Critical Care Nuts & Bolts

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Agenda

View Module 11: Shock States on YouTube

15.75 Contact Hours | Course Length: 939 Minutes


Chest Pain: When to Worry, Part I 110 minutes
Module Description
In this module we will review basic cardiac anatomy and physiology, focusing on the structures of the heart and how they ensure appropriate functioning of the cardiac system. We will review the various valves and discuss how valvular disorders can affect cardiac output, cardiac workload, and overall perfusion. We will also discuss the pathological changes that occur when a patient experiences chest pain associated with Acute Coronary Syndromes, as well as the appropriate measures for treatment. 12-lead ECG analysis and interpretation will be discussed.

Module Learning Outcomes
This module prepares the learner to:
  1. Review basic cardiac physiology, with special emphasis on the structures and valves of the heart and how they can affect blood flow throughout the heart.
  2. Compare and contrast the differences between NSTEMI and STEMI evaluation and treatment.
  3. Describe current diagnostic and laboratory findings associated with Acute Coronary Syndromes
  4. Discuss the pathological changes that occur within the cardiac vascular system that contribute to Acute Coronary Syndromes and appropriate treatment recommendations from the American Heart Association.

Chest Pain: When to Worry, Part II
56 minutes
Module Description
In this module we will review basic cardiac anatomy and physiology, focusing on the structures of the heart and how they ensure appropriate functioning of the cardiac system. We will review common complications encountered after experiencing an acute MI, recognition of symptoms, and patient management of these complications. We will also discuss other causes of chest pain, not related to the coronary vascular system, including chest trauma, and aortic aneurysms and dissections.

Module Learning Outcomes
This module prepares the learner to:
  1. Review basic cardiac physiology, with special emphasis on the structures and valves of the heart.
  2. Discuss clinical presentation of papillary muscle rupture, septal rupture and ventricular wall rupture that may occur after experiencing an acute MI. Treatment options will also be discussed.
  3. Discuss chest trauma and its complications and treatment.
  4. Review recognition and treatment of aortic aneurysms and aortic dissections.

Acute and Chronic Heart Failure: The Epidemic
48 minutes
Module Description
In this module we will discuss the pathological changes that occur with both diastolic and systolic heart failure as well as the appropriate measures for treatment. Physical assessment findings will be reviewed. Pharmacological management and mechanical treatment options will be presented as well.

Module Learning Outcomes
This module prepares the learner to:
  1. Verbalize the differences in pathophysiology, diagnosis, and management of systolic and diastolic heart failure. Compare and contrast the differences in managing acute decompensated versus chronic heart failure.
  2. Describe the interplay between the sympathetic nervous system, renin-angiotensin-aldosterone system, and the hypothalamic-pituitary-adrenal axis during the response to physiologic stressors.
  3. Discuss alternative treatment modalities for advanced heart failure, including intra-aortic balloon pump therapy, ventricular assist devices, and transplantation.

Pulmonary Anatomy and Assessment
61 minutes
Module Description
In this module we will review the normal structures found within the respiratory system. We will describe the differences between ventilation and oxygenation. Interpretation of arterial blood gases will be reviewed including physiological states that can lead to ABG abnormalities. Chest X-ray interpretation will also be discussed.

Module Learning Outcomes
This module prepares the learner to:
  1. Review the basic anatomy and physiology of the pulmonary system, describing the normal assessment findings associated with appropriate respiratory function.
  2. Adequately interpret six arterial blood gases (ABGs), and describe the ABG changes associated with acute respiratory failure.
  3. Describe normal chest X-ray assessment interpretation, and identification of abnormal findings.

The Patient with Shortness of Breath
71 minutes
Module Description
This module will discuss the patient who is experiencing acute shortness of breath. Discussion will focus on acute respiratory failure, causes, assessment and treatment. Etiologies that will be discussed will include Acute Respiratory Distress Syndrome (ARDS) as well as pulmonary embolism, COPD, emphysema and chronic bronchitis.

Module Learning Outcomes
This module prepares the learner to:
  1. Describe the pathophysiologic changes, presentations, and at least three treatments each for chronic bronchitis, emphysema, severe asthma, pneumonia and ARDS.
  2. Discuss predisposing conditions that lead to the development of a pulmonary embolus. Review of the clinical assessment and treatment will be discussed in addition to prevention of this complication.

Recognizing Renal Failure
44 minutes
Module Description
This module will review common causes of renal failure encountered in the acute care setting. Etiologies will be discussed to help differentiate between pre-renal, intrinsic, and post-renal uropathies. Various diagnostic and treatment modalities will be reviewed in addition to discussing the RIFLE classification of renal failure. Hemodialysis and continuous renal replacement therapies will also be described.

Module Learning Outcomes
This module prepares the learner to:
  1. List at least three causes of acute renal failure seen with patients in the acute care setting.
  2. Review diagnostic tests and treatments of the following types of acute renal failure (ARF): Pre-renal, intrinsic and post-obstructive uropathies including the RIFLE criteria.
  3. Discuss alternative therapies for acute renal failure including continuous renal replacement therapy.

Neuro Complications: Acute Change in Level of Consciousness
137 minutes
Module Description
The neurological system is very complex. This module will review the anatomy and physiology of the neurological system, including basic assessment findings. We will discuss the types of closed head injuries that can occur and the assessment/treatment for each. Principles of monitoring and managing increased intracranial pressures will also be described in detail. Both hemorrhagic and ischemic stroke management will be discussed as well as diagnostic findings for each. Delirium and behavior management will also be reviewed.

Module Learning Outcomes
This module prepares the learner to:
  1. List at least two functions of the following areas of the brain: frontal, temporal, parietal and occipital lobes; cerebrum and cerebellum; pons and medulla.
  2. Compare and contrast the pathophysiology, presentation and treatments of epidural vs. subdural hematomas.
  3. List at least three presenting signs and symptoms of ischemic and hemorrhagic stroke.
  4. Discuss the differences between delirium and dementia as well as suggested treatment recommendations.

Interpreting Lab Values
43 minutes
Module Description
This module will review basic laboratory interpretation of the components of the complete blood count, including review of the various types of white blood cells and their function. We will also discuss common electrolyte abnormalities, clinical presentation, and treatment.

Module Learning Outcomes
This module prepares the learner to:
  1. Describe the normal ranges for a complete blood count, including interpretation of the results and what the clinical impact may be.
  2. Discuss common electrolyte disorders encountered in the critical care environment, presenting symptoms, and treatment required to correct such imbalances.

Interpreting Hemodynamic Parameters
99 minutes
Module Description
In this module, we will discuss important principles related to fluid management and vasopressor therapies used in the acute care and critical care setting. Manipulating the cardiac output, preload and afterload will be discussed including pharmacological effects of various medications. We will also discuss advanced hemodynamic monitoring, waveform analysis, and interpretation of the data. Appropriate correlation of all data points in relation to the clinical presentation is vital to ensure accurate interpretation of the data collected.

Module Learning Outcomes
This module prepares the learner to:
  1. Discuss fluid and vasopressor management of acutely ill patients, describing pharmacological effects of various medications used.
  2. Discuss advanced hemodynamic monitoring techniques, interpretation of various waveforms, and management of hemodynamic parameters.

Troubleshooting Ventilators
58 minutes
Module Description
This module will discuss basic ventilator parameters and what they mean. We will review clinical indications that would require mechanical ventilator support, as well as review various modes of ventilation. Discussion of managing these modes will also be reviewed.

Module Learning Outcomes
This module prepares the learner to:
  1. Describe indications for mechanical ventilator support, including ventilator failure and oxygenation failure states.
  2. Discuss various ventilator parameters, and describe which parameters are associated with the different types of ventilator modes.
  3. Discuss management of potential complications associated with mechanical ventilation.

Shock States
70 minutes
Module Description
Shock is a term used to include multiple situations and disease processes that result in tissue hypoperfusion. This module will identify the different types of shock and discuss the etiology, presentation and management of each.

Module Learning Outcomes
This module prepares the learner to:
  1. Discuss the pathophysiology associated with various shock states.
  2. Discuss hemodynamic findings and variations found between the different shock states.
  3. Review components of oxygen delivery and extraction through the use of tissue-oxygenation monitoring.

Tissue Oxygenation
67 minutes
Module Description
Tissue oxygenation is important in all types of shock, and the ICU nurse should understand the concept and be able to improve both the delivery and the demand. This module will address the concept of tissue oxygenation and discuss the issues of improving oxygen delivery and lowering the oxygen demand to improve tissue oxygenation.

Module Learning Outcomes
This module prepares the learner to:
  1. Discuss the relationship between oxygen delivery and oxygen consumption.
  2. State the three determinants of oxygen delivery and identify interventions to improve delivery.
  3. Describe the role of SVO2 monitoring in determining adequacy of tissue oxygenation.
  4. State the normal SVO2 and identify possible causes of low SVO2.

Sepsis
75 minutes
Module Description
Surviving sepsis guidelines and the Surviving Sepsis Campaign have been shown to improve outcomes in sepsis. This module will discuss the sepsis process, techniques to prevent sepsis and rapid recognition and treatment guidelines for sepsis. 

Module Learning Outcomes
This module prepares the learner to:
  1. Discuss the new surviving sepsis guidelines and care recommendations from the Surviving Sepsis Campaign (SSC).
  2. Discuss the research findings that support the recommended changes in patient management with severe sepsis.
  3. Describe the initial sepsis bundles.

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