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Objectives

Keck School of Medicine of the University of Southern California The 47th Annual USC Weil Symposium on Critical Care and Emergency Medicine

Objectives

After attending appropriate sessions, the registrant is to:

• Identify acute cardiovascular crises, including chest pain, acute coronary syndromes, heart failure, major rhythm disturbances, pericardial disease and their management. Discuss the current role of hemodynamic monitoring, including central catheters and the newly recognized role of microcirculatory imaging for diagnosis and management of circulatory shock. Describe diagnosis and current management of acute renal failure, pancreatitis, liver failure and acute immunological crises. Define new criteria for diagnosis of pulmonary embolism and its management. Review current indications for blood transfusions and their alternatives. Define antimicrobial therapy for life threatening infections and limitations of diverse resuscitative fluids and vasopressor agents. Distinguish between primary cardiac and primary asphyxial cardiac arrest and update priorities of management in accord with new guidelines, including options for defibrillation, hypothermia, and management of post resuscitation myocardial dysfunction and ischemic brain damage.
• Describe diagnosis and management of both community and hospital acquired pneumonias and life-threatening exacerbations of obstructive airway diseases. Identify options for noninvasive ventilation, methods and devices by which the airway is less invasively secured including the use of the laryngeal mask airway, simplified modes of mechanical ventilation, the management of acute respiratory failure and prevention of ventilator induced lung injury.
• Describe antimicrobial management of life-threatening bacterial, viral and mycotic infections, including hospital acquired infections. Describe the epidemiology and management of antibiotic resistance, including MRSA and clostridium difficile. Recognize emerging and reemerging communicable diseases, including tuberculosis and avian influenza. Review guidelines for prophylactic antibiotics together with management of immunocompromised patients and the priority of hospital infection control. Discuss diagnosis and treatment of sepsis, septic shock, toxic shock, and multiorgan failure, including fluid resuscitation and indications for early medical and surgical treatment and the role of drotrecogin alfa. Understand new concepts of hemostatis, including the role of Factor VII for management of uncontrolled hemorrhage. Discuss the role of ultrasound for both imaging the heart, chest and abdominal organs and for placement of central catheters at the bedside.
• Address the role and impact of career Critical Care Practitioners. Consider human values and ethical priorities during lifesaving interventions. Identify and treat anxiety and manage postoperative pain. Recognize the risks of dementia, especially in the elderly critically ill. Describe guidelines for care of the elderly and priorities of end-of-life care. Adopt protocols for analgesia and sedation based on increasingly objective criteria. Increase awareness of potentially life threatening errors at the bedside and options for their prevention, including quality and safety initiatives especially asepsis, and device options for minimizing complications during and after insertion of catheters and tubes. Implement clinical information systems pertinent to acute care. Review malpractice cases pertinent to life saving interventions.
• Describe current guidelines for diagnosis of acute renal failure and options for renal replacement therapy. Review mechanisms and management of urinary tract obstruction. Discuss management of liver failure, electrolyte and acid base emergencies. Identify hyperand hypoglycemia, ketoacidosis and hyper- and hypo-osmolal states. Discuss gastrointestinal crises, including pancreatitis and the hepato-renal syndrome. Describe the initial management of the severely burn injured patients. Define indications and methods of percutaneous gastrostomies and guidelines for nutrition.
• Review management of seizures, syncope and both hemorrhagic and thrombolitic strokes, intracranial hemorrhages, and initial management of head injuries. Perform differential diagnosis and optimize management of acute strokes, including medical and surgical management. Identify intoxications with diverse poisons and street drugs. Address the care of the morbidly obese patient. Discuss the initial management of wounds, including burns, and hypothermia after traumatic injuries. Discuss goal-directed resuscitation.