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
The acute coagulopathy of trauma exerts a large toll on patient mortality, with most patients dying of CNS injury or shock, usually within hours of hospital admission. Given the narrow therapeutic window for clinical interventions, having an understanding of the mechanisms involved in the coagulopathy of trauma-shock is critical. This learning activity addresses the issue of coagulopathy in trauma care, noting specifically the role of shock as an inducer of acute traumatic coagulopathy and providing a breakdown of contributing physiologic events.



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

• Define the mechanisms that comprise the acute coagulopathy of trauma
• Explain the role of shock as an inducer of acute traumatic coagulopathy
• Describe the effects of hypothermia and dilution on patients with severe coagulopathy

Faculty
Bryan A. Cotton, MD, MPH
Associate Professor of Surgery
Department of Surgery
Division of Acute Care Surgery
The University of Texas Health Science Center at Houston
Center for Translational Injury Research
Houston, Texas


Richard P. Dutton, MD, MBA
Professor of Anesthesiology
University of Maryland School of Medicine
Attending Anesthesiologist
R Adams Cowley Shock Trauma Center
Baltimore, Maryland


Martin A. Schreiber, MD, FACS
Professor of Surgery
Trauma/Critical Care Section
Oregon Health & Science University
Portland, Oregon


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 (CMH), 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 0.25 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 September 11, 2009 through September 11, 2010, 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
Bryan A. Cotton, MD, MPH	Has no real or apparent conflicts of interest to report.
Richard P. Dutton, MD, MBA	Consulting: Novo Nordisk Pharmaceuticals Contracted Research: Octapharma AG
Martin A. Schreiber, 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, MA; Linda Graham, RN, BSN, BA; Jan Schultz, RN, MSN, CCMEP; and Julia Kirkwood, RN, BSN	Have no real or apparent conflicts of interest to report.
ECM: Bart Zoni, Executive Director; Pat Crowley, Sr. Director, Operations; Jodi Andrews, Foundation Manager; Gay Boyle, Editorial Services	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 (ECM), 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, ECM, 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.