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by Glenn Eiger, M.D., F.C.C.P. - Jefferson Medical College, Thomas Jefferson University; Associate Professor of Medicine; Director, Internal Medicine Residency Program and Associate Chairman, Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA and Gregory Tino, M.D., F.C.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
February 9-13, 2009
Location: Hyatt Regency Sarasota, Florida
OBJECTIVES
| OVERALL OBJECTIVES: The overall objective is to provide the participant with practical and clinically relevant information. Upon completion of this CME activity, the physician or healthcare provider should be able to describe the current approach to formulating differential diagnoses, diagnostic, therapeutic, and preventive management of the various disciplines presented. |
| SPECIFIC OBJECTIVES
| | Day 1 | COPD – Overview of Patient Management Parts I & II. - Upon completion of this session, the participant should be able to:
| 1. | Derive an understanding of the definition and pathophysiology of COPD.
| | 2. | Characterize the natural history and clinical features of COPD.
| | 3. | Outline the adverse health effects of cigarette smoking and present recommendations for helping patients “kick the habit”.
| | 4. | Identify the many aspects of outpatient management including long term oxygen therapy and pharmacologic treatment. We will present a treatment algorithm and discuss indications for specialist referral.
| | 5. | Review surgical treatment options for emphysema.
| “Nuts and Bolts” of Pulmonary Function Testing – The Basics. - We will review the “nuts and bolts” of pulmonary function testing in an easy to understand fashion with an emphasis on outpatient office spirometry.
Upon completion of this session, the participant should be able to:
| | 1. | Identify the components of PFTs including spirometry, lung volumes and diffusion.
| | 2. | Characterize the indications for PFTs.
| | 3. | Describe when bronchodilator and bronchoprovocation studies are useful.
| | 4. | Develop a stepwise approach to PFT interpretation and be able to distinguish common patterns.
| | 5. | Recognize different patterns of upper airway obstruction.
| | A variety of actual PFTs will be presented for interpretation and review.
| Asthma Update. - We will review the current status of outpatient asthma diagnosis and treatment, emphasizing recent NIH guidelines.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the pathophysiology of this inflammatory disease.
| | 2. | Identify the typical and atypical clinical presentations with cases serving as examples.
| | 3. | Characterize the available diagnostic modalities.
| | 4. | Develop a stepwise approach to treatment including bronchodilators, corticosteroids and methylxanthines. There will be a mention of new agents and alternative therapies.
| | 5. | Select techniques to ensure patient compliance. We will review proper inhaler technique and peak flow monitoring.
| | 6. | Identify the patient who is not responding and define indications for subspecialty referral.
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| | Day 2 | Disorders of Sleep – Obstructive Sleep Apnea and Others. - Sleep apnea is a common disorder seen in general practice.
Upon completion of this session, the participant should be able to:
| 1. | Describe the epidemiology of obstructive sleep apnea.
| | 2. | Identify the clinical presentation and how to take a thorough “sleep history.”
| | 3. | Characterize the diagnostic work-up including overnight polysomnography.
| | 4. | Differentiate treatment modalities including CPAP, dental appliances, surgery & others.
| | 5. | Review obesity hypoventilation syndrome, central sleep apnea, Cheyne Stokes breathing, narcolepsy and periodic leg movements of sleep.
| Pleural Diseases. - Pleural effusions can be caused by a wide variety of disorders.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the anatomy of the pleural space and the physiology of pleural fluid formation.
| | 2. | Outline the imaging modalities available including plain chest radiography, ultrasonography and CT scanning.
| | 3. | Identify the indications and contraindications for thoracentesis.
| | 4. | Characterize pleural fluid in a cost effective manner with an emphasis on differential diagnosis.
| | 5. | Identify the indications for pleural biopsy and diagnostic pleuroscopy.
| | 6. | Outline treatment modalities available.
| | A variety of cases will be presented demonstrating some common and some not so common causes of pleural effusion. Recommendations on specialist referral will be provided. |
| Approach to the Patient with Chronic Cough. - Cough is a very common outpatient problem, which can be difficult to manage.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the pathophysiology and most common etiologies of cough.
| | 2. | Outline pertinent features of a focused history and physical.
| | 3. | Develop a 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.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the respiratory effects of anesthesia and surgery with emphasis on patients with at-risk complications.
| | 2. | Describe the perioperative risk factors associated with post-op pulmonary complications.
| | 3. | Identify the elements of appropriate preoperative evaluation including the role of arterial blood gas measurement and spirometry.
| | 4. | Describe preoperative measures that can minimize operative and postoperative respiratory complications.
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| | Day 3 | Approach to Acid-Base Disturbances. - Upon completion of this session, the participant should be able to:
| 1. | Identify primary metabolic and respiratory acid- base disturbances and their compensatory mechanisms.
| | 2. | Discover a formal, stepwise approach to the interpretation of any acid-base problem.
| | 3. | Outline the differential diagnosis of the major simple and mixed acid-base disturbances.
| | Several illustrative case studies will be discussed. |
| Acute Respiratory Failure and Mechanical Ventilation. - We will provide a practical review of this exciting topic. We will cover the basics of mechanical ventilation.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the pathophysiology and differential diagnosis of acute hypoxemic and hypersonic respiratory failure.
| | 2. | Describe the pathophysiology and differential diagnosis of acute respiratory failure.
| | 3. | Identify the basic concepts of management for patients on mechanical ventilation.
| | 4. | Differentiate commonly used ventilator modes. We will also discuss the use of positive end expiratory pressure (PEEP).
| | 5. | Identify the indications for and complications of mechanical ventilation.
| | 6. | Characterize weaning, including general principles and strategies for weaning from mechanical ventilation.
| | Shock and Hemodynamic Monitoring. - Shock is a common problem in the intensive care unit. Upon completion of this session, the participant should be able to:
| | 1. | Define shock and describe the causes. We will focus on the pathophysiology of common entities.
| | 2. | Characterize basic resuscitation techniques including volume replacement and the use of vasopressors. The discussion will include a review of early goal directed therapy.
| | 3. | Recognize the current controversies surrounding the use of invasive hemodynamic monitoring.
| | 4. | Define new treatments for septic shock. This will include the use of activated protein C and the role of corticosteroids.
| Community Acquired Pneumonia. - We will review the diagnosis and treatment of this common disorder with emphasis on the published guidelines.
Upon completion of this session, the participant should be able to:
| | 1. | Categorize patients with respect to severity of illness.
| | 2. | Develop a strategy to triage patients - outpatient therapy, hospitalize or ICU.
| | 3. | Characterize the different pathogens that commonly cause community acquired pneumonia.
| | 4. | Identify the current status of diagnostic work-up including the use of cultures, gram stains, serology and bronchoscopy. We will emphasize a cost effective approach.
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| | Day 4 | Tuberculosis. - Upon completion of this session, the participant should be able to:
| 1. | Characterize the epidemiology of tuberculosis.
| | 2. | Discriminate the clinical presentations including pulmonary, pleural and extrapulmonary tuberculosis.
| | 3. | Identify ATS/CDC criteria for positive tuberculin skin test.
| | 4. | Review treatment of LTBI.
| | 5. | Distinguish the role of skin testing, sputum examination and bronchoscopy in diagnosis.
| | 6. | Outline the most recent ATS/CDC/IDSA Guidelines for TB therapy. We will discuss specific agents and their toxicities as well as formal treatment regimens.
| | 7. | Characterize 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. | Define the major types of lung carcinoma, particularly small cell and non-small cell cancer.
| | 3. | Characterize the basic clinical aspects of both small cell and non-small cell cancer including staging, natural history, and associated extrapulmonary syndromes.
| | 4. | Outline a diagnostic strategy for patients with suspected lung cancer.
| | 5. | Identify 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. Cases will include a variety of pulmonary as well as non-pulmonary topics.
Upon completion of this session, the participant should be able to:
| | 1. | Identify and properly evaluate a patient with occupational asthma.
| | 2. | Generate a differential diagnosis and approach to a patient with a nonresolving infiltrate.
| | 3. | Recognize the causes and evaluation of a solitary pulmonary nodule.
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| | Day 5 | Interstitial Lung Disease – The Basics. - The focus of the discussion will be on sarcoidosis and idiopathic pulmonary fibrosis. These are two disorders a primary care provider should be familiar with. Upon completion of this session, the participant should be able to:
| 1. | Characterize the spectrum of interstitial lung disease.
| | 2. | Develop a basic understanding of the diagnostic work-up, which can include high resolution CT scanning and tissue biopsy.
| | 3. | Identify the clinical and radiographic manifestations of sarcoidosis. An overview of management will be provided.
| | 4. | Outline the typical presentation of idiopathic pulmonary fibrosis as well as management issues.
| | 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’s referral. |
| | Pulmonary Cases for Review. - A wide variety of cases will be discussed in order to review some of the important points outlined during the week. We will also present some new information that was not formally covered in the previous sessions. The session will be interactive.
| Hemoptysis. - A common and occasionally life-threatening emergency.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the causes for hemoptysis.
| | 2. | Characterize the severity of a bleeding episode.
| | 3. | Identify the diagnostic modalities available.
| | 4. | Outline acute basic therapy and understand indications for specialist referral.
| Pulmonary Thromboembolic Disease. - A very common, difficult to diagnose problem with devastating consequences if not treated promptly.
Upon completion of this session, the participant should be able to:
| | 1. | Characterize the epidemiology, risk factors, & clinical presentation of PE & DVT.
| | 2. | Identify the role of DVT prophylaxis and the current status of low molecular weight heparin.
| | 3. | Diagram the diagnostic work-up including V/Q scanning, lower extremity studies, CT scanning, pulmonary angiography and others.
| | 4. | Outline treatment modalities including anticoagulation, thrombolysis & vena cava filters.
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