Optimizing Outcomes in Distributive Shock: A Self-assessment Program

Title:

Optimizing Outcomes in Distributive Shock: A Self-assessment Program

Topic: Critical Care
Relevant Terms: Distributive shock; sepsis; septic shock
Primary Audience: Critical care teams of physicians; nurses; nurse practitioners; physician assistants; pharmacists, respiratory care therapists, dieticians and physical therapists; and other clinicians involved in the evaluation and management of patients with distributive shock
Launch Date: 29-Mar-18
Credits: 0.5 AMA PRA Category 1 Credit
0.5 AANP contact hour of continuing education
Expiration Date: 29-Mar-19
Curriculum Name: Optimizing Outcomes in Distributive Shock: Recognizing Patients at Risk and Implementing...

Learning Objectives

After completing this activity, the participant will demonstrate the ability to:

  1. Describe the blood pressure regulatory systems, including adrenal/sympathetic, arginine/vasopressin, and renin-angiotensin-aldosterone systems
  2. Discuss the current treatment strategies for distributive shock
  3. Recognize patients with clinical refractory hypotension
  4. Identify new and emerging therapies for the treatment of distributive shock
  5. Collaborate with members of the interprofessional health care team for effective team management of distributive shock

    Faculty

    Herbert Patrick MD, BSEE, MSEE
    Pulmonary Disease, Internal Medicine and Critical Care Medicine
    Thomas Jefferson University Hospital
    Philadelphia, PA
    Michael Pinsky, MD, MCCM
    Professor of Critical Care Medicine, Bioengineering, Anesthesiology, Cardiovascular Diseases, and Clinical & Translational Sciences
    Vice Chair for Academic Affairs
    University of Pittsburgh
    Pittsburgh, PA
    Maureen A. Seckel, RN, APRN, MSN, CCRN, CCNS, ACNS-BC, FCCM
    Lead Critical Care Clinical Nurse Specialist Sepsis Coordinator
    Christiana Care Health Services
    Newark, DE
    Steven Q. Simpson, MD, FCCP, FACP
    Professor of Medicine
    Interim Division Director
    Medical Director MICU, MTICU, MSICU
    Division of Pulmonary and Critical Care
    University of Kansas
    Kansas City, KS
    Planning Committee
    Gregg Sherman, MD
    National Association for Continuing Education
    Plantation, FL
     
    Harvey C. Parker, Ph.D., CCMEP
    National Association for Continuing Education
    Plantation, FL
     
    Deborah Paschal, CRNP
    Clinical Nurse Practitioner
    Jefferson Northeast Health
    Philadelphia, PA
     
    Joshua Kilbridge, President
    Kilbridge Associates
    San Francisco, CA
     
    Holly A. Rodgers, MSN, CRNP, ACNPC-AG, CCRN
    Surgical Intensive Care Unit
    Corporal Michael J. Crescenz VA Medical Center 
    Philadelphia, PA
     
    Kaitlyn Gregory, DNP, CRNP, FNP-BC
    Nurse Practitioner - Thoracic Surgery
    Fox Chase Cancer Center
    Philadelphia, PA
     
    PROGRAM OVERVIEW:
    Shock is a clinical manifestation of circulatory failure leading to inadequate tissue perfusion. Based on the pathophysiological mechanisms involved, four types of shock are recognized: hypovolemic shock (from fluid loss), cardiogenic shock (due to pump failure), obstructive shock (obstruction to blood circulation leading to inadequate oxygenation), or distributive shock (vasodilation resulting from the release of inflammatory mediators). Of these, distributive shock is the most common form of shock among patients in the intensive care unit (ICU). Distributive shock is often associated with sepsis but can also form an important component in other forms of advanced shock.
     
    Early initiation of appropriate therapy – within an hour of development of hypotension – is crucial for clinical improvement and reduction in mortality. Education on the three-major blood pressure regulatory systems, as highlighted by the fact that although shock may be refractory to adrenal/sympathetic and arginine/vasopressin system-mediated therapies, these systems continue to be leveraged for managing hypotension, while the role of the RAAS may be underrecognized. Distributive shock can be refractory to treatment with catecholamine and fluid administration and patients may benefit from new and emerging therapies such as angiotensin II and agents acting on the RAAS.
     
    This curriculum is designed to provide learners with a serial learning curriculum to bridge the knowledge and performance gaps related to distributive shock with personalized learner pathways.  This educational initiative offers a two-phased curriculum. Phase 1 will offer a Self Assessment Program (SAP) to allow learners to assess their knowledge and skills in this area, compare their selections and scores with all other learners to date, and review commentary from the faculty.  The goal of the SAP is to make learners aware of their strengths and weaknesses in this subject area.
     
    After completing the SAP, learners will receive up to three brief, single-issue focused activities designed to cover all key learning points of the curriculum.  Learners will be invited to participate in the subset of these activities that best address their learning gaps. 
     
    DISCLOSURE POLICY STATEMENT:
    It is the policy of NACE to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. NACE assesses conflict of interest with its faculty, planners and managers of CME activities. Conflicts of interest that are identified are resolved by reviewing that presenter's content for fair balance and absence of bias, scientific objectivity of studies utilized in this activity, and patient care recommendations.
     
    While NACE endeavors to review faculty content, it remains the obligation of each physician or other healthcare practitioner to determine the applicability or relevance of the information provided from this course in his or her own practice.
     
    DISCLOSURE OF CONFLICTS OF INTEREST:
     
    Faculty
    Herbert Patrick MD, BSEE, MSEE, speaks and teaches at Edwards Lifesciences. He also has ownership interests at Advanced Vital Signs, INC.
     
    Michael Pinsky, MD, MCCM, serves as an advisor on Cardiovascular Shock for Edwards, LIDCO and Cheetah Medical. He is also a principal investigator on Cardiovascular Shock for the NIH
     
    Maureen A. Seckel, RN, APRN, MSN, CCRN, CCNS, ACNS-BC, FCCM, has no real or apparent conflicts of interest to report. 
     
    Steven Q Simpson, MD, FCCP, FACP, has no real or apparent conflicts of interest to report. 
     
    Planning Committee
    Gregg Sherman, MD, has no real or apparent conflicts of interest to report. 
     
    Harvey Parker, PhD, has no real or apparent conflicts of interest to report. 
     
    Deborah Paschal, CRNP, has no real or apparent conflicts of interest to report
     
    Josh Kilbridge has no real or apparent conflicts of interest to report. 
     
    Holly A. Rodgers, MSN, CRNP, ACNPC-AG, CCRN, has no real or apparent conflicts of interest to report. 
     
    Kaitlyn Gregory, DNP, CRNP, FNP-BC, has no real or apparent conflicts of interest to report. 
     
    DISCLOSURE OF UNLABELED USE:
    NACE requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.
     
    DISCLAIMER
    The opinions expressed during the educational activity are those of the faculty and do not necessarily represent the views of NACE. The information is presented for the purpose of advancing the attendees' professional development.
     
    ACCREDITATION STATEMENT:
    The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
     
    National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number 121222.
     
    This CME activity was planned and produced in accordance with the ACCME Essentials and the AANP CE Standards and Policies and AANP Commercial Support Standards.
     
    For CME questions, please contact: NACE at info@naceonline.com
     
    Contact this CME provider for privacy and confidentiality policy statement information at:http://www.naceonline.com/privacy_policy.php
     
    CREDIT DESIGNATION STATEMENT:
    The National Association for Continuing Education designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim credit commensurate with the extent of their participation in the activity.
     
    National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider Number 121222. This program has been approved for 0.5 hr contact hours of continuing education (which includes 0.25 hours of pharmacology)
     
    TO OBTAIN CME CREDITS:
    • Read the learning objectives and faculty disclosures.
    • Participate in the activity.
    • Complete the post-test and activity evaluation.
    • Physicians who successfully complete the post-test and evaluation will receive CME credit.
    • Nurse Practitioners who successfully complete the post-test and evaluation will receive AANP CE credit.
    • You must score 60% or higher on the post-test to receive credit for this activity.
    • All other participants who successfully complete the post-test and evaluation will receive a certificate of participation.
     
    COURSE FORMAT/MEDIUM: Internet CME Activity
     
    ESTIMATED TIME TO COMPLETE: 30 minutes
     
    ACKNOWLEDGEMENT:
    This activity is sponsored by National Association for Continuing Education.
     
    This activity is supported by educational funding provided by LaJolla Pharmaceuticals.
     
    If you have any questions regarding this activity, send an email to info@naceonline.com.
       
    Copyright © 2018 National Association for Continuing Education. All rights reserved. These materials may be used for personal use only. Any rebroadcast, distribution, or reuse of this presentation or any part of it in any form for other than personal use without the express written permission of NACE is prohibited.
     
     
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