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Anesthesia Camp Grand Cayman 2014 CME

Date:
January 29 - February 1, 2014
Location:
Grand Cayman, Cayman Islands
Description:
Upon completion of this educational activity, participants should be able to: Treat anemia and/or hypovolemia; diagnose and treat coagulopathies; reduce the rate of ‘never events'; provide anesthetics to elderly patients that hopefully maximize rapid recovery of function and discharge.  

The Duke University School of Medicine designates this educational activity for a maximum of 24.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.(General Session=22 credits; Optional Sail=2 Credits for a total of 24 CME Credits)

Venue: Ritz-Carlton Grand Cayman
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Question: A 20-year-old woman presents to her family practitioner for evaluation of progressive fatigue, lightheadedness, dyspnea on exertion, and epistaxis that began insidiously about 2 weeks ago. She also comments that her urine is dark.

  • Medical history: Significant only for intermittent epistaxis dating back to childhood, which had never been evaluated. She denied easy bruising or bleeding gums; her menstrual flow was described as “heavy” since menarche and throughout adolescence.
  • Family history: Benign.
  • Surgical history: Significant for a cesarean hysterectomy 2 years ago due to postpartum hemorrhage in the recovery room which could not be controlled pharmacologically or with uterine artery ligation. Patient reported a normal “blood count” at her routine postpartum visit. The in-office hematocrit was 15%. A peripheral blood smear revealed decreased platelets, spherocytes and a reticulocyte count of 10.0%. The direct Coomb’s test was positive.
Additional admission labs at a community hospital were significant for the following:
  • HCT: 16.2%
  • WBC count: 7400
  • Neutrophil count: 53%
  • Platelet count: 62000
  • Reticulocyte count: 10.7%
  • PT/PTT: Normal
  • LDH: 532 IU/L
  • Indirect bilirubin: 4.9 mg/dL
  • Haptoglobin: 9 mg/dL
The patient underwent a slow transfusion with PRBCs. Based on the initial evaluation, what is the most likely diagnosis?

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