Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Bleeding and Coagulation Disorders

Video Transcription

Video Summary

Nicole Siparsky, a surgeon intensivist, presented a comprehensive talk on managing bleeding, clotting, and thrombocytopenia. Starting with the importance of thorough history and physical exams, she emphasized identifying conditions like thrombocytopenia and coagulopathy that impact patient outcomes. Key diagnostic steps include evaluating the clotting cascade, calcium levels, CBCs, and COAGs.<br /><br />Siparsky detailed advanced diagnostic techniques like viscoelastic studies and management strategies for specific conditions: <br />- <strong>Drug-Induced Thrombocytopenia</strong>: Distinguishing between immune and non-immune types.<br />- <strong>Immune Thrombocytopenia and TTP</strong>: Using steroids, IVIG, and plasma exchange.<br />- <strong>Heparin-Induced Thrombocytopenia (HIT)</strong>: Management using direct thrombin inhibitors.<br />- <strong>DIC</strong>: Treating the patient’s symptoms rather than focusing on lab results.<br />- <strong>Hepatic Failure Bleeding</strong>: Administer vitamin K and consider balanced transfusion or PCC.<br />- <strong>Massive Transfusion Protocols</strong>: Opt for balanced transfusion (1:1:1 ratio) and early tranexamic acid administration. <br /><br />Siparsky also touched on managing bleeding with anticoagulants and antiplatelet agents and noted the evolving practice in using whole blood versus component therapy in trauma. Her approach aimed at balancing practical, evidence-based decisions with patient-centered care in critical scenarios.

Keywords

bleeding management

thrombocytopenia

coagulopathy

viscoelastic studies

massive transfusion

anticoagulants

trauma care

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