Current Topics in Shock and Sepsis Management: Traumatic Hemorrhagic Shock and Septic Shock
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Current Topics in Shock and Sepsis Management: Traumatic Hemorrhagic Shock and Septic Shock

This course combines audio and digital components to review critical care management of traumatic hemorrhagic shock management as well as sepsis and septic shock. Includes 9.5 AMA PRA Category 1 Credits™.

Modules

We hope you enjoy this course! If you have any questions, our Customer Service Team is here to help Monday - Friday, 9:00am-5:30pm EST, and can be reached at 678-366-7933 or ebm@ebmedicine.net

Authors

Ashley Norse, MD
Associate Professor & Associate Chair, Clinical Operations; Medical Director, Emergency Medicine Clinical Center, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
Lauren P. Black, MD, MPH
Assistant Professor, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
Jason David, MD
Department of Emergency Medicine, University of Nevada, Las Vegas, Las Vegas, NV
Elizabeth L. DeVos, MD, MPH, FACEP
Associate Professor & Medical Director, International Emergency Medicine Education; Program Director, COM International Medical Education Programs, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
Faheem W. Guirgis, MD, FACEP
Associate Professor, Department of Emergency Medicine; Program Director, Emergency Medicine and Acute Care Research Fellowship; Director, Center for Research Training, University of Florida Health – Jacksonville, Jacksonville, FL
Christopher Pitotti, MD, FACEP
Associate Program Director, University of Nevada-Las Vegas Emergency Medicine Residency, Las Vegas, NV; Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Peer Reviewers

Michael Allison, MD
Assistant Director, Adult Intensive Care Unit, Saint Agnes Hospital Center, Baltimore, MD
Ryan M. Knight, MD
Assistant Professor of Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Clinical Staff, University of Cincinnati, Cincinnati, OH
Jeremy Rose, MD, MPH
Assistant Medical Director, Emergency Medicine, Mount Sinai Beth Israel Hospital; Assistant Professor, Icahn School of Medicine at Mount Sinai, New York, NY
Leslie V. Simon, DO
Associate Professor, Mayo Clinic Alix School of Medicine; Chair, Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL
Eric M. Steinberg, DO, FACEP
Assistant Program Director, Emergency Medicine Residency, Mount Sinai Beth Israel; Assistant Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Podcast Presenter

Sam Ashoo, MD
Emergency physician practicing in Tallahassee, FL; board-certified in emergency medicine and clinical informatics

Audio Lecturers

Jennifer Axelband, DO
Associate Medical Director, Medical Critical Care Education, at St. Luke's University Hospital - Bethlehem Campus, Bethlehem, PA
R. Phillip Dellinger, MD, FCCM, FCCP
Professor of Medicine and Distinguished Scholar, Cooper Medical School of Rowan University; Director, Cooper Research Institute; Senior Critical Care Attending, Cooper University Hospital, Camden, NJ

Audio Webinar Presenter

Scott D. Weingart, MD, FCCM, FUCEM, DipHTFU
Professor of Emergency Medicine; Chief, Division of Emergency Critical Care; Director, Resuscitation and Acute Critical Care Unit; Stony Brook Medicine, Stony Brook, NY

Product Details

Publication Date: April 15, 2021

CME Expiration Date: October 31, 2023

CME Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME. Credit Designation: EB Medicine designates this enduring material for a maximum of 9.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Current Topics in Shock and Sepsis Management: Traumatic Hemorrhagic Shock and Septic Shock is eligible for 9.5 Category 2-A or 2-B credit hours by the American Osteopathic Association. The “An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department” journal issue is approved by the American College of Emergency Physicians for 4 hours of Category I credit. The “Updates and Controversies in the Early Management of Sepsis and Septic Shock” journal issue is approved by the American College of Emergency Physicians for 4 hours of Category I credit.

Table of Contents

Module 1: An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department + EMplify podcast audio discussion

  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Etiology and Pathophysiology
    1. The Lethal Triad
  6. Differential Diagnosis
  7. Prehospital Care
    1. Stabilization
      1. Tourniquet Use
      2. Hemostatic Dressings
      3. Airway and Breathing
      4. Circulation
      5. Tranexamic Acid
      6. Temperature Management
    2. Transport
  8. Emergency Department Preparation
  9. Emergency Department Evaluation
    1. Assessment and Recognition of the Hemorrhagic Shock State
  10. Diagnostic Studies
    1. Ultrasound and Other Imaging
    2. Laboratory Testing
    3. Viscoelastic Clot Testing
  11. Treatment
    1. Hemorrhage Control With In-Hospital Hemostatic Devices
    2. Resuscitative Endovascular Balloon Occlusion of the Aorta
    3. Cardiac Arrest
    4. Resuscitative Thoracotomy
    5. Airway
    6. Breathing
    7. Circulation
      1. Fluid Resuscitation
      2. Massive Transfusion
      3. Crystalloid Therapy
      4. Whole Blood and Red Blood Cells
      5. Plasma
      6. Platelets
      7. Blood Product Ratios
      8. Permissive Hypotension
    8. Hemostatic Products
      1. Tranexamic Acid
      2. Prothrombin Complex Concentrate
      3. Direct Oral Anticoagulant Reversal Agents
      4. Fibrinogen
  12. Special Circumstances and Populations
    1. Central Nervous System Injury
    2. Pediatric Patients
  13. Controversies and Cutting Edge
  14. Disposition
  15. Key Points
  16. Summary
  17. Time- and Cost-Effective Strategies
  18. Risk Management Pitfalls for Traumatic Hemorrhagic Shock
  19. Case Conclusions
  20. Clinical Pathway for Management of Traumatic Hemorrhagic Shock in the Emergency Department
  21. Tables and Figures
    1. Table 1. Traumatic Hemorrhagic Shock Differential
    2. Table 2. Signs and Symptoms of Hemorrhage, by Class (ATLS®)
    3. Table 3. Clinical Prediction Calculators for Shock
    4. Figure 1. Bystander Awareness Campaign Information
    5. Figure 2. Fluid in Morison Pouch on eFAST
    6. Figure 3. TEG Waveforms in Various Coagulopathic States Showing Clot Firmness Versus Time
    7. Figure 4. ER-REBOA™ PLUS Catheter
    8. Figure 5. Zones of Aortic Occlusion in Resuscitative Endovascular Balloon Occlusion of the Aorta
  22. References

Module 2: Updates and Controversies in the Early Management of Sepsis and Septic Shock + EMplify podcast audio discussion

  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Definitions and Terminology
  5. Critical Appraisal of the Literature
  6. Epidemiology
  7. Etiology and Pathophysiology
  8. Differential Diagnosis
  9. Prehospital Care
  10. Emergency Department Evaluation
    1. History
    2. Physical Examination
  11. Diagnostic Studies
    1. Laboratory Testing
    2. Lactate Versus Central Venous Oxygen Saturation
    3. Procalcitonin
    4. Imaging
    5. Scoring Systems
  12. Treatment
    1. Initial Management
    2. COVID-19 Effect on Sepsis Screening and Management
    3. Intravenous Fluids
      1. Fluid Volume and Timing
      2. Fluid Type
      3. Fluid Status Assessment
    4. Antibiotics
      1. Antibiotic Timing
      2. Antibiotic Coverage
    5. Vasopressors and Inotropes
      1. Norepinephrine Versus Dopamine
      2. Vasopressin
      3. Epinephrine
      4. Phenylephrine
      5. Vasopressor Timing
        • Angiotensin II
    6. Corticosteroids
    7. Blood Transfusion
  13. Special Populations
    1. Pregnant Patients
    2. Patients With End-Stage Renal Disease
  14. Controversies and Cutting Edge
    1. Controversies
      1. Hour-1 Bundle
      2. Fluid Volume
      3. Etomidate
      4. Vitamin C
    2. Cutting Edge
  15. Disposition
    1. End-of-Life Care
  16. Summary
  17. Risk Management Pitfalls for Sepsis Management in the Emergency Department
  18. Time- and Cost-Effective Strategies
  19. Case Conclusions
  20. Clinical Pathways
    1. Clinical Pathway for Sepsis Screening in the Emergency Department
    2. Clinical Pathway for Initial Management of Patients With Sepsis
  21. Tables
    1. Table 1. Sequential Organ Failure Assessment Score
    2. Table 2. Definitions of Sepsis, Severe Sepsis, and Septic Shock
    3. Table 3. Noninfectious Conditions That May Mimic Sepsis
    4. Table 4. Potential Sources of Infection Associated With Sepsis, by Organ System
    5. Table 5. Historical and Physical Examination Findings Concerning for Sepsis
    6. Table 6. Antibiotic Recommendations by Source of Infection
  22. References

 

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