Critical Care Management Of Bleeding Disorders: Emergency Department Best Practices (Critical Care CME)

About This Resource

Critical Care Management of Bleeding Disorders will inform your practice and update current practices as they pertain to blood product transfusion, reversal of anticoagulation, coagulopathy in acute intracranial hemorrhage, resuscitation of the patient with massive upper GI bleeding, and the use of blood products in critically ill patients. These fields are rapidly changing, especially with the addition of target-specific oral anticoagulants.

Product Details

Publication Date: October 1 , 2016

CME Expiration Date: October 1, 2019

CME: This enduring material includes 9 AMA PRA Category 1 Credits^TM. (Critical Care CME)

Editor

William A. Knight, IV, MD, FACEP, FNCS
Associate Professor of Emergency Medicine and Neurosurgery; Medical Director, Emergency Medicine Advanced Practice Provider Program, Associate Medical Director, Neuroscience ICU, University of Cincinnati, Cincinnati, OH; Critical Care Editor, Emergency Medicine Practice

Authors

Kevin Scott, MD
Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA

Colin Greineder, MD, PhD
Instructor, Department of Emergency Medicine, Postdoctoral Research Fellow, Institute of Translational Medicine and Therapeutics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA

Lauren Weinberger Conlon, MD
Associate Residency Director, Department of Emergency Medicine, Assistant Professor, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA

Isaac Tawil, MD
Assistant Professor, Department of Surgery, Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, NM

David B. Seder, MD, FCCP
Director of Neurocritical Care, Maine Medical Center, Portland, ME; Assistant Professor of Medicine, Tufts University School of Medicine, Boston, MA

Jennifer Duprey, DO, MPH
Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME

Ryan G. K. Mihata, MD, MPH, FACEP
Assistant Professor of Emergency Medicine/Critical Care, Wright State University, Boonshoft School of Medicine, Dayton, OH

John-Adam Bonk, MD
Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH

Meaghan P. Keville, MD
Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, OH

Table of Contents

Review 1: Critical Care Management Of Bleeding Disorders: Emergency Department Best Practices

1. Introduction
2. The Use Of Blood Products In Critically Ill Patients
   1. Transfusion Ratios Of Plasma, Platelets, And Red Blood Cells In Severe Trauma (PROPPR Trial)1
   2. Age Of Transfused Blood In The Critically Ill (ABLE Trial)2
3. Emergency Management Of Coagulopathy In Acute Intracranial Hemorrhage
   1. Platelet Transfusion After Acute Stroke: The PATCH Trial
   2. Guideline For Reversal Of Antithrombotics In Intracranial Hemorrhage
4. Resuscitation Of The Patient With Massive Upper Gastrointestinal Bleeding
   1. Nasogastric Tube Lavage
   2. Prophylactic Antibiotics
5. References

Review 2: The Use Of Blood Products In The Critically Ill Patient: Indications And Risks

1. Abstract
2. Case Presentations
3. Abbreviations Used In This Issue
4. Introduction
5. Critical Appraisal Of The Literature
6. Going Deeper: How Red Blood Cell, Plasma, And Platelet Transfusions Work
   1. Packed Red Blood Cells
   2. Plasma Components
   3. Platelets
7. What Patients Need: Packed Red Blood Cells, Plasma, Or Platelet Transfusions?
   1. Packed Red Blood Cell Indications
   2. Plasma Indications
   3. Platelet Indications
   4. Cryoprecipitate Indications
8. Tools And Techniques: Practical Considerations For Transfusions
   1. Infusion Considerations
   2. Autotransfusion
9. Complications Of Blood Product Administration
   1. Transfusion-Related Acute Lung Injury
   2. Acute Hemolytic Transfusion Reactions
   3. Delayed Hemolytic Transfusion Reaction
   4. Transfusion-Associated Circulatory Overload
   5. Transfusion-Transmitted Bacterial Infections
   6. Urticarial Transfusion Reaction And Anaphylactic Transfusion Reactions
   7. Febrile Nonhemolytic Transfusion Reactions
   8. Transfusion-Related Immunomodulation
   9. Transfusion-Associated Graft-Versus-Host Disease
   10. Distinguishing Major From Minor Transfusion Reactions
10. Measuring Response
11. Special Circumstances
    1. Leukoreduced And Irradiated Blood Products
    2. Erythrocyte Alloimmunization And Delayed Hemolytic Transfusion Reaction In Sickle Cell Disease
12. Informing Patients And Obtaining Consent
13. Cutting Edge: Use Of Oxygen-Carrying Substitutes
14. Massive Transfusion/Exsanguination Protocols
15. Disposition
16. Summary
17. Case Conclusions
18. Must-Do Markers Of Quality Emergency Department Critical Care
19. References
20. CME Questions

Review 3: Emergency Management Of Coagulopathy In Acute Intracranial Hemorrhage

1. Abstract
2. Case Presentations
3. Abbreviations
4. Introduction
5. Critical Appraisal Of The Literature
6. Antithrombotic Mechanisms And Monitoring Of Effect
   1. Vitamin K Antagonists
   2. Antiplatelet Agents
   3. Heparins
   4. Pentasaccharides
7. Antithrombotic Reversal Strategies
   1. Reversing Vitamin K Antagonists
      1. Vitamin K
      2. Plasma Transfusion
      3. Coagulation Factor Concentrates (PCC And rFVIIa)
   2. Reversing Antiplatelet Agents
      1. Platelet Transfusion
      2. Desmopressin And rFVIIa
   3. Reversing Heparins
      1. Protamine
   4. Reversing Pentasaccharides
      1. rFVIIa
   5. Reversing Thrombolytic Agents
8. Special Circumstances: Patients At High Risk For Thrombotic Disorders
9. Cutting Edge: New Oral Anticoagulants And Challenges
10. Disposition
11. Summary
12. Must-Do Markers Of Quality ED Critical Care
13. Case Conclusions
14. References
15. CME Questions

Review 4: Resuscitation Of The Patient With Massive Upper Gastrointestinal Bleeding

1. Abstract
2. Case Presentation
3. Introduction
4. Critical Appraisal Of The Literature
5. Etiology And Pathophysiology
6. Treatment
   1. Stabilization And Monitoring
   2. Procedural Therapies
      1. Endoscopy
      2. Balloon Tamponade
      3. Additional Procedural Therapies
   3. * Pharmacologic Therapies
      1. Proton Pump Inhibitors
      2. Somatostatin
      3. Vasopressin
   4. * Blood Product Transfusion
      1. Goal #1: Provide Intravascular Volume Resuscitation
      2. Goal #2: Optimize Oxygen-Carrying Capacity
      3. Goal #3: Reverse Coagulopathy
           Reversal Of Medically Induced Coagulopathy Warfarin
           Dabigatran
           Rivaroxaban
           Unfractionated Heparin
           Clopidogrel
7. Special Circumstances
8. Disposition
9. Summary
10. Case Conclusion
11. Must-Do Markers Of Quality Care
12. References
13. CME Questions