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Related Concept Videos

Disorders of Hemostasis01:24

Disorders of Hemostasis

2.7K
Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
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Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

535
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

363
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
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Extrinsic and Intrinsic Pathways of Hemostasis01:20

Extrinsic and Intrinsic Pathways of Hemostasis

15.0K
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
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Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Updated: Mar 20, 2026

Application of Hemostatic Devices in Laparoscopic Hepatectomy
04:23

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Published on: April 19, 2022

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Postoperative bleeding and coagulation disorders.

Charles Marc Samama1

  • 1Department of Anaesthesia and Intensive Care Medicine, Cochin and Hôtel-Dieu University Hospitals, Paris, France.

Current Opinion in Critical Care
|June 3, 2016
PubMed
Summary

New research offers insights into managing massive bleeding and direct oral anticoagulants. Current evidence suggests specific transfusion ratios may help, while preemptive fibrinogen offers no benefit, guiding clinical practice for anesthesiologists and intensivists.

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Area of Science:

  • Haemostasis and Thrombosis
  • Critical Care Medicine

Background:

  • Massive bleeding and direct oral anticoagulant (DOAC) management are critical clinical challenges.
  • Existing guidelines and practices require updates based on emerging evidence.

Purpose of the Study:

  • To review and synthesize recent data on managing massive bleeding.
  • To provide an updated perspective on the use of monitoring and antidotes for DOACs.

Main Methods:

  • Review of recent studies and clinical trials.
  • Analysis of data concerning blood product transfusion ratios (e.g., 1:1:1) in massive hemorrhage.
  • Evaluation of evidence regarding fibrinogen concentrate administration.
  • Assessment of current practices and emerging data on DOAC monitoring and reversal agents.

Main Results:

  • A recent trauma study partially supports higher ratios of plasma, platelets, and red blood cells.
  • Preemptive administration of fibrinogen concentrates has not demonstrated significant benefits.
  • DOAC monitoring is feasible and recommended in specific clinical scenarios.
  • Development of DOAC antidotes is ongoing, with many questions remaining.

Conclusions:

  • Updated evidence aids clinicians in managing patients with massive bleeding.
  • New data inform the appropriate use of monitoring and antidotes for DOACs.
  • These findings support evidence-based decision-making for anesthesiologists and intensivists.