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Live CME Seminars
Critical Care CME - Pulmonary Medicine CME |
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by Seth Hoffman, M.D. - University of Pennsylvania School of Medicine; Assistant Professor of Clinical Medicine, Department of Medicine; Associate Director, Pulmonary Diagnostic Services, Pulmonary, Allergy and Critical Care Division, Hospital of the University of Pennsylvania, Philadelphia, PA and Gregory Tino, M.D., F.C.C.P., F.A.C.P. - University of Pennsylvania School of Medicine; Associate Professor of Medicine; Chief, Pulmonary Clinical Service, Hospital of the University of Pennsylvania, Philadelphia, PA.
Learning Objectives
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Critical Care and Pulmonary Medicine: An Update and Review
March 28 – April 1, 2011
Location: Hyatt Regency Sarasota, Florida
| SPECIFIC OBJECTIVES
| | Day 1 | COPD – Overview of Patient Management Parts, I & II - COPD is a common and important clinical entity. We will review the current status of its diagnosis and treatment. Evidence-based practice parameters will be reviewed. Upon completion of this session, the participant should be able to:
| 1. | Derive an understanding of the definition and pathophysiology of COPD.
| | 2. | Integrate the natural history and clinical features of COPD.
| | 3. | Relate the adverse health effects of cigarette smoking and present recommendations for helping patients “kick the habit”.
| | 4. | Differentiate or recommend any of the options for outpatient management including long term oxygen therapy, pulmonary rehabilitation and pharmacologic treatment. Formulate a treatment algorithm and determine indications for specialist referral.
| | 5. | Specify surgical treatment options for emphysema.
| | “Nuts and Bolts” of Pulmonary Function Testing - We will review the “nuts and bolts” of pulmonary function testing in an easy to understand fashion with an emphasis on outpatient office spirometry. A variety of actual PFT's will be presented for interpretation and review. American Thoracic Society Guidelines will be referenced. Upon completion of this session, the participant should be able to:
| | 1. | Order proper PFTs, including bronchodilator and bronchoprovocation studies, to meet clinical indications.
| | 2. | Analyze the components of PFTs, including spirometry, lung volumes, and diffusion capacity, and use flow-volume loops to differentiate patterns of upper airway obstruction.
| | 3. | Utilize American Thoracic Society Guidelines to integrate PFT components in a stepwise fashion to distinguish among common patterns of pulmonary function decrements and suggest diagnoses.
| | Asthma Update - We will reveal the status of asthma diagnosis and treatment, emphasizing evidence-based NHLBI guidelines. Upon completion of the study, the participant should be able to:
| | 1. | Discuss the pathophysiology of this inflammatory disease.
| | 2. | Detect typical and atypical clinical presentations of asthma and order the proper diagnostics, with cases serving as examples.
| | 3. | Utilize a stepwise, evidence-based approach to treatment, illustrate proper inhaler technique and peak flow monitoring, and recommend techniques to ensure patient compliance.
| | 4. | Assess patients for treatment failure, and recommend subspecialty referral.
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| | Day 2 | Community Acquired Pneumonia - We will review the diagnosis and treatment of this common disorder with emphasis on the most up to date evidence-based published guidelines. Numerous cases will present chest x-rays, and Gram stains will illustrate important points. Upon completion of this session, the participant should be able to:
| 1. | Utilize evidence-based guidelines to assess pneumonia-related severity of illness and recommend outpatient therapy, hospitalization, or ICU levels of care.
| | 2. | Integrate patient characteristics and microbial epidemiology to order evidence-based, empiric antibiotic therapy.
| | 3. | Formulate a cost-effective work-up which might include gram stain/cultures, serology, and bronchoscopy.
| | Pleural Diseases - Pleural effusions can be caused by a wide variety of disorders. A variety of cases will be presented demonstrating some common and some not-so-common causes of pleural effusion. Upon completion of this session, the participant should be able to:
| | 1. | Discuss the anatomy of the pleural space and the physiology of pleural fluid formation.
| | 2. | Order appropriate workup for pleural disorders including plain chest radiography, ultrasonography, CT scanning, thoracentesis, pleural biopsy, and diagnostic pleuroscopy.
| | 3. | Analyze pleural fluid in a cost-effective manner to formulate a thorough differential diagnosis.
| | 4. | Recommend treatment for pleural effusions or specialist referral.
| | Approach to the Patient with Chronic Cough - Cough is a very common outpatient problem, which can be difficult to manage. An evidence-based approach to diagnosis and treatment from the ACCP will be reviewed. Upon completion of this session, the participant should be able to:
| | 1. | Integrate the pathophysiology and clinical aspects of the most common etiologies of cough.
| | 2. | Relate pertinent features of a focused history and physical.
| | 3. | Develop and apply evidence-based and cost effective approach to diagnosis and treatment.
| | Preoperative Pulmonary Assessment - The primary care provider is commonly asked to “clear” a patient with lung disease for surgery. Evidence-based practice parameters from the ACP will be reviewed. Upon completion of this session, the participant should be able to:
| | 1. | Assess the respiratory effects of anesthesia and surgery with an emphasis on patients with at-risk complications.
| | 2. | Assess the perioperative risk factors associated with post-op pulmonary complications.
| | 3. | Formulate the elements of appropriate preoperative evaluation including the role of spirometry.
| | 4. | Employ preoperative and post-operative measures that can minimize postoperative respiratory complications in at-risk patients.
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| | Day 3 | Approach to Acid-Base Disturbances - Several illustrative case studies will be discussed. Upon completion of this session, the participant should be able to:
| 1. | Discover a formal, stepwise approach to the interpretation of any acid-base problem.
| | 2. | Analyze and determine primary metabolic and respiratory acid-base disturbances and their compensatory mechanisms.
| | 3. | Construct the differential diagnosis of the major simple and mixed acid-base disturbances.
| | Acute Respiratory Failure and Mechanical Ventilation - We will provide a practical review of this exciting topic. We will cover the basics of mechanical ventilation and weaning. Evidence-based recommendations will be reviewed. Upon completion of this session, the participant should be able to:
| | 1. | Integrate the pathophysiology and differential diagnosis of acute hypoxemic and hypercapnic respiratory failure.
| | 2. | Apply the basic concepts of management to patients on mechanical ventilation.
| | 3. | Differentiate commonly used ventilator modes. Relate the appropriate use of positive end expiratory pressure (PEEP).
| | 4. | Determine the indications for and complications of mechanical ventilation.
| | 5. | Employ general principles and strategies for liberation from mechanical ventilation.
| | Shock and Hemodynamic Monitoring - Shock is a common problem in the intensive care unit. The international surviving sepsis campaign evidence-based guidelines will be reviewed. Upon completion of this session, the participant should able to:
| | 1. | Detect shock (including non-hypotensive shock), and differentiate among its common causes.
| | 2. | Employ appropriate basic shock therapy, including the evidence-based, early goal-directed therapy for septic shock.
| | 3. | Select patients for whom invasive hemodynamic monitoring may be considered.
| | 4. | Assess patients for activated protein C and corticosteroids.
| | Disorders of Sleep – Obstructive Sleep Apnea and Others - Sleep apnea is a common disorder seen in general practice. Evidence-based practice parameters will be reviewed. Upon completion of the study, the participant should be able to:
| | 1. | Employ a thorough sleep history, and integrate the clinical presentation with pertinent epidemiology to differentiate among the classes of sleep disorders; specific mention will be made of obstructive sleep apnea, insomnias, obesity hypoventilation syndrome, central sleep apnea, Cheyne-Stokes breathing, narcolepsy, and periodic leg movements of sleep.
| | 2. | Order initial sleep-disorder related diagnostics, including overnight polysomnography.
| | 3. | Assess patients for the general classes of obstructive sleep apnea treatments by incorporating evidence-bases for CPAP, dental appliances, surgery, and others.
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| | Day 4 | Tuberculosis - Tuberculosis remains a major global health issue. Upon completion of this session, the participant should be able to:
| 1. | Review the epidemiology of tuberculosis.
| | 2. | Discriminate the clinical presentations of pulmonary and extrapulmonary tuberculosis.
| | 3. | Apply the ATS/CDC criteria for positive tuberculin skin test.
| | 4. | Prescribe treatment of LTBI based on current evidence-based ATS/CDC guidelines.
| | 5. | Assess the diagnostic options including the role of sputum analysis and bronchoscopy.
| | 6. | Formulate the most recent evidence-based ATS/CDC/IDSA Guidelines for TB therapy. We will discuss specific agents and their toxicities as well as formal treatment regimens.
| | 7. | Appraise the problem of multi-drug resistant tuberculosis and implications for therapy.
| | Lung Cancer - Primary lung cancer remains a major cause of morbidity and mortality. A number of new approaches to diagnosis and therapy have been developed. Upon completion of this session, the participant should be able to:
| | 1. | Discuss the epidemiology of lung cancer.
| | 2. | Differentiate the major types of lung carcinoma, particularly small cell and non-small cell cancer.
| | 3. | Determine the basic clinical aspects of both small cell and non-small cell cancer including staging, natural history, and associated extrapulmonary syndromes.
| | 4. | Develop a diagnostic strategy for patients with suspected lung cancer.
| | 5. | Formulate current treatment options for small cell and non-small cell lung cancer.
| | Critical Care Cases for Review, Parts I & II - A variety of Critical Care cases will be presented with audience participation. X-rays and other diagnostic studies will be shown in an attempt to emphasize some of the common problems seen in the ICU. These will include a variety of pulmonary as well as non-pulmonary topics and evidence-based sources will be referenced. The sessions will be interactive. Upon completion of this session, the participant should be able to:
| | 1. | Evaluate common organ failures in critical illness.
| | 2. | Utilize evidence-based, ICU-therapies for common organ failures.
| | 3. | Detect common complications of ICU therapies.
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| | Day 5 | Interstitial Lung Disease - The focus of the discussion will be sarcoidosis and idiopathic pulmonary fibrosis. These are two disorders with which a primary care provider should be familiar. We will present a variety of cases with X-rays, CT scans, and pathology to illustrate important features. The discussion will focus on basic concepts and will include guidelines on specialist referral. Upon completion of this session, the participant should be able to:
| 1. | Differentiate among the spectrum of interstitial lung disease.
| | 2. | Integrate clinical history, high-resolution CT scanning, and tissue biopsy to help diagnose interstitial lung diseases, including sarcoidosis and idiopathic pulmonary fibrosis.
| | 3. | Assess general risks and benefits of therapy for interstitial lung diseases such as sarcoidosis or idiopathic pulmonary fibrosis by integrating disease characteristics and patient characteristics.
| | Pulmonary Cases for Review - Cases will be presented to highlight some common pulmonary problems. Upon completion of this session, the participant should be able to:
| | 1. | Differentiate occupational asthma, work-aggravated asthma, and irritant-induced asthma (reactive airways dysfunction syndrome), and recommend general management strategies.
| | 2. | Integrate patient characteristics to evaluate a non-resolving infiltrate.
| | 3. | Utilize evidence-based guidelines to evaluate a solitary pulmonary nodule.
| | Hemoptysis - A common and occasionally life-threatening emergency. Upon completion of this session, the participant should be able to:
| | 1. | Develop a differential diagnosis for the causes for hemoptysis.
| | 2. | Determine the severity of a bleeding episode.
| | 3. | Employ the diagnostic modalities available.
| | 4. | Develop an acute basic therapy and integrate appropriate indications for specialist referral.
| | Venous Thromboembolism - Venous thromboembolism is a very common, often difficult to diagnose problem with devastating consequences if not treated promptly. Evidence-based approaches to the diagnosis and treatment of DVT and PE, including ACCP guidelines, will be presented. Upon completion of this session, the participant should be able to:
| | 1. | Appraise the epidemiology, risk factors, and clinical presentation of PE and DVT.
| | 2. | Determine the role of DVT and PE prevention and employ current recommendations to accomplish it.
| | 3. | Develop an appropriate diagnostic work-up including V/Q scanning, lower extremity studies, CT scanning, pulmonary angiography and others.
| | 4. | Distinguish appropriate indications and use of treatment modalities including anticoagulation, thrombolysis and vena cava filters.
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