Target Audience
This activity has been designed to meet the educational needs of trauma surgeons, anesthesiologists, and other healthcare practitioners who may treat or diagnose patients with traumatic injury and hemorrhage.


Statement of Need
Trauma is the third leading cause of death overall and the leading cause of death among those aged 1 to 44 years in the United States. Hemorrhage is a major contributor to the dilemma of traumatic injury and its subsequent care. Patients with massive traumatic hemorrhage inevitably develop coagulopathy as a result of hemodilution and consumption of platelets and clotting factors. Hemorrhagic shock is a predictor of poor outcome in the injured patient and often results in death due to complications, such as eventual organ failure, and the development of infections, including sepsis.

As a critically injured patient progresses through the phases of trauma care, death from causes unrelated to specific injuries becomes more common. More than 80% of the trauma deaths that occur in the OR do so as a result of hemorrhage. These severe injuries comprise a category known as surgical bleeding and account for approximately 50% of hypotensive patients.

Trauma care is continually evolving in an effort to enhance outcomes. Currently, the trend is toward nonoperative management of hemorrhage that was previously considered surgical in nature. The acquired coagulopathy of trauma is an important clinical issue requiring ongoing study and debate.


Educational Objectives
After completing this activity, the participant should be better able to:

• Review the markers, symptoms, and characteristics of the 4 classes of hemorrhagic shock
• Describe the “bloody vicious cycle” that results in hemorrhage-related mortality following traumatic injury
• Describe the impact of various ratios of blood-product transfusion on victims of traumatic injury

Faculty Chairperson
Richard P. Dutton, MD, MBA
Associate Professor of Anesthesiology
University of Maryland School of Medicine
Director of Trauma Anesthesiology
R Adams Cowley Shock Trauma Center
Baltimore, Maryland

Faculty
John B. Holcomb, MD, FACS
Commander, US Army Institute of Surgical Research
Trauma Consultant for the Surgeon General
Fort Sam Houston, Texas


Physician Continuing Medical Education
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM), the Cardiovascular & Metabolic Health Foundation, and Educational Concepts in Medicine. PIM is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Postgraduate Institute for Medicine designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Method of Participation
During the period June 16, 2008 through June 16, 2009, participants must:

• Read the learning objectives and faculty disclosures
• Study the educational activity
• Complete the posttest by recording the best answer to each question
• Complete the evaluation form

A statement of credit will be issued upon receipt of a completed activity evaluation form and a completed posttest with a score of 70% or better.


Fee
There is no fee to participate in or to receive credit for this educational activity.


Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter	Reported Financial Relationship
Richard P. Dutton, MD, MBA	Consultant: Novo Nordisk Pharmaceuticals
John B. Holcomb, MD, FACS	Has no real or apparent conflicts of interest to report.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager	Reported Financial Relationship
PIM Clinical Reviewers: Trace Hutchison, PharmD; Jan Hixon, RN, BSN, MSN; Linda Graham, RN, BSN; and Jan Schultz, RN, BSN, MSN	Have no real or apparent conflicts of interest to report.
ECM: Bart Zoni, Executive Director; Patrick Crowley, Senior Director of Operations	Have no real or apparent conflicts of interest to report.

Media
Internet

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Cardiovascular & Metabolic Health Foundation (CMH), Educational Concepts in Medicine, and Novo Nordisk Pharmaceuticals do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, CMH, Educational Concepts in Medicine, and Novo Nordisk Pharmaceuticals. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.


Commercial Support
This activity is supported by an educational grant from Novo Nordisk Pharmaceuticals.