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By Nathan Blecker, M.D., Division of Trauma/Department of Surgery, Summa Health Medical Group , Nathan Heinzerling, M.D., Trauma Services, Akron Children’s Hospital

Objectives (Educational Content) :

• Describe normal hemostasis and coagulation pathways. • Describe causes of coagulopathy and its management. • Introduce the concept of ROTEM/TEG to guide resuscitation. • Learn interpretation of ROTEM/TEG studies. • Discuss differences between ROTEM and TEG.

Target Audience:

Emergency Medicine, Surgery and Trauma providers.

Identified Gap:

The American College of Surgeons Committee on Trauma requires a structured effort by trauma programs to demonstrate a continuous process for improving care for injured patients and states that an evidence-based rather than an empiric approach presents more meaningful criteria against which trauma care can be measured. A standardized approach to recurring care issues minimizes unnecessary variation, allow better outcome assessment, and makes changes in care easier to implement and more uniform. They further recommend that all members of the trauma team are knowledgeable about current practices in trauma care, that multidisciplinary education should be ongoing in all trauma centers, and that performance improvement programs should be an important part of educational activities.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:


Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.


Drs. Blecker and Heinzerling have indicated that she has no relevant financial interest in any pharmaceutical or medical device company and that this activity was developed independent of commercial interest.

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.


Current Surgical Therapy, 12th edition​

Schwartz Principles of Surgery 12th edition ​

Cotton, BA, Rapid thromboelastography delivers real time results that predict transfusion within 1 hour of admission ​

Cotton, B, Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients ​

Cotton, B, A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions ​

Boffard, KD, Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo controlled, double-blind clinical trials ​

Hauser, CJ, Results of the CONTROL trial: efficacy and safety of recombinant Factor VII in the management of refractory traumatic hemorrhage ​

Holcomb, J, The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study: Comparative Effectiveness of a Time-varying Treatment with Competing Risks ​

Holcomb, J, Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients with Severe Trauma The PROPPR Randomized Clinical Trial ​

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