Gregg Sherman, MD
National Association for Continuing Education
Harvey C. Parker, Ph.D.
National Association for Continuing Education
Deborah Paschal, CRNP
Clinical Nurse Practitioner
Jefferson Northeast Health
Joshua Kilbridge, President
San Francisco, CA
Holly A. Rodgers, MSN, CRNP, ACNPC-AG, CCRN
Surgical Intensive Care Unit
Corporal Michael J. Crescenz VA Medical Center
Kaitlyn Gregory, DNP, CRNP, FNP-BC
Nurse Practitioner - Thoracic Surgery
Fox Chase Cancer Center
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:
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.
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.
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.
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 firstname.lastname@example.org
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.