE US with others you think would benefit or even your training leads to help us distribute the resource further! Twitter: @FOAMdation
In this special podcast episode, we are joined by a third person: Flight NP and PT Intensivist, Dan Rauh. Dan joins us at the 2018 Every Coast Helicopter Operations (ECHO) annual conference as a fellow clinical track speaker and critical care panel participant. Tune in as we discuss three, in-depth topics including Nurse Practitioner autonomy, advanced acid/base interpretation, and coagulopathy reversal. Dan also provides an easy way to calculate triple acid/base disorders including anion gap and osmolality analysis. Time Stamps: 02:25- NP vs. PA and autonomy 05:28- Acid/base including triple disorders 26:12- Coagulopathy and TEG ------------------------------------------------ Follow us on Twitter @HLTHPodcast Follow us on Facebook @heavyliesthehelmet Visit our website at heavyliesthehelmet.com Contact us at heavyliesthehelmet@gmail.com Disclaimer: The views, information, or opinions expressed during the HLTH podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. HLTH is not responsible for the accuracy of any information contained in the podcast series available for listening or reading on this site. The primary purpose of this podcast series is to educate and inform. This podcast series does not constitute other professional advice or services.
You are in a peripheral hospital without onsite laboratory support after hours and you are involved in the care of a young parturient with uterine atony who has now bled over 2litres. Although you have called in someone to do some laboratory testing - you know that these results will be at least 45-90minutes away. How likely is it that this woman has become coagulopathic? What approach should you take in this setting? Should you use empiric coagulation supportive therapy? FFP? Fibrinogen? TXA? Hi everyone, This week we have the audio of a great talk Nolan wrote for the obstetric intensive care symposium held in Adelaide earlier this year, and which he then kindly presented to our department in April. Pregnancy is a procoagulant state and during haemorrhage obstetric coagulopathy is actually relatively rare. The underlying mechanisms are different to trauma and other patient groups and we should use this knowledge to help us in our use of blood product therapy especially when rapid coagulation testing (eg viscoelastic tests like ROTEM) are not rapidly available. However there are some exceptions to this rule - beware early onset of coagulopathy in women with abruption, HELLP, and AFE! Links Obstetric Intensive Care Symposium Adelaide 2018 https://www.picet.org.au/programme.php If you want to watch the video of this talk with it's powerpoint slides: https://www.dropbox.com/s/y57pf26ge9mry8g/Obstetric%20coagulopathy%20Nolan%20KEMH%20dept%20talk%20version.mp4?dl=0
In this week's clinical case, Dr. John Baird (Stanford) shares the story of a patient he's been following who's experienced a neurologic complication of her hematologic illness. Check it out. Produced by James E. Siegler. Music by Chris Zabriskie, Ian Southerland, Julie Maxwell, Jason Shaw, and Rafael Archangel. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for routine clinical decision making. REFERENCES George JN. Clinical practice. Thrombotic thrombocytopenic purpura. The New England journal of medicine. 2006;354:1927-35. George JN and Nester CM. Syndromes of thrombotic microangiopathy. The New England journal of medicine. 2014;371:654-66. Bakshi R, Shaikh ZA, Bates VE and Kinkel PR. Thrombotic thrombocytopenic purpura: brain CT and MRI findings in 12 patients. Neurology. 1999;52:1285-8. Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE and Tobian AA. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood. 2015;125:1470-6.
Petra Innerhofer discusses reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma.
Biohacking is the approach of assessing body functioning and assessing the impact of life style choices. Steve Fowkes, an expert in biohacking, discusses how we can determine if our metabolism is fast or slow, the physical manifestations of the metabolism rate, and how we can hack / alter our metabolism rate. He discusses the body's pH as an important mechanism in health and its role in circadian rhythms. This goes beyond the message of alkalinize as it depends on the individual, the time of day and his life style choices. He will tell you how to hack your own pH and circadian rhythms for optimal performance and health. Other self tests discussed include: An easy self assessment for a coagulopathy as well as approaches for for modifying/ hacking its impact. He will also discuss a simple self test to assess carbon dioxide levels.
Biohacking is the approach of assessing body functioning and assessing the impact of life style choices. Steve Fowkes, an expert in biohacking, discusses how we can determine if our metabolism is fast or slow, the physical manifestations of the metabolism rate, and how we can hack / alter our metabolism rate. He discusses the body's pH as an important mechanism in health and its role in circadian rhythms. This goes beyond the message of alkalinize as it depends on the individual, the time of day and his life style choices. He will tell you how to hack your own pH and circadian rhythms for optimal performance and health. Other self tests discussed include: An easy self assessment for a coagulopathy as well as approaches for for modifying/ hacking its impact. He will also discuss a simple self test to assess carbon dioxide levels.
Dr. Ernest "Gene" Moore the editor of The Journal of Trauma and Acute Care Surgery discusses how he approaches the coagulopathic trauma patient and his experience with splenic salvage.
Presented by Michael R. Foley, MD
Presented by Michael R. Foley, MD
Day and Olusanya present many interesting articles from the Journal of the Intensive Care Society. They discuss a case of coagulopathy on novel anticoagulants, riginal research on use of automatic acceptance criteria to improve patient transfers. and intensive care follow up of UK military casualties. All the articles are #FOAMed and can be accessed from: http://inc.sagepub.com/content/15/2.toc
In this VetGirl podcast, Dr. Marie Holowaychuk, DACVECC discusses the use of desmopressin (DDAVP) for the treatment of aspirin-induced coagulopathy! So, if you're about to take a dog to surgery, and just found out he's been on chronic aspirin therapy, consider listening to this podcast... it'll help with the oozing!
In this VetGirl podcast, Dr. Marie Holowaychuk, DACVECC discusses the use of desmopressin (DDAVP) for the treatment of aspirin-induced coagulopathy! So, if you're about to take a dog to surgery, and just found out he's been on chronic aspirin therapy, consider listening to this podcast... it'll help with the oozing!
Dr. Klaus Gorlinger is one of the leading international experts in the management of coagulopathy and has dedicated his career to perfecting the art & science of hemostatic resuscitation. One of his major fields of expertise is the use of Point of Care (POC) guided algorithms for goal directed coagulopathy management. Dr. Gorlinger is now the ...
Evolution and inflammation. Karim Brohi critiques our approach to sepsis and how we should consider more judicious, multi-directional approach.
The techniques and equipment of cardiopulmonary bypass (CPB) have evolved over the past 60 years, and numerous numbers of cardiac surgical procedures are conducted around the world using CPB. Despite more widespread applications of percutaneous coronary and valvular interventions, the need for cardiac surgery using CPB remains the standard approach for certain cardiac pathologies because some patients are ineligible for percutaneous procedures, or such procedures are unsuccessful in some. The ageing patient population for cardiac surgery poses a number of clinical challenges, including anemia, decreased cardiopulmonary reserve, chronic antithrombotic therapy, neurocognitive dysfunction, and renal insufficiency. The use of CPB is associated with inductions of systemic inflammatory responses involving both cellular and humoral interactions. Inflammatory pathways are complex and redundant, and thus, the reactions can be profoundly amplified to produce a multiorgan dysfunction that can manifest as capillary leak syndrome, coagulopathy, respiratory failure, myocardial dysfunction, renal insufficiency, and neurocognitive decline. In this review, pathophysiological aspects of CPB are considered from a practical point of view, and preventive strategies for hemodilutional anemia, coagulopathy, inflammation, metabolic derangement, and neurocognitive and renal dysfunction are discussed. To view the article, click here.
Holley analyses the cascade of events in bleeding trauma patients leading to Australia's latest evidenced-based guidelines on transfusion protocols in critical bleeding.
A discussion regarding causes of coagulopathy in trauma and the use of TEG in its diagnosis and management.
An in-depth discussion regarding use of TEG to diagnose both hypo- and hyper-coagulable states following injury
Coagulopathy in liver transplantation, hepatorenal syndrome
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