Optimizing Outcomes in Distributive Shock: Early Recognition and Treatment

Emergency Medicine
Curriculum:
Optimizing Outcomes in Distributive Shock: Recognizing Patients at Risk and Implementing Evolving Strategies of Care
Credits:
0.25 AMA PRA Category 1 Credit(s)™
Launch Date:
22-May-18
Expiration Date:
21-May-19

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

Relevant Terms:

Distributive shock; sepsis; septic shock

Herbert Patrick, MD, BSEE, MSEE, FACP, FCCP, FCCM

Herbert Patrick, MD, BSEE, MSEE, FACP, FCCP, FCCM
Internal Medicine, Pulmonary Diseases and Critical Care Medicine
Jefferson Health - Northeast
Philadelphia, PA

Dr. Herbert Patrick is an Intensivist and Program Director of the Critical Care Medicine Fellowship Program at Jefferson Health. He completed his undergraduate bachelor and graduate master’s degrees in electrical engineering at the University of Pennsylvania. He worked in the biomedical industry until obtaining his medical degree at Jefferson Medical College and Pulmonary training at Temple University Hospital. He has been Pulmonary-Critical Care faculty at Jefferson University Hospital as Medical Director of Respiratory Care and at Hahnemann University Hospital as Director of Critical Care Services. He is triple board certified and a Fellow of the American College of Physicians, American College of Chest Physicians and American College of Critical Care Medicine.

Michael Pinsky, MD, MCCM

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

Dr. Michael R. Pinsky is a Professor of Critical Care Medicine, Bioengineering, Cardiovascular Diseases, Clinical & Translational Science, and Anesthesiology at the University of Pittsburgh. His primary research interests are cardiovascular and pulmonary physiology, shock resuscitating, sepsis, energy metabolism, healthcare informatics, and outcomes research. He received his MD, CM from McGill University in 1974, Internal Medicine and Pulmonary fellowship at Stanford University in 1979 and Cardiopulmonary Physiology at Johns Hopkins Medical Institutions in 1981. 

Maureen A. Seckel, RN, APRN, MSN, CCRN, CCNS, ACNS-BC, FCCM

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

Maureen Seckel has published and presented at national forums on critical care including evidence-based practices and sepsis. She is lead critical care clinical nurse specialist and sepsis leader for an 1100 bed healthcare system.  She has expertise with both invasive and non-invasive monitors and methods to assess volume resuscitation. Maureen is an author on the 2016 Surviving Sepsis Guidelines and was a member of the Surviving Sepsis National Inpatient Collaborative.

Steven Q. Simpson, MD, FCCP, FACP

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

Dr. Steven Simpson has been the medical director for multiple tertiary and academic ICUs and has led the sepsis team at the University of Kansas since 2004. He is past chair of CHEST’s Critical Care NetWork, led CHEST’s annual postgraduate course in critical care for six years, and has served numerous times on the program committee for the CHEST annual meeting. He has extensive research experience in sepsis, including cell and molecular studies, clinical trials, translational studies, and epidemiology. He founded the Kansas Sepsis Project, a collaborative effort to raise the quality of sepsis care across his home state and has led the Midwest Critical Care Collaborative since its inception in 2005. Dr. Simpson is a member of the board of directors and is Medical Director of Sepsis Alliance, a national education and advocacy group for victims of sepsis.
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. Collaborate with members of the interprofessional health care team for effective team management of distributive shock

Planning Committee
Gregg Sherman, MD
National Association for Continuing Education
Plantation, FL
 
Harvey C. Parker, Ph.D.
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
 
Joshua 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 0.25 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 0.25 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: 15 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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